New Reduction Technique for Severely Displaced Pediatric Radial Neck Fractures

Author(s): Neher CG, Torch MA

Source: J Ped Orthop 23:626-628, 2003.

Summary:

The treatment of radial neck fractures remains controversial. The indications for reduction and the necessity to achieve complete reduction are areas of disagreement. The remodeling potential of the proximal radius is great and large amounts of angulation (up to 50 degrees) have been shown to correct over time. Most importantly, open reduction is associated with inferior results, which is either related to the severity of injury of the surgery itself.  The standard reduction maneuver involves direct pressure over the radial head and some combination of varus stress and/or longitudinal traction.  Angulation greater than 60 degrees is difficult to correct with these maneuvers.  During reduction, the authors noted that the radial shaft would displace toward the ulnar and prohibit adequate reduction of the fracture. They describe a modified technique and the results on four patients.

The techniques is as follows: Flouroscopy to localize the radial head and determine the forearm rotation that maximizes angular displacement. Elbow in extension and forearm maintained in position of maximum angular displacement. Assistant places a lateral force on the radial shaft with both thumbs.  Surgeon places a varus stress on the elbow and direct pressure on the radial head with thumb to reduce angulation.

This technique was effective in four children, all with angulation greater than 60 degrees. All fractures were reduced to near-anatomic position.  All gained full motion, except one lacked complete elbow extension (five degrees). This modified technique offers promise to those children with radial neck fractures that are moderately to severely angulated. The authors do mention that some apposition needs to be present and this technique requires general anesthesia for complete muscle relaxation to allow satisfactory reduction. Since open reduction diminishes overall outcome, this maneuver may be of benefit to those individuals caring for these injuries.

 

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J Ped Orthop 23:626-628, 2003.