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SUMMARY Moderate doses of radiation therapy have been shown to be effective in preventing the clinical manifestation of occult metastases in the neck and of preventing the development of contralateral metastases in patients whose primary and ipsilateral nodes are controlled. Further, the addition of radiotherapy to radical neck dissection has been documented to decrease the incidence of local recurrence. Appropriately defined and limited (functional) neck dissections have now been shown to be at least equal to the classical (Crile) procedure in terms of therapeutic effectiveness. Guidelines are suggested for the combination of limited neck dissections with radiotherapy aimed at minimising the morbidity of radial neck dissection, while insuring that the chances of control of cancer in the neck remain optimal.

A series of 43 radial neck or head fractures in children was analysed with respect to the type of fracture and whether conservative or surgical treatment had been employed. Thirty-seven patients were examined after a follow-up period of 1-18 years (average 8 years). Tilting of the radial head, the length of the radius and the size of the radial head were measured roentgenologically to evaluate any growth disturbances. The results were good in 24, fair in 10 and poor in 3 cases. In the 14 patients treated surgically results were good in five, fair in six and poor in three cases. All but two of these patients had an angulation of the radial head of 30 degrees or more. The result was good in 20 of the 23 patients who were treated conservatively because the angulation was less than 30 degrees after reduction. In fair and poor cases the function was impaired by the limitation of motion. Disturbances in growth were generally slight, but an enlargement of the radial head was observed in 16 cases at the follow-up.

A series consisting of 29 children with markedly dislocated fractures of the neck of the radius has been analysed. The method of measuring the angular dislocation is discussed. A true dislocation not exceeding 30 degrees may be left unreduced. Associated skeletal lesions of the elbow imply a less favourable prognosis.

Conservative management is important in most children's fractures. Open surgical methods may be necessary in a few specific injuries such as fractures of the lateral humeral condyle, fractures of the radial neck with severe displacement, and some fractures of the medial epicondyle.Volkmann's ischemic contracture requires prompt surgical treatment if conservative measures fail. Other rare bone injuries in children, such as fracture of the femoral neck and osteochondral fracture within the knee joint, may require open operation.Nonetheless, except for these uncommon situations, nature is on the side of the judicious physician who aids rather than impedes it.

Introduction The aim of our study was to analyze medium and long-term results of proximal ulnar osteotomy with and without ligament injury in neglected Monteggia injury in children. Material and methods This retrospective, multicenter study included 28 patients. Clinical criteria concerned the range of motion, pain and MEPI score, and radiologic criteria comprised of Storen line, head-neck ratio, radial neck angle, and signs of osteoarthritic remodeling. Results Twenty-eight patients were reviewed, at a mean 6 years’ follow-up (range, 2–34 y). Sixteen had proximal ulnar osteotomy without ligament reconstruction, and 12 had associated ligamentoplasty. Both groups showed significant clinical and radiological improvement, with no significant difference. Patients operated within less than 1 year had better clinical and radiographic results. There was no correlation between age at surgery and quality of results. The 5 patients who underwent condyloradial pinning showed early recurrence of dislocation and osteoarthritic remodeling. The three cases of Bado type-3 lesion had early recurrence of dislocation. Discussion Proximal ulnar osteotomy gives good long-term results in Bado type-1 lesions, regardless of age, if performed before 1 year, in the absence of osteoarthritic remodeling. Associated ligamentoplasty does not seem to be useful. Level of evidence IV (retrospective).

After resection of the proximal ulna for chondrosarcoma, the elbow was reconstructed by dislocating the radius posteriorly until the radial neck articulated with the trochlea. The triceps tendon was sutured to the radial head. At 9 months' follow-up, the elbow was painless and stable with 35-135 degrees of flexion.

Displacement of the proximal fragment in fractures of the radial neck is rare. When it does occur, the proximal fragment is usually displaced posteriorly (O'Brien, 1965). In the case reported here the proximal fragment was dislocated anteriorly and the radial shaft was displaced medial to the coronoid process of the ulna. This particular injury has been reported once previously (Manoli, 1979).

We present a method for the reducing a displaced radial head in children, by rotating the forearm while pressing over the displaced fragment. This has been successful in a series of 10 cases.

The aim of this study is to determine the functional long-term outcome after non-operative and operative treatment of radial neck fractures in adults. Thirty-four consecutive patients with a mean age of 46.4 (18.0 to 63.0) years with a fracture of the radial neck who were treated between 2000 and 2014 were examined regarding the clinical and radiological outcome. Twenty patients were treated non-operatively, and 14 patients underwent surgery. After a mean follow-up of 5.7 (2.0 to 15.7) years, the clinical scores showed good results in both groups. The Disabilities of Arm, Shoulder and Hand score was 16.1 (0 to 71.6) in the non-operative group and 8.8 (0 to 50.8) in the operative group, respectively. The Mayo Elbow Performance Score was 80.0 (30 to 95) in the non-operative group and 82.5 (35 to 95) in the non-operative group, respectively. The initial angle of the radial head towards the shaft (RHSA) was significantly higher in the operative group in the anterior-posterior plane (12.8° [2 to 23] vs. 26.3° [1 to 90], p = 0.015). In the follow-up radiographs, the RHSA was significantly lower in the operative group (15.1° [3 to 30] vs. 10.9° [3 to 18], p = 0.043). Five patients developed 7 complications in the non-operative group, and 7 patients developed 12 complications in the operative group. Revision rates were higher in the operative groups as 1 patient received radial head resection in the non-operative (5%) group while 7 patients in the operative group (50%) needed revision surgery. A good functional long-term outcome can be expected after operative and non-operative treatment of radial neck fractures in adults. If needed due to major displacement, open reduction is associated with a higher risk of complications and the need for revision surgery but can achieve similar clinical results. DRKS DRKS00012836 (retrospectively registered)

A case of posterior fracture-dislocation of the elbow with a comminuted radial head fracture which subsequently went on to nonunion is reported. Radiographs at followup revealed a pseudoarthrosis of the radial neck, with at least part of the normal pronation and supination occurring through the pseudoarthrosis site.

Presentation of a new method of providing stable internal fixation which allows early movement of the elbow and the proximal radio-ulnar joint

In thirty-three children with fractures of the radial head or neck, and with a minimum follow-up of two years, fractures of the radial neck were most common. The proximal radial epiphysis was usually closed by the age of fifteen years. The older children in the series had the worst prognosis, as did children with other associated upper-extremity injuries, usually on the medial aspect of the elbow. The results were best if treatment was initiated early, and closed reduction usually gave the most satisfactory results. Roentgenograms of the involved elbow were often abnormal even with a good clinical result, but the long-term result in such situations is uncertain.

Displaced radial neck fractures in children usually are treated by open reduction, which introduces additional trauma. Furthermore, the results are not always excellent. In two series of radial neck fractures in children (Types II and III of O'Brien classification), ten were treated surgically (Group I) and 12 were treated by percutaneous leverage method with a Kirschner wire immediately removed after the reduction (Group II). The overall results in Group 2 were better than in Group I. Surgical reduction should be reserved for failed reductions by percutaneous leverage method.