PERCUTANEOUS Kirschner WIRE POKING REDUCTION AND ELASTIC STABLE INTRAMEDULLARY NAILING FIXATION FOR SEVERE DISPLACED RADIAL NECK FRACTURES IN CHILDREN_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WUMin ,  GUANJianzhong , XIAOYuzhou , ZHOUJiansheng , DAIXiusong , WANGXiaopan , WANGZhaodong , CHENXiaotian

Department of Orthopedics, the First Affiliated Hospital of Bengbu Medical College, Laboratory of Tissue and Transplant in Anhui Province, Bengbu Anhui, 233003, P. R. China;

Corresponding author：

GUANJianzhong, Email: jzguan2002@163.com

Keywords：

Radial neck fracture; Percutaneous; Poking reduction; Internal fixation; Children

DOI：

10.7507/1002-1892.20150317

Video：

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Objective To assess the effectiveness of percutaneous Kirschner wire poking reduction and elastic stable intramedullary nailing fixation for treating severe displaced radial neck fractures in children. Methods Between November 2010 and August 2014, 17 children with severe displaced radial neck fractures were treated with percutaneous Kirschner wire poking reduction and elastic stable intramedullary nailing fixation. There were 13 boys and 4 girls with an average age of 8.7 years (range, 6-14 years). The right side was involved in 9 cases, and the left side was involved in 8 cases. The causes of injury were falling in all cases. The angular deformity at fracture was 64-102° (mean, 84°). According to the Judet classification, 7 cases were classified as grade ⅠVa and 10 cases as grade ⅠVb. The time from injury to operation was 4.2 days (range, 1-7 days). Metaizeau classification and Tibone-Stoltz elbow performance score were used to access the radiological and clinical results, respectively. Results The operation time was 20-50 minutes (mean, 30 minutes). All incisions healed by first intention. The patients were followed up 12-46 months (mean, 20 months). All fractures healed at 2 months after operation. There was no complication of malunion, early epiphyseal closure, avascular necrosis, enlargement of the radial head epiphysis, cubitus varus and valgus deformities, or proximal radioulnar joint synostosis. One case had elbow extension limitation. At last follow-up, the elbow range of motion in flexion, extension, pronation, and supination showed no significant difference between affected side and normal side (P>0.05). The clinical results were excellent in 16 cases and good in 1 case, with an excellent and good rate of 100%. The angulation was 0-12° (mean, 3.7°) on the X-ray film; anatomic reduction or nearly anatomic reduction was obtained, and the radiological results were excellent in 13 cases and good in 4 cases, with an excellent and good rate of 100%. Conclusion Percutaneous Kirschner wire poking reduction followed by fixation with elastic stable intramedullary nailing is a simple, safe, minimally invasive, and effective method to treat severe displaced radial neck fractures in children.

Citation： WUMin, GUANJianzhong, XIAOYuzhou, ZHOUJiansheng, DAIXiusong, WANGXiaopan, WANGZhaodong, CHENXiaotian. PERCUTANEOUS Kirschner WIRE POKING REDUCTION AND ELASTIC STABLE INTRAMEDULLARY NAILING FIXATION FOR SEVERE DISPLACED RADIAL NECK FRACTURES IN CHILDREN. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(12): 1478-1482. doi: 10.7507/1002-1892.20150317 Copy

1.	Metaizeau JP, Prevot J, Schmitt M. Reduction and fixation of fractures of the neck of the radious be centro-medullary pinning. Original technic. Rev Chir Orthop Reparatrice Appar Mot, 1980, 66(1):47-49.
2.	Metaizeau JP, Lascombes P, Lemelle JL, et al. Reduction and fixation of displaced radial neck fractures by closed intramedullary pinning. J Pediatr Orthop, 1993, 13(3):355-360.
3.	Al-Aubaidi Z, Pedersen NW, Nielsen KD. Radial neck fractures in children treated with the centromedullary Metaizeau technique. Injury, 2012, 43(3):301-305.
4.	Klitscher D, Richter S, Bodenschatz K, et al. Evaluation of severely displaced radial neck fractures in children treated with elastic stable intramedullary nailing. J Pediatr Orthop, 2009, 29(7):698-703.
5.	Basmajian HG, Choi PD, Huh K, et al. Radial neck fractures in children:experience from two level-1 trauma centers. J Pediatr Orthop B, 2014, 23(4):369-374.
6.	Judet H, Judet J. Fractures et orthopédie de l'enfant. Paris:Maloine, 1974:39-41.
7.	Tibone JE, Stoltz M. Fractures of the radial head and neck in children. J Bone Joint Surg (Am), 1981, 63(1):100-106.
8.	Cha SM, Shin HD, Kim KC, et al. Percutaneous reduction and leverage fixation using K-wires in paediatric angulated radial neck fractures. Int Orthop, 2012, 36(4):803-809.
9.	Al-Aubaidi Z, Pedersen NW, Nielsen KD. Radial neck fractures in children treated with the centromedullary Metaizeau technique. Injury, 2012, 43(3):301-305.
10.	Falciglia F, Giordano M, Aulisa AG, et al. Radial neck fractures in children:results when open reduction is indicated. J Pediatr Orthop, 2014, 34(8):756-762.
11.	Song KS, Kim BS, Lee SW. Percutaneous leverage reduction for severely displaced radial neck fractures in children. J Pediatr Orthop, 2015, 35(4):e26-30.
12.	Okcu G, Aktuglu K. Surgical treatment of displaced radial neck fractures in children with Metaizeau technique. Ulus Travma Acil Cerrahi Derg, 2007, 13(2):122-127.
13.	Metaizeau JP. Reduction and osteosynthesis of radial neck fractures in children by centromedullary pinning. Injury, 2005, 36 Suppl 1:A75-77.
14.	Bither N, Gupta P, Jindal N. Pediatric displaced radial neck fractures:retrospective results of a modified Metaizeau technique. Eur J Orthop Surg Traumatol, 2015, 25(1):99-103.
15.	Pesudo JV, Aracil J, Barcelo M. Leverage method in displaced fractures of the radial neck in children. Clin Orthop Relat Res, 1982, (169):215-218.
16.	邱贵兴, 戴尅戎. 骨科手术学. 3版. 北京:人民卫生出版社, 2005:1243.

1. Metaizeau JP, Prevot J, Schmitt M. Reduction and fixation of fractures of the neck of the radious be centro-medullary pinning. Original technic. Rev Chir Orthop Reparatrice Appar Mot, 1980, 66(1):47-49.
2. Metaizeau JP, Lascombes P, Lemelle JL, et al. Reduction and fixation of displaced radial neck fractures by closed intramedullary pinning. J Pediatr Orthop, 1993, 13(3):355-360.
3. Al-Aubaidi Z, Pedersen NW, Nielsen KD. Radial neck fractures in children treated with the centromedullary Metaizeau technique. Injury, 2012, 43(3):301-305.
4. Klitscher D, Richter S, Bodenschatz K, et al. Evaluation of severely displaced radial neck fractures in children treated with elastic stable intramedullary nailing. J Pediatr Orthop, 2009, 29(7):698-703.
5. Basmajian HG, Choi PD, Huh K, et al. Radial neck fractures in children:experience from two level-1 trauma centers. J Pediatr Orthop B, 2014, 23(4):369-374.
6. Judet H, Judet J. Fractures et orthopédie de l'enfant. Paris:Maloine, 1974:39-41.
7. Tibone JE, Stoltz M. Fractures of the radial head and neck in children. J Bone Joint Surg (Am), 1981, 63(1):100-106.
8. Cha SM, Shin HD, Kim KC, et al. Percutaneous reduction and leverage fixation using K-wires in paediatric angulated radial neck fractures. Int Orthop, 2012, 36(4):803-809.
9. Al-Aubaidi Z, Pedersen NW, Nielsen KD. Radial neck fractures in children treated with the centromedullary Metaizeau technique. Injury, 2012, 43(3):301-305.
10. Falciglia F, Giordano M, Aulisa AG, et al. Radial neck fractures in children:results when open reduction is indicated. J Pediatr Orthop, 2014, 34(8):756-762.
11. Song KS, Kim BS, Lee SW. Percutaneous leverage reduction for severely displaced radial neck fractures in children. J Pediatr Orthop, 2015, 35(4):e26-30.
12. Okcu G, Aktuglu K. Surgical treatment of displaced radial neck fractures in children with Metaizeau technique. Ulus Travma Acil Cerrahi Derg, 2007, 13(2):122-127.
13. Metaizeau JP. Reduction and osteosynthesis of radial neck fractures in children by centromedullary pinning. Injury, 2005, 36 Suppl 1:A75-77.
14. Bither N, Gupta P, Jindal N. Pediatric displaced radial neck fractures:retrospective results of a modified Metaizeau technique. Eur J Orthop Surg Traumatol, 2015, 25(1):99-103.
15. Pesudo JV, Aracil J, Barcelo M. Leverage method in displaced fractures of the radial neck in children. Clin Orthop Relat Res, 1982, (169):215-218.
16. 邱贵兴, 戴尅戎. 骨科手术学. 3版. 北京:人民卫生出版社, 2005:1243.

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PERCUTANEOUS Kirschner WIRE POKING REDUCTION AND ELASTIC STABLE INTRAMEDULLARY NAILING FIXATION FOR SEVERE DISPLACED RADIAL NECK FRACTURES IN CHILDREN

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