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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]