Fracture of radial neck and proximal ulna with medial displacement of the radial shaft

Abstract

Introduction: Radial neck injuries are reasonably common, and when present as isolated injuries with minimal displacement or angulation, a good outcome is anticipated. Elbow injuries are common in children but radial neck fractures are relatively rare (5% to 10%) in paediatric elbow fractures. Objective: To assess the fracture of radial neck and proximal ulna with medial displacement of the radial shaft. Materials and Methods: This was a retrospective study conducted at Dept. of Ortho-Surgery, Sheikh Sayera Khatun Medical College Hospital, Gopalgonj, Bangladesh from January 2018 to December 2021. Medical records of ten patients who had displaced radial neck fractures treated at our Hospital.  Ten patients who had displaced radial neck fractures (Judet type III and type IV) treated. Patients were assessed for functional outcome by Mayo elbow performance score (MEPS), the Tibone and Stoltz functional criteria, and for complications with the average follow-up of four years (range: six months to seven years). Patients were assessed for functional outcome by Mayo elbow performance score (MEPS), the Tibone and Stoltz functional criteria, and for complications with the average follow-up. Results: The mean age of the patients was 9.12±2.2 years (range: 4 to 14 years). Eight (80%) patients were males and two (20%) patients were females. The right side was the most commonly injured side (right at 68% and left at 32%). Six (60%) cases were of Judet type III and (40%) cases were of Judet type IV. The mean fracture angulation of the series was 56.5 degrees (range 33.2 degrees to 79.2 degrees). Four patients had isolated radial neck fractures and four patients had associated proximal ulna fractures and one patient had associated posterolateral elbow dislocation. Among two patients treated with percutaneous pin leverage and intramedullary nailing by the Metaizeau technique, one patient had an excellent outcome, and the other had a good outcome. Among four cases treated with open reduction and K-wire fixation, two patients had good outcomes, one patient had a fair outcome, and one patient had a poor outcome. Conclusion: The majority of moderately to severely displaced pediatric radial neck fractures which need intervention can be managed by the closed reduction technique of Metaizeau with or without pin leverage with excellent to good functional outcomes at short-term follow-up. Some cases need open reduction which also has good to fair outcomes.