Intraoperative elbow joint arthrography assisted closed reduction by leverage technique and percutaneous pin fixation to treat radial neck fracture in children

JIANG Hai; LI Min; WU Yong-tao; WU Ge; WANG Bing; QU Ji-ning; MIAO Wu-sheng

doi:10.3969/j.issn.2095-252X.2017.07.008

Abstract：Objective To investigate the value of intraoperative elbow joint arthrography assisted close reduction with leverage technique and percutaneous pin fixation to treat radial neck fracture in children. Methods From January 2014 to March 2016, 17 cases were treated with this method. According to O'brien system, there were 4 cases of type Ⅱ and 13 cases of type Ⅲ. There were no cases complicated with nerve injury. All cases were treated with close reduction with leverage technique and percutaneous pin fixation. The intraoperative elbow joint arthrography was used for assistance. The radial neck fractures were fixed with two or three Kirschner wires from lateral side. The elbow was immobilized by cast or brace in flexion 90 degrees and forearm in pronation. The Kirschner wires were removed 3 - 4 weeks postoperatively and exercises were done immediately. Results All patients were followed up for 9 months to 40 months, 15 months in average. According to reduction classification of Metaizeau, 12 cases were excellent, 3 cases were good, and 2 cases were fair. According to clinical classification of Metaizeau, 15 cases were excellent, 2 cases were good. No necrosis of radial head occurred in closed reduction cases. Necrosis of radial head occurred in the case of open reduction. No infection, radioulnar synostosis, or damage of deep branch of radial nerve occurred in any case. Conclusions Elbow joint arthrography can display the articular surface of radial head clearly. It is helpful to assist closed reduction with leverage technique, and to judge the relationship of fracture site after close reduction especially for younger children. The percutaneous pin fixation can maintain the good reduction position and prevent the displacement postoperatively. It is easy to perform and less traumatic. The outcomes are encouraging.