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Purposes: This study aim to describe surgical outcome in treating postoperative radial neck nonunion and to perform a systematic review to evaluate the surgical outcome of symptomatic radial neck nonunion. Methods: The study included ten patients with symptomatic postoperative radial neck nonunion from 2010 to 2016 which were treated surgically with either bone grafting (bone-grafting group) or radial head resection (resection group). The patient demographics, pre- and postoperative clinical scores were recorded. The PubMed, OVID/Medline, Cochrane, Google Scholar, and EMBASE databases were searched using the keywords "radial neck nonunion" according to the MeSH index. A systematic review was performed using PRISMA guidelines. Results: Average time from primary surgery to nonunion was 10.7 months. Four and six patients received bone-grafting and radial head resection procedure. The mean age for resection group is older than bone grafting group (59 versus 28.75 years). The resection group patients presented with more significant pre-operative symptoms, associated injuries, loss of radial head articular congruity, and bone loss. All patients achieved favorable outcome. The systematic review included 12 publications with a total of 19 patients. The incidence of radial neck nonunion was 73.7% and 26.3% following conservative and operative treatment respectively. About 42.1% received operative treatment due to symptomatic progression. Conclusions: Radial neck nonunion is rare and mostly appears asymptomatic. Operative treatment is advocated for symptomatic cases. Articular congruity and degree of bone loss are major determinant for surgical treatment of radial neck nonunion. Surgical treatment for symptomatic radial neck nonunion resulted in favorable outcome. [ABSTRACT FROM AUTHOR]

Background: Radial head and neck fractures are one of the common fractures of the elbow in adult patients. There are controversial in treatment of nondisplaced head and neck fracture. However, nonoperative treatment remain as a choice treatment of nondisplaced radial head fracture without motion block. Case Report: we presented a 23 years-old patient who had bilateral nondisplaced radial head fracture. The Patients was managed with conservative treatment and early elbow range of motion. Finally, the patient had full range of motion without any pain in his both elbows. Conclusion: Nonoperative treatment with early range of motion remain as a treatment for bilateral nondisplaced radial head fracture with acceptable outcome.

Purpose: The simultaneous and ipsilateral occurrence of medial epicondylar and radial neck fractures is rare. This study evaluated the clinical and radiological outcomes of medial to lateral diagonal injury of the elbow (MELAINE). Methods: Six males and 6 females were diagnosed with MELAINE (left: 10, 83.3%; right: 2, 16.7%). Medial epicondylar and radial neck fractures were classified according to Papavasiliou's classification (seven type II, two type III, three type IV) and Judet's classification (three type I, four type II and five type III), respectively. All patients underwent surgery. The carrying angle, range of motion, and Kim et al. Elbow Performance Score were used to evaluate clinical and functional outcomes; related complications were recorded. Results: Mean age at injury and mean follow-up were 11.1 ± 2.5 (range, 6–14) and 40 ± 25.6 months (range, 13–90), respectively. All fractures consolidated in 6.3 ± 1.2 weeks on average (4–9). Outcomes were good (n = 1; 8.3%) to excellent (n = 11; 91.7%). The carrying angle of the injured and uninjured side was 15.5°± 2.6° and 14.7°± 2°, respectively (p = 0.218). The range of motion of elbow flexion-extension and forearm pronation-supination of the injured side was 144.2°± 10.4°, 4.6°± 5.4°, 76.7°± 9.1°, 80.4°± 9.2°, respectively, with no significant differences from the healthy side (p > 0.05). The Elbow Performance Score of the injured and uninjured side was 96.3 ± 5.3 and 98.8 ± 2.3, respectively (p = 0.139). No cases of infection, cubitus valgus, stiffness, or instability were recorded. Conclusion: Although uncommon, MELAINE should not be neglected. Surgery aims to stabilize the elbow and avoid valgus deformity. If diagnosed and treated, clinical and radiological results are excellent in most cases. [ABSTRACT FROM AUTHOR]

PurposeTo explore the characteristics, mechanism, treatment, and prognosis of head–neck separation type of Monteggia equivalent fractures in children.MethodsPatients with this injury were reviewed retrospectively. The lesion was characterized by a fracture of the ulnar with radial neck fracture but without dislocation of the radial head. Our classification was based on the direction of displacement and angulation of fractures on radiographs, divided into the extension-valgus type and flexion-varus type. The fractures were treated with reduction and internal fixation, depending on the fracture type. The clinical results were evaluated by using radiology and the Mayo Elbow Performance Score (MEPS).ResultsA total of 12 patients were followed up for an average of 40.5 months. The ulnar fractures were treated with closed reduction (CR) and K-wire fixation in one patient, elastic stable intramedullary nail (ESIN) fixation in four patients, open reduction (OR) and plate fixation in five, with no fixation in two. CR with ESIN fixation was successful in 11 patients with radial neck fractures, but one underwent OR and K-wire fixation. All fractures healed on time, with fewer complications (avascular necrosis in one patient, and bulk formation of metaphysis in another). The therapeutic efficacy was evaluated by using MEPS and was found to be excellent in 10 patients, good in one, and fair in another.ConclusionsThe head–neck separation type of Monteggia equivalent fractures in children is rare. Its characteristics are different from that of Monteggia fracture. The length and anatomic structure of the ulna should be restored and stabilized first, while the radial neck fracture should be treated with CR and ESIN fixation. Satisfactory clinical results can be achieved with fewer complications.

Background: Although most paediatric radial neck fractures can be treated with closed reduction, some severely displaced fractures require open reduction. The purpose of this study is to compare the effects of ESIN and KW fixation in open reduction of radial neck fracture in children. Methods: Twenty-four patients with mean age of 8.5 years were included. Four of the patients had a Judet type III fracture and 20 had a Judet type IV fracture. Ten patients who underwent percutaneous KW fixation were assigned to group A, while 14 patients who underwent ESIN fixation were assigned to group B. Variables of interest included age, sex, fracture type, associated lesions, surgical time, fracture reduction, cost, follow-up, healing time, X-rays, clinical outcomes, and complications. Results: There were no significant between-group differences in sex, age, additional injuries, fracture type, and quality of reduction. Costs were significantly lower in Group A. Fracture healing was achieved in 23 of 24 patients (10/10 in group A and 13/14 in group B). In a postoperative elbow function assessment based on the Steele and Graham classification, 80% of patients in group A had a score of excellent or good, compared to 78.6% of patients in group B. Two cases of nail shifting and joint protrusion were observed in group B, one of which also presented with nonunion during follow-up. Conclusions: Both KW and ESIN may achieve good clinical outcomes, but KW is associated with lower costs, easier implant removal (without the need for a secondary surgery), and lower iatrogenic complications. [ABSTRACT FROM AUTHOR]

Background: Radial neck fractures in the pediatric population represent up to 1% of all pediatric fractures. Judet type III and IV radial neck fractures represent difficulties in closed and open reduction. The Metaizeau technique has been used as a tool to reduce these. Objective: This study aimed to evaluate the clinical and radiological outcomes following Metaizeau technique for displaced radial neck fracture in children. Patients and methods: A prospective operation clinical study of 18 patients, with fracture radial neck, who underwent closed reduction and internal fixation with Métaizeau technique. Follow up Clinical and radiological evaluation was performed and any complications were recorded. Results: The function of elbow according to Mayo elbow performance score was excellent and good in 22.2% and 77.8% respectively. Also, the radiological results were excellent and good in 22.2% and 77.8% respectively. No complications were noted. Conclusion: We have managed to achieve stable fixation of the reduction without any loss of position and consequently, better outcomes with no complications. [ABSTRACT FROM AUTHOR]

Background: Fractures of the radial neck accounts for 1% of all childhood fractures and 5% to 10% of childhood traumatic lesions involving the elbow. Intramedullary percutaneous nail reduction (Metaizeau technique) is considered the most effective surgical technique. Objective: The purpose of this study was to identify the main clinical features of radial neck fracture in children and to evaluate the functional results of the Metaizeau technique. Conclusion: The elastic stable intramedullary pinning according to the Metaizeau technique is the treatment of choice for displaced radial neck fractures in children. [ABSTRACT FROM AUTHOR]

Abstract Background Displaced radial neck fractures in children are challenging to treat. The age of the patient and the degree of angulation are the main criteria to consider when managing these fractures in children. Various surgical techniques have been described in the literature for both indirect and direct reduction and for fixation. However, the best treatment is still debated. Case presentation The case presented is of a 6-year-old Caucasian boy with an impacted and displaced radial neck fracture. With the patient in lateral position, under general anesthesia, elbow arthroscopy was performed to better visualize the articular surface and to assist with reduction and fixation. The fracture was reduced and fixed with a single K-wire under direct arthroscopic visualization. No associated lesions were found. An above-elbow cast was applied after surgery. The cast and K-wire were removed 3 weeks later. At the 3-month follow-up, the patient showed a full recovery with complete range of movement without any postoperative and radiographic complications. Conclusion Traditionally, surgery for displaced radial neck fractures in children is performed by closed reduction with percutaneous pinning or elastic intramedullary nail fixation under fluoroscopic guidance. Direct visualization of the articular surface via an open approach allows better reduction in complex fracture patterns but is related to a higher risk of complications: elbow stiffness, instability, or avascular necrosis. Elbow arthroscopy in children could be a valid alternative to open fixation surgery for displaced radial neck fractures without the complications associated with articular exposure, allowing the direct visualization of the fracture and reducing radiation exposure. Although technically demanding, we believe elbow arthroscopy should be considered an alternative option because it is effective in assisting reduction and fixation and enables the detection of associated joint lesions.

Radial neck fractures are the third most common elbow fracture in children. Open reduction may be required if closed or mini-open techniques are not successful in reducing the fracture. Previous reports on open reduction have noted poor outcomes and complications with this treatment approach. However, it is unknown whether it is the open procedure itself or the severity of the initial injury that leads to the poor results. The purpose of this study was to evaluate the correlation between intraoperative findings at the time of open reduction of radial neck fractures and the clinical and radiographic outcomes. Data from patients who underwent open reduction for an acute radial neck fracture between January 2009 and December 2018 were abstracted and reviewed. Patients undergoing open treatment for a nonunion or malunion and those with inadequate follow-up were excluded. Demographic data, injury characteristics, treatment strategies, intraoperative findings, and clinical and radiographic outcomes were assessed. Twenty-two patients met the inclusion criteria. Of these patients, 14 were girls. The mean age was 9.7 ± 3 years, and the mean follow-up period was 15.8 months. Fifteen patients had a Judet grade IV displacement. Fair or poor outcomes were observed in 12 patients (55%). Ten reoperations were recorded during the study period. Age, weight, and associated injuries were not predictive of poor outcomes. Intraoperative findings of soft-tissue stripping and radial head comminution were the only significant predictors of fair or poor clinical outcomes (P <.001) and subsequent radiographic changes including fragmentation and collapse of the radial head and arthritic changes (P <.001). The quality of reduction and the choice of hardware were not significantly associated with either clinical or radiographic outcomes. Our findings support the notion that the outcomes of open reduction of radial neck fractures are most closely correlated with the injury severity, with the intraoperative findings of complete soft-tissue stripping or comminution of the radial head fragment being significant predictors of poor clinical and radiographic outcomes. The choice of hardware and the quality of reduction achieved at the time of surgery have less significance than injury severity. [ABSTRACT FROM AUTHOR]

Background: Olecranon apophyseal fractures in children are uncommon. The bulk of these injuries are nondisplaced and therefore can be treated nonoperatively. Objective: To study the outcome of open reduction and internal fixation of olecranon fracture. Patients and methods: Our case report of a 9 years old girl who sustained left elbow trauma after falling directly over the elbow. Attended the outpatient clinic of the Department of Orthopedic Surgery, Alnoor Specialist Hospital, Makkah, Saudi Arabia, radiographs showed olecranon and radial neck fractures, olecranon fracture was displaced so we fix it with K-wire and tension band, while the radial neck fracture was treated conservatively. Results: At the 12 weeks follow-up, she achieved a complete range of motion of the left elbow with good functional outcomes and with no complications. The goal in such complex fractures is to achieve a stable congruent joint with gradual rehabilitation to reach a good functional outcome. Conclusion: open reduction and internal fixation of the olecranon fracture is the optimal treatment to achieve a complete range of motion and good functional outcome. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study is to evaluate the outcomes of operatively treated Mason Type III radial head fractures. Additionally, this project seeks to assess efficacy of PROMIS in evaluating post-operative outcomes for this patient population., Methods: A total of 143 patients who underwent operative treated Mason Type III radial head fractures were analyzed retrospectively. PROMIS physical function (PF), PROMIS upper extremity (UE), PROMIS pain interference (PI), demographic variables, and range of motion were collected and analyzed over 12-month follow-up., Results: Radial head arthroplasty (RHA) was performed on 89 patients, open reduction and internal fixation (ORIF) was performed on 47 patients, and radial head excision was performed on 7 patients. Among the RHA patients, PROMIS PF, PI and UE demonstrated a change of -1.33 (p < 0.05), -1.48 (p < 0.05), and 2.23 (p < 0.05) respectively from injury to 12-months. Among the ORIF patients, PROMIS PF, PI and UE demonstrated a change of 3.22 (p < 0.05), -1.56 (p < 0.05), and 2.09 (p < 0.05) respectively from injury to 12-months. At the pre-operative and 12-month visits, the RHA group demonstrated lower PROMIS PF scores 34.75 vs 38.02 (p < 0.05) and 33.42 vs 41.24 (p < 0.05) respectively. Ther was no difference in PROMIS PI, UE, or elbow range of motion between the two groups at 6- or 12-month follow-up (p > 0.05)., Conclusion: Comparing the RHA and ORIF groups, there was no difference in PROMIS PI or UE scores nor was there a clinically significant improvement at the 6- or 12-month mark. The ORIF group demonstrated improved PROMIS PF at all follow-up periods and did show a clinically significant improvement. Patient Acceptable Symptom State (PASS) correlated only with PROMIS UE at 6- and 12- months for both groups., (© 2024 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights reserved.)

Background: Radial neck fractures in children account for 5 to 10% of all elbow fractures in children. They are extra-articular fractures of the radius proximal to the bicipital tuberosity. The physis is typically involved as a Salter-Harris I or II pattern. Alternatively, the fracture sometimes is extraphyseal, through the metaphysis. In children there is considerable potential for remodeling after these fractures. Up to 30° of radial head tilt and up to 3 mm of transverse displacement are acceptable. Many modalities of treatment are available regarding Surgical &Non-Surgical treatments. Objectives: To evaluate the functional outcome after surgical percutaneous joystick reduction therapy of severely angulated radial neck fracture in children. Type of the study: A prospective study. Methods: During the period between February/2012 and May/2015, we made a prospective study of (18) patients suffered from O′Brien type II&III radial neck fracture with severe angulation that require surgery seen at Al-Kindy Teaching Hospitals. However, we select a group of children who had more than 30° of Radial head angulation really cannot treated by conservative method. Angulated radial neck fractures in children reduced with a percutaneous Kirschner wire. We select of surgical procedure after failure of thumbing intraoperatively. The primary indication for surgery was changing type II&III to typeI which can go on in manage conservatively. Results: All the (18) patients treated with percutaneous pinning techniques were followed-up, clinically and radiographically evaluated pre-surgery, post-surgery and finally (6) months after surgery. The mean angulation of the fractures was 64° (30° - 90°) before reduction and 10°(0° - 22°) after reduction. Mean fracture displacement after reduction in all cases was less than 3 mm. Range of Motion (ROM) in flexion, extension, pronation and supination was the functional parameter in our study as graded by (the grading system of Steele). We obtained an outcome of excellent results in 15 patient (83%), good results in 3 patients (17%) and we have no fair or poor results. Conclusions Percutaneous Joystick Reduction Techniqueusing K-wire in children with radial neck fractures is a safe, short, easy procedure requires only good technical measures, minimally invasive in nature with minimal hospitalization time, has a minimal morbidity and complication rates, it is recommended surgical treatment that can achieve recovery of normal radial neck angulation, elbow motion and yielding excellent results.

Fractures of the radial neck accounts for 1% of all childhood fractures and 5% to 10% of childhood traumatic lesions involving the elbow. Intramedullary percutaneous nail reduction (Metaizeau technique) is considered the most effective surgical technique. The purpose of this study was to identify the main clinical features of radial neck fracture in children and to evaluate the anatomical and functional results of the Metaizeau technique. In this retrospective study, we evaluated 22 patients under the age of 16 who were treated for radial neck fracture at the orthopedic and trauma surgery department of Sahloul University Hospital in Sousse over a period of 16 years from January 2001 to April 2017. Authors used Metaizeau classification. Functional results were evaluated by Mayo elbow performance score (MEPS) and the radiological evaluation was based on standard images with measurement of the residual rocker. The average age was 8.6 years (5-13 years). Seven fracture were grade III injuries and three grade IV. In the immediate postoperative period, radiological measurements showed a residual rocker less than 20° in 86.3% and more than 20° in 13.7% of cases. At an average follow-up of 13 months and a half, the MEPS score was excellent and good for 17 patients. Four types of complications were found: necrosis of the radial head in 1 case, pseudarthrosis in 1 case, periarticular calcification in 2 cases and stiff-ness of the elbow in 3 cases. Despite the small number of patients in our series, we believe that the elastic stable intramedullary pinning according to the Metaizeau technique is the treatment of choice for displaced radial neck fractures in children.

Background: Displaced radial neck fractures in children are challenging to treat. The age of the patient and the degree of angulation are the main criteria to consider when managing these fractures in children. Various surgical techniques have been described in the literature for both indirect and direct reduction and for fixation. However, the best treatment is still debated.Case Presentation: The case presented is of a 6-year-old Caucasian boy with an impacted and displaced radial neck fracture. With the patient in lateral position, under general anesthesia, elbow arthroscopy was performed to better visualize the articular surface and to assist with reduction and fixation. The fracture was reduced and fixed with a single K-wire under direct arthroscopic visualization. No associated lesions were found. An above-elbow cast was applied after surgery. The cast and K-wire were removed 3 weeks later. At the 3-month follow-up, the patient showed a full recovery with complete range of movement without any postoperative and radiographic complications.Conclusion: Traditionally, surgery for displaced radial neck fractures in children is performed by closed reduction with percutaneous pinning or elastic intramedullary nail fixation under fluoroscopic guidance. Direct visualization of the articular surface via an open approach allows better reduction in complex fracture patterns but is related to a higher risk of complications: elbow stiffness, instability, or avascular necrosis. Elbow arthroscopy in children could be a valid alternative to open fixation surgery for displaced radial neck fractures without the complications associated with articular exposure, allowing the direct visualization of the fracture and reducing radiation exposure. Although technically demanding, we believe elbow arthroscopy should be considered an alternative option because it is effective in assisting reduction and fixation and enables the detection of associated joint lesions. [ABSTRACT FROM AUTHOR]

Fractures of the radial neck accounts for 1% of all childhood fractures and 5% to 10% of childhood traumatic lesions involving the elbow. Intramedullary percutaneous nail reduction (Metaizeau technique) is considered the most effective surgical technique. The purpose of this study was to identify the main clinical features of radial neck fracture in children and to evaluate the anatomical and functional results of the Metaizeau technique. In this retrospective study, we evaluated 22 patients under the age of 16 who were treated for radial neck fracture at the orthopedic and trauma surgery department of Sahloul University Hospital in Sousse over a period of 16 years from January 2001 to April 2017. Authors used Metaizeau classification. Functional results were evaluated by Mayo elbow performance score (MEPS) and the radiological evaluation was based on standard images with measurement of the residual rocker. The average age was 8.6 years (5-13 years). Seven fracture were grade III injuries and three grade IV. In the immediate postoperative period, radiological measurements showed a residual rocker less than 20° in 86.3% and more than 20° in 13.7% of cases. At an average follow-up of 13 months and a half, the MEPS score was excellent and good for 17 patients. Four types of complications were found: necrosis of the radial head in 1 case, pseudarthrosis in 1 case, periarticular calcification in 2 cases and stiff-ness of the elbow in 3 cases. Despite the small number of patients in our series, we believe that the elastic stable intramedullary pinning according to the Metaizeau technique is the treatment of choice for displaced radial neck fractures in children. [ABSTRACT FROM AUTHOR]

Background: This systematic review is an attempt to provide an evidence-based analysis of literature on management of severely displaced radial neck fractures (with > 60° displacement) in children. Material and Methods: A systematic literature search was conducted to identify all original articles published between 01/01/1999 and 20/01/17 on surgical treatment of radial neck fractures in children in the following databases: MEDLINE, EMBASE, and CINAHL PLUS. Studies reporting pre-operative fracture displacement and post-operative outcomes according to standard outcome measures were included. Results: Out of 887 studies identified on initial search, 48 were eligible for full-text review and 14 studies with a total of 173 patients were included in the final review. The overall success rate after severely displaced radial neck fractures in skeletally immature patients was 87% (95% CI, 82%, 92%). Closed reduction methods reported higher success rate of 90% (95% CI, 85%, 95%) compared to open reduction methods 77% (95% CI, 63%, 89%). Conclusion: The average rate of patients achieving excellent/good outcomes following surgical management after severely displaced radial neck fractures in this review is better than reports from previous reviews. Considering the limitations in current evidence base including lack of direct comparison of techniques and small study samples, large comparative studies controlling for possible confounders are merited. [ABSTRACT FROM AUTHOR]

Introduction: Onset of radial neck osteolysis (RNO) has been reported after radial head replacement (RHR), but data are sparse regarding impact and risk factors. We therefore conducted a retrospective study, 1) to quantify RNO after RHR, 2) to assess clinical and radiological impact, and 3) to identify risk factors., Hypothesis: RNO prevalence is high, but functional impact is limited., Material and Method: A single-center retrospective study included all patients undergoing RHR for acute radial head fracture between 2008 and 2017: 53 patients, with a mean age of 53.8±15.7 years [range, 21-85 years]. At a minimum 2 years' follow-up, patients were assessed clinically on joint range of motion and Mayo Elbow Performance Score (MEPS) and radiologically on standard radiographs. Associations between RNO and various parameters were assessed., Results: At a mean 46.7±19.8 months' follow-up [range, 24-84 months], RNO was found in 54.7% of cases (29/53), with mean 4.0 ±2.8mm distal extension [range, 1.2-13.4mm], corresponding to 13.4±7.3% of stem height [range, 2.7-27.7%]. RNO at last follow-up was not significantly associated with reduced flexion-extension (121.9° versus 114.0°; p=0.11), pronation-supination (152.6° versus 138.3°; p=0.25) or MEPS (84.7 versus 84.8; p=0.97), or with higher rates of postoperative complications (11/29 (37.9%) versus 7/24 (29.2%); p=0.782) or surgical revision (11/29 (37.9%) versus 10/24 (41.7%); p=0.503). RNO was significantly associated with cementless fixation (19/29 (65.5%) versus 7/24 (29.2%); p=0.01), unipolar prosthesis (21/29 (72.4%) versus 7/24 (29.2%); p=0.002), high filling-ratio, whether proximal (88% versus 77%; p=0.002), middle (84% versus 75%; p=0.007) or distal (69% versus 59%; p=0.032), and shorter radial stem (33.2mm versus 46.3mm; p=0.011). No demographic parameters showed significant association with RNO at last follow-up., Conclusion: RNO was frequent after RHR, but without clinical or radiological impact in the present series. The risk factors identified here argue for involvement of stress shielding., Level of Evidence: IV, cohort study., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Radial neck fractures are not common (5-10%) but are very difficult to treat and have many possible complications. [1, 2] In the conservative treatment it's impossible to reduce severe displaced fractures, resulting in malfunction. Open reduction frequently leads to intra articular calcification, avascular necrosis, and joint stiffness. [3] In most cases, intramedullary nailing allows complete reduction without capsulotomy and very low complication rate of infection.[4] The pin is left in the bone, stabilizes the epiphysis, and prevents secondary displacement. [8, 9]. [ABSTRACT FROM AUTHOR]

Purpose: To explore the characteristics, mechanism, treatment, and prognosis of head-neck separation type of Monteggia equivalent fractures in children., Methods: Patients with this injury were reviewed retrospectively. The lesion was characterized by a fracture of the ulnar with radial neck fracture but without dislocation of the radial head. Our classification was based on the direction of displacement and angulation of fractures on radiographs, divided into the extension-valgus type and flexion-varus type. The fractures were treated with reduction and internal fixation, depending on the fracture type. The clinical results were evaluated by using radiology and the Mayo Elbow Performance Score (MEPS)., Results: A total of 12 patients were followed up for an average of 40.5 months. The ulnar fractures were treated with closed reduction (CR) and K-wire fixation in one patient, elastic stable intramedullary nail (ESIN) fixation in four patients, open reduction (OR) and plate fixation in five, with no fixation in two. CR with ESIN fixation was successful in 11 patients with radial neck fractures, but one underwent OR and K-wire fixation. All fractures healed on time, with fewer complications (avascular necrosis in one patient, and bulk formation of metaphysis in another). The therapeutic efficacy was evaluated by using MEPS and was found to be excellent in 10 patients, good in one, and fair in another., Conclusions: The head-neck separation type of Monteggia equivalent fractures in children is rare. Its characteristics are different from that of Monteggia fracture. The length and anatomic structure of the ulna should be restored and stabilized first, while the radial neck fracture should be treated with CR and ESIN fixation. Satisfactory clinical results can be achieved with fewer complications., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Su, Li, Ma, Yang, Hao, Jia, Dang, Lu, Liu, Yang, Wang, Wang and Jie.)

Closed reduction and intramedullary pinning (CIMP) in pediatric radial neck fractureswas first reported by Metaizeau in 1980 andsatisfactory results have been published several times. The current literature did not encounter any publication related to the implementation of Metaizeau method to adult patients. We applied Metaizeau technique to an adult radial neck fracture and we have achieved satisfactory results. As this case report is single case of this method applied to an adult, we decided to present this case.

Closed reduction and intramedullary pinning (CIMP) in pediatric radial neck fractureswas first reported by Metaizeau in 1980 andsatisfactory results have been published several times. The current literature did not encounter any publication related to the implementation of Metaizeau method to adult patients. We applied Metaizeau technique to an adult radial neck fracture and we have achieved satisfactory results. As this case report is single case of this method applied to an adult, we decided to present this case. [ABSTRACT FROM AUTHOR]

Background: Minimally displaced radial head and neck fractures are common and the outcome with conservative treatment is generally excellent. A new protocol was introduced to manage patients with these suspected fractures at a major urban hospital. Simple, undisplaced fractures without other associated injuries or instability were discharged with structured advice but no further face-to-face review. Patients with more complex injuries were reviewed at a “virtual clinic.” The aim of this study was to examine the outcome of this process in terms of patient flow, satisfaction, reattendance, and reintervention. Methods: The 202 eligible patients, who presented during a 1-year period from October 2011 to October 2012, were identified retrospectively from a prospectively collected administrative database. Mason type III and IV fractures were excluded. A questionnaire was administered by mail or phone call to assess satisfaction with the process, information received, and function. Results: Twenty (10%) patients required face-to-face review in a clinic, whereas 182 (90%) were managed with direct discharge; 155 patients responded to the survey (77%). The overall satisfaction rate was 96% in the suspected fracture group and 87% in the definite fracture group (P = .08). Satisfaction with the information provided was 95%. Two (1%) required late surgical intervention. Conclusion: In this study, patients with suspected Mason I or II fractures were managed with limited face-to-face follow-up with high satisfaction rates. The reintervention rate was extremely low. This process has significant benefits to patients, who have fewer hospital visits, and to orthopaedic departments, which have more time to devote to complex cases. [Copyright &y& Elsevier]

Background: The treatment of radial neck fractures in children varies according to the displacement, angulation, and skeletal maturity. There is a general agreement that displaced radial neck fractures with more than 30° angulations (Judet type III and IV fractures) should be surgically treated. There are several treatment possibilities for Judet type III and IV fractures including percutaneous pin reduction, elastic stable intramedullary nailing (ESIN), and open reduction with or without internal fixation. In this retrospective study we compared the clinical and radiographical outcomes, and complications following intramedullary versus percutaneous pinning in displaced radial neck fractures in children. Materials and methods: Between 2000 and 2011, 20 patients were treated using closed reduction: in 12 cases we used percutaneous pinning, and in 8 cases we used ESIN. According to Judet classification the two groups were composed as follows: 10 (77 %) type III and 3 (23 %) type IV fractures in the percutaneous pinning group; 4 (57 %) type III, and 3 (43 %) type IV fractures in the ESIN group. Results: After an average of 42 months, excellent results in Mayo elbow performance scores (MEPS) were obtained in 71 and 69 % of ESIN and percutaneous pinning groups respectively, with good results in the remaining cases apart from one fair case (8 %) in the percutaneous pinning group. After a radiological evaluation, all fractures healed in excellent or good alignment. When comparing the two groups, the subjects treated with the ESIN technique had higher range of motion (ROM) in flexion, extension and pronation. No patients developed complications, except three cases of asymptomatic enlargements of the radial head, reported only in the percutaneous pinning group. Conclusion: In this research the clinical outcome, assessed with the MEPS, and the radiological alignment, were comparable between the subjects that were treated with percutaneous pinning and those with ESIN techniques; whereas the ESIN technique demonstrated higher ROM in flexion, extension and pronation. The ESIN technique seems to be the ideal approach both for the higher ROM values and for the absence of complications. [ABSTRACT FROM AUTHOR]

Non-union of radial neck fractures in adults is rare. This review aims to identify factors contributing to the non-union of undisplaced radial neck fractures and assess treatment options and outcomes. Systematic searches of English articles in PubMed, Embase, Ovid Medline, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews were undertaken in September 2021 according to the PRISMA guidelines. The search terms were (fracture) AND (radial neck) AND (non-union OR non-union). Eligible studies reported adults who experienced undisplaced radial neck fractures that went on to non-union without prior surgical intervention. Fifteen case reports/series were included involving 29 non-unions in 27 patients. The largest study included eight patients. There were 11 males (38%) and 18 females (62%). The average age at the time of the presentation was 55 (range: 29-73). In 13 cases, comorbidities were commented on, including association with smoking in 4 (30%), diabetes in 3 (23%), and excessive alcohol in 5 (38%). The average time from injury to a diagnosis of non-union was 6.7 (range: 2-24) months. The average time of follow-up was 28.6 (range:6-84) months. Eight minimally symptomatic or asymptomatic non-unions were managed conservatively without complication. Seventeen symptomatic non-unions were managed operatively. Treatments included open fixation (1), open fixation with bone grafting (1), bone grafting alone (2), arthroplasty (2), radial head resection (2), and unknown surgery (7). Patients managed operatively achieved full or near-full, asymptomatic range of motion at an average of 5.4 (3-12) months postoperatively. Non-union is a rare complication of an adult radial neck fracture, and risk factors may include female gender, smoking, diabetes, and chronic alcohol. Persistence with non-operative management is encouraged as it can resolve symptoms with or without a radiographic union. Operative options range from bone grafting +/- fixation to arthroplasty. On average, the time from injury to the decision made to operate is 6.5 (3-12) months. A comfortable, functional range of motion is possible with all treatment strategies., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Wilton et al.)

Introduction: Non-union of radial neck fractures is not common in adults, and surgical treatment is rarely required. This case report documents non-union of the radial neck with persistent pain around the elbow joint and tenderness over the neck of the radius, limited range of motion for 12 months. The authors performed an iliac bone graft and temporary K-wire fixation for non-union of the radial neck after an isolated radial neck fracture. Case presentation: A 54-year-old woman slipped with her hand outstretched 12 months prior to presentation. She was diagnosed with a radial neck fracture, but her injury was eventually diagnosed as a non-union fracture, and she was transferred to our hospital. The patient had tenderness of the radial head and neck and an increasing tendency of pain in the forearm during external rotation with resistance. Flexion was a maximum of 80°, extension was limited to 20°, and internal rotation and external rotation were decreased to 60°. On plain radiographs, a clear radiolucent shadow was present between the bone fragment and radius. After the autogenous iliac bone graft, a temporary K-wire was fixed, and at eight weeks postoperatively, the bone was united. The patient is in the month 24 of postoperative follow-up and is able to perform daily activities without tenderness. Conclusion: If elbow joint pain, tenderness, and limitation of range of motion are present in non-union of radial neck fracture, surgical treatment is necessary. If there is no injury to the ligament around the elbow or instability, the authors consider bone graft and temporary K-wire fixation as an excellent treatment option for bony union and early exercise of the joint. [ABSTRACT FROM AUTHOR]

Background: The proximal radius features a complex anatomy. Several studies have been published on the anatomy using different technical approaches; however, most of these studies were conducted with a special focus on parameters relevant to radial prosthetic design. The purpose of our study was to explore the complex geometry of the proximal radius with regard to fracture implant design. Methods: Our computed tomography-based measurements of 78 multiplanar reformatted radii allow for exact assessment of its geometry and offer a scientific rationale towards the design of fracture implants. We conducted measurements on the radial head, the radial neck, the radial tuberosity, the radial head-to-neck angle, and the safe zone. Results: A wide range of normal anatomy has been demonstrated for all parameters. Sex differences are statistically significant in all registered parameters, except the radial head-to-neck angle. Although measurements of maximum vs minimum radial head, neck, and tuberosity diameters show close correlation, diameter-to-length correlations, such as radial head diameter vs radial head height and radial neck diameter vs radial neck length, are low. Conclusions: Besides the wide range in size, intraindividual parameter variations have to be taken into account in the design of anatomically precontoured plates. The results of this study indicate that these plates will still need to offer the ability of “bend to match.” [Copyright &y& Elsevier]

Peripheral nerve injury is a serious potential complication following an upper extremity fracture. A rare case of acute posterior interosseous nerve and ulnar nerve palsy following a minimally displaced radial neck fracture is reported. With nonsurgical management, both nerves demonstrated excellent functional recovery. Although rare, nerve palsies can occur during a variety of upper extremity clinical situations, including minimally displaced fractures, and the importance of a detailed neurologic examination cannot be overstated. [ABSTRACT FROM AUTHOR]

Purpose: Bulky implants may lead to symptomatic soft tissue irritation after open reduction and internal fixation of radial head and neck fractures. The purpose of our study was to compare the anatomic fit of precontoured radial head plates. Methods: We stripped 22 embalmed human cadaveric radiuses of soft tissues. We investigated 6 radial head plates: (1) the Medartis radial head buttress plate (MBP), (2) the Medartis radial head rim plate (MRP), (3) the Synthes radial neck plate (SNP), (4) the Synthes radial head plate (SHP), (5) the Acumed radial head plate (AHP), and (6) the Wright radial head plate (WHP). Each plate was applied to each radial head at the place of best fit within the safe zone. We tested 4 parameters of anatomic fit: (1) plate-to-bone distance, (2) plate contact judged by 3 different observers, (3) pin–subchondral zone distance, and (4) plate-to-bone contact after adjustment of the plates. Results: The MBP and MRP showed the lowest profile by objective measurements, the SNP and AHP had a moderate profile, and the SHP and WHP demonstrated the bulkiest profile. The subjective assessments also demonstrated the best fit for the MBP, a good fit for the SNP, a moderate fit for the MRP and AHP, and a poor fit for the SHP and WHP. The MBP, MRP, and AHP could always provide pin-subchondral zone contact, unlike the SHP, SNP, and WHP. After bending, significant improvement of plate-to-bone distance could only be seen for the MBP, MRP, and WHP. The ranking among plates remained the same except for the WHP, which showed a significantly lower plate-to-bone distance than the SHP. Conclusions: Currently available radial head implants are heterogeneous. The MBP and MRP showed the lowest profile and best anatomic fit. Owing to the complex radial head anatomy, to date there is no one radial head plate that perfectly fits all radial heads. Clinical relevance: Conformance of existing plates to the radial head and neck is not perfect. Careful plate selection and modification, when necessary, may minimize interference of this hardware with the surrounding soft tissues and facilitate recovery of motion. [Copyright &y& Elsevier]

Purpose: Open reduction and internal fixation of radial neck fractures can lead to secondary loss of reduction and nonunion due to insufficient stability. Nevertheless, there are only a few biomechanical studies about the stability achieved by different osteosynthesis constructs. Methods: Forty-eight formalin-fixed, human proximal radii were divided into 6 groups according to their bone density (measured by dual-energy x-ray absorptiometry). A 2.7-mm gap osteotomy was performed to simulate an unstable radial neck fracture, which was fixed with 3 nonlocking implants: a 2.4-mm T plate, a 2.4-mm blade plate, and 2.0-mm crossed screws, and 3 locking plates: a 2.0-mm LCP T plate, a 2.0-mm 6x2 grid plate, and a 2.0-mm radial head plate. Implants were tested under axial (N/mm) and torsional (Ncm/°) loads with a servohydraulic materials testing machine. Results: The radial head plate was significantly stiffer than all other implants under axial as well as under torsional loads, with values of 36 N/mm and 13 Ncm/°. The second-stiffest implant was the blade plate, with values of 20 N/mm and 6 Ncm/°. The weakest implants were the 2.0-mm LCP, with values of 6 N/mm and 2 Ncm/°, and the 2.0-mm crossed screws, with values of 18 N/mm and 2 Ncm/°. The 2.4-mm T plate, with values of 14 N/mm and 4 Ncm/°, and the 2.0-mm grid plate, with values of 8 N/mm and 4 Ncm/° came to lie in the midfield. Conclusions: The 2.0-mm angle-stable plates—depending on their design—allow fixation with comparable or even higher stability than the bulky 2.4-mm nonlocking implants and 2.0-mm crossed screws. [Copyright &y& Elsevier]

The purpose of this study was to describe the anatomy of the intramedullary canal of the radial neck for stem design of radial head prostheses. Radial neck measurement was performed from the proximal edge of the radial tuberosity to the distal border of the articular surface on 40 macerated proximal radii using X-rays and Optosil imprints of the intramedullary canal. Radial neck to shaft angle was measured under image intensification. The neck length was 13.3 mm (range 8.0–20.0 mm) measured on X-rays and 13.5 mm (range 9.9–18.8 mm) on Optosil imprints. Concerning the neck’s intramedullary canal we obtained a minimum diameter of 9.7 mm (range 6.3–16.4 mm) on X-ray. Corresponding Optosil imprints had a mean diameter of 11.6 mm (range 6.6–18.6 mm) at their proximal end, 10.5 mm (range 5.5–16.3 mm) in the middle and a minimum of 9.8 mm (range 6.0–16.9 mm) at the distal end. Differences between left and right sides were not significant between X-ray and Optosil imprints, nor between left X-ray and right imprints and vice versa at a P-level of 0.001. Radial neck to shaft angle was 167.8° (range 160.5–178°) measured under image intensification at a rotation angle of 58.6° (range 50–70°) supination. Geometry of the radial neck’s intramedullary canal has been described for stem design. The minimum diameter was seen at the distal end, just proximal to the radial tuberosity. A forearm rotation of 58.6° to full supination should be considered during implantation of monopolar prostheses. The wide variety of lengths and diameters complicates standard prosthetic design, but ipsilateral and contralateral X-rays can be useful for preoperative stem size calculation. [ABSTRACT FROM AUTHOR]

Objective. To assess the fixation rigidities of a custom designed blade plate, a 2.7 mm T-plate and 3.0 mm cannulated screws.Design. A cadaveric non-comminuted radial neck fracture model was employed to test the three fixation methods, using a multi-directional shear loading protocol.Background. The management of displaced radial neck fractures in adults remains unsatisfactory due to failure of internal fixation with secondary loss of reduction, and non-unions.Methods. The stiffness of the various fixation methods was measured in five directions of loading in the transverse plane. Failure testing was performed on the final testing condition for each specimen, in a posteroulnar to anteroradial direction.Results. The direction of specimen loading did not have a significant effect on the stiffness of the various methods of fixation (P=0.4). There was no significant difference in the fixation stiffness between the 3.0 mm screws or blade plate, however, both were superior to the T-plate (P<0.05).Conclusions. Although the 2.7 mm T-plate has been reported in the literature as a viable method of fixation for radial neck fractures, it may not be optimal from the viewpoint of fixation stability. In the setting of a non-comminuted radial neck fracture, the use of cross-cannulated screws or blade plate fixation is preferred.RelevanceThis study supports the use of cross-cannulated screws or blade plate fixation for non-comminuted fractures of the radial neck. [Copyright &y& Elsevier]

Integrity of soft tissues plays a major role in the final outcome of fractures of the proximal radius. Numerous minimally invasive operative techniques were developed to avoid additional trauma during surgical procedure. An overview over the literature is given in the present paper. We report a modified technique of Kapandji for percutaneous reduction and stabilization of displaced radial neck and radial head fractures in children. Functional results in 5 cases were good, and the children had no complaints. In one case with a luxation of the elbow and a fracture of the lateral epicondyle of humerus persitent rotation deficit was oberseved. The modified percutaneous method described here demonstrates an alternative procedure to reduce and stabilize displaced radial head and radial neck fractures. In contrast to open reduction this method avoids impairment of the anular ligament and joint capsule. Associated complex injuries of the elbow with soft tissue trauma, however, may lead to unsatisfactory functional results despite minimal operative technique and anatomic reduction. [ABSTRACT FROM AUTHOR]

Radial neck fractures usually have high union rates. We describe the case of a young fit male who suffered a minimally displaced traumatic radial neck fracture which resulted in non-union. In spite of this, 16 months following injury the patient had no elbow pain or functional disability. Investigative procedures revealed no structural collapse of the radial head. A review of literature complements the case report. [ABSTRACT FROM AUTHOR]

Minimally displaced or impacted radial neck fractures are commonly sustained after elbow trauma, although few require surgical treatment or result in lasting complications. Whereas they are rare, radial neck nonunion after this injury can have adverse implications for patient function and quality of life. The current study presents a case series of 8 radial neck nonunions after minimally displaced or impacted radial neck fractures. Using our institution's electronic medical record database, referred to as the Synthetic Derivative database, we performed a retrospective review of all radial neck fractures that presented to our institution over 15 years. Of 472 minimally displaced or impacted radial neck fractures, 8 progressed to symptomatic nonunion. Average age of these patients was 54 ± 9.3 years. One patient presented with bilateral radial neck nonunions. Nonunion after an impacted radial neck fracture is a rare yet frustrating outcome for patients and providers alike. Our results estimate the rate of symptomatic radial neck nonunion after minimally displaced or impacted radial neck fractures to be 1.7%. Prognostic IV. [ABSTRACT FROM AUTHOR]

Introduction: Radial fracture accounts for 1% of fractures in children. It is potentially serious, and treatment is controversial. Several studies assessed prognostic factors, only one of which used exclusive intramedullary nailing, despite this being the gold standard., Hypothesis: Open surgery provides poor functional results in radial neck fracture., Material and Method: All patients undergoing reduction and internal fixation of radial neck fracture between 2005 and 2015 were analysed. Inclusion criteria comprised Jeffery type 1 fracture with open growth plate, complete file, and ≥1 year's follow-up. Treatment systematically comprised Métaizeau intramedullary nailing, with crossover to open reduction only in case of failure. Good results were defined as full range of motion and pain-free elbow., Results: Fifty-six patients were included: 33 girls, 23 boys; mean age, 9 years. On the Judet classification modified by Métaizeau, 4 fractures were grade 2, 29 grade 3, 15 grade 4A and 8 grade 4B. Closed reduction was performed in 48 cases, including 8 with the help of percutaneous leverage effect. Eight required a surgical approach. Twenty-three showed postoperative reduction defect. At a mean 74 months' follow-up, at a mean age of 15 years, 37 patients had reached full skeletal maturity. Sixteen had poor results. Open reduction was associated with poor outcome (p<0.01). Age, initial epiphyseal tilt, associated lesions, immobilisation time, time to nail removal and residual tilt after reduction did not significantly affect outcome (p-values>0.05). Percutaneous leverage effect had no impact on the quality of results (p=1)., Discussion: Open reduction is to be avoided in radial neck fracture. A prospective study is needed to assess remodelling potential according to age., Level of Evidence: IV, retrospective study., (Copyright © 2020. Published by Elsevier Masson SAS.)

Introduction: In the pediatric population, fractures of the radial neck account for approximately 1% of all fractures and can have substantial consequences. Given the growing popularity of horse riding and the high-energy traumas that this can entail, we sought to assess prognosis for radial neck fracture sustained in horse riding., Hypothesis: Radial neck fracture sustained in horse riding is more severe and more frequently associated with other ipsilateral osteoarticular lesions which worsen prognosis., Material and Method: We performed a multicenter retrospective comparative study in a continuous series of 39 patients. The inclusion criteria consisted of radius neck fracture in children under the age of 15 years. Endpoints comprised associated lesions at time of trauma, and ranges of elbow motion in pronation/supination and flexion/extension at last follow-up., Results: Compared to other etiologies, radial neck fractures following horse-riding accidents were more frequently associated with other ipsilateral osteoarticular lesions (p=0.0002), and more often required open reduction (p=0.0409) and postoperative rehabilitation (p=0.041). However, there were no significant differences in any ranges of motion at last follow-up (p>0.05)., Conclusion: Radial neck fractures following horse-riding accidents in children were more severe than those caused by other mechanisms. Awareness campaigns in riding clubs and development of specific protective equipment should be considered to reduce occurrence., Level of Evidence: Therapeutic III - Retrospective comparative study., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Purpose: Isolated pediatric radial head and neck fractures are rare. In recent literature, their incidence is estimated to be around 1% of all fractures. High rates of complications are reported. Beside non-operative treatment, head fractures are treated with k-wires, mini-screws or polypins, whereas neck fractures are treated more and more with elastic stable intramedullary nailing (ESIN). Purpose of the study was to evaluate the operative management, complications and clinical outcomes of these injuries.Methods: Retrospective analysis between 2002 and 2014. 19 children with isolated radial head and neck fractures were treated in our institution. Age averaged 11 years (range 6-16). Operative treatment with elastic stable intramedullary nailing (ESIN) was performed in 13 patients, in one patient with an additional k-wire; two screw, two k-wire and one polypin fixation was performed in the others. One child was treated non-operatively.Results: Follow up averaged 19 months (2-89). Initial complications occurred in nine children such as fracture dislocation (1), nonunion (1), malunion (1), elbow ankylosis (1), infection (1), crossunion (2), intraarticular screw penetration (1) and radial nerve irritation (1). ESIN lead a complication rate of 36%, mini-screw fixation and k-wire fixation showed a complication rate of 100%. All children (100%) with an open reduction maneuver and 36% children with closed or percutaneous reduction developed a complication. Secondary surgeries included ESIN removal and k-wire fixation (1), open arthrolysis (1), debridement (1), removal of crossunion (1), radial head removal plus arthrolysis (3) and screw removal (1). Subsequently 74% (14) children showed a free or <20° limited range of motion on final follow up. Implant removal was performed after an average of 8 weeks (5-12). Three patients were transferred to our surgical department after a complication following initial treatment. Excluding these, an overall complication rate of 37.5% was noted.Conclusions: Radial head injuries in children are rare. In this population, neck fractures occur more frequently. If conservative treatment is not possible, ESIN seems to be a simple and protective procedure for neck fractures; polypins or screws can be used for complicated radial head fractures. Complications occur frequently after open reduction. If closed reduction and internal fixation is possible, range of motion can be completely restored. [ABSTRACT FROM AUTHOR]