Objective: The aim of this study was to analyze the outcomes of treatment and the rate of complications in children treated with flexible intramedullary nailing (FIN) for radial neck fractures.Methods: The study included 26 children (11 males and 15 females) with a median age of 9.5 years, treated with FIN for the radial neck fractures between May 2011 and May 2018. Immobilization after the surgery was not used. The median follow-up was 41 months. According to the Judet classification, 15 fractures were classified as type III and 11 as Type IV. For each patient, clinical, radiological, and disability of the arm, shoulder, and hand (DASH) scores were calculated.Results: All patients achieved complete radiographic healing at a median of 5 weeks. The nails were removed at a median of 4 months. The rate of complications was 11.5%, including 1 radial head necrosis, 1 angulation of 15°, and 1 displacement of the radial head. Twenty patients (76.9%) achieved a perfect clinical healing, while 23 patients (88.5%) achieved a perfect radiological healing. The median DASH score was 1.25. No cases of delayed healing were recorded. After removing of the nails, all patients returned to full function of the extremity and all complications were resolved.Conclusion: The use of FIN for treating fractures of the radial neck in children shows very good functional and cosmetic results. It allows mobilization with rapid pain reduction. It is a minimally invasive, simple, and reproducible technique with a low rate of complication. Owing to excellent results, surgical stabilization of radial head and neck fractures using FIN is recommended in children and adolescents.
___
1. Metaizeau JP. Reduction and osteosynthesis of radial neck fractures in children by centromedullary pinning. Injury 2005; 36: 75-7. [Crossref]
2. Métaizeau JP, Prevot J, Schmitt M. Reduction and fixa-tion of fractures of the neck of the radius by centromedullary pinning. Original technique. Rev Chir Orthop Reparatrice Appar Mot 1980; 66: 47-9.
3. Métaizeau JP, Lascombes P, Lemelle JL, Finlayson D, Prevot J. Reduction and fixation of displaced radial neck fractures by closed intramedullary pinning. J Pediatr Orthop 1993; 13: 355-60. [Crossref]
4. Prathapkumar KR, Garg NK, Bruce CE. Elastic stable intramedullary nail fixation for severely displaced fractures of the neck of the radius in children. J Bone Joint Surg. 2006; 88: 358-61. [Crossref]
5. Klitscher D, Richter S, Bodenschatz K, et al. Evaluation of severely displaced radial neck fractures in children treated with elastic stable intramedullary nailing. J Pediatr Orthop 2009; 29: 698-703. [Crossref]
6. Neher CG, Torch MA. New reduction technique for severely displaced pediatric radial neck fractures. J Pediatr Orthop 2003; 23: 626-8. [Crossref]
7. Al-Aubaidi Z, Pedersen NW, Nielsen KD. Radial neck fractures in children treated with the centromedullary Métaizeau technique. Injury 2012; 43: 301-5. [Crossref]
8. Koca K, Erdem Y, Neyişci Ç, Erşen Ö. Intramedullary elastic nailing of the displaced radial neck fractures in children. Acta Orthop Traumatol Turc 2017; 51: 451-4. [Crossref]
9. Çevik N, Cansabuncu G, Akalın Y, Otuzbir A, Öztürk A, Özkan Y. Functional and radiological results of percutaneous K-wire aided Métaizeau technique in the treatment of displaced radial neck fractures in children. Acta Orthop Traumatol Turc 2018; 52: 428-34. [Crossref]
10. Ursei M, Sales De Gauzy J, et al. Surgical treatment of radial neck fractures in children by intramedullary pinning. Acta Orthop Belg 2006; 72: 131-7.
11. Biyani A, Mehara A, Bhan S. Percutaneous pinning for radial neck fractures. Injury 1994; 25: 169-71. [Crossref]
12. Gummesson C, Atroshi I, Ekdahl C. The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: Longitudinal construct validity and measuring self-rated health change after surgery. BMC Musculoskelet Disord 2003; 4: 11. doi: 10.1186/1471-2474-4-11. Epub 2003 Jun 16. [Crossref]
13. Kaufman B, Rinott MG, Tanzman M. Closed reduction of fractures of the proximal radius in children. J Bone Joint Surg Br 1989; 71: 66-7. [Crossref]
14. Benz G, Roth H. Fractures of the elbow joint by children and adolescent. Unfallchirurgie 1985; 11: 128-35. [Crossref]
15. Helenius I, Lamberg TS, Kääriäinen S, Impinen A, Pakarinen MP. Operative treatment offractures in children is increasing. A population-based study from Finland. J Bone Joint Surg Am 2009; 91: 2612-6. [Crossref]
16. Ugutmen E, Özkan K, Özkan FU, Eceviz E, Altıntaş F, Unay K. Reduction and fixation of radius neck fractures in children with intramedullary pin. J Pediatric Orthop B 2010; 19: 289-93. [Crossref]
17. Steele JA, Graham HK. Angulated radial neck fractures in children. A prospective study of percutaneous reduction. J Bone Joint Surg Br 1992; 74: 760-4. [Crossref]
18. Steinberg EL, Golomb D, Salama R, Wientroub S. Radial head and neck fractures in children. J Pediatr Orthop 1988; 8: 35-40. [Crossref]
19. Pogorelić Z, Kadić S, Milunović KP, Pintarić I, Jukić M, Furlan D. Flexible intramedullary nailing for treatment of proximal humeral and humeral shaft fractures in children: A retrospective series of 118 cases. Orthop Traumatol Surg Res. 2017; 103: 765-70. [Crossref]
20. Pogorelić Z, Furlan D, Biočić M, Meštrović J, Jurić I, Todorić D. Titanium intramedullary nailing for treatment of simple bone cysts of the long bones in children. Scott Med J 2010; 55: 35-8. [Crossref]
21. Furlan D, Pogorelić Z, Biočić M, et al. Elastic stable intramedullary nailing for pediatric long bone fractures: experience with 175 fractures. Scand J Surg 2011; 100: 208-15. [Crossref]
22. Devgan A, Singh R, Kumar S, Verma V, Magu NK, Siwach RC. Indirect reduction and intramedullary pinning in severely displaced radial neck fractures in children. Int J Clin Med 2011; 2: 75-8. [Crossref]
23. Sandmann GH, Crönlein M, Neumaier M, et al. Reduction and stabilization of radial neck fractures by intramedullary pinning: A technique not only for children. Eur J Med Res 2016; 21: 15. doi: 10.1186/s40001-016-0210-4. [Crossref]
24. Eberl R, Singer G, Fruhmann J, Saxena A, Hoellwarth ME. Intramedullary nailing for the treatment of dislocated pediatric radial neck fractures. Eur J Pediatr Surg 2010; 20: 250-2. [Crossref]
25. Kalem M, Şahin E, Kocaoğlu H, Başarır K, Kınık H. Comparison of two closed surgical techniques at isolated pediatric radial neck fractures. Injury 2018; 49: 618-23. [Crossref]