Illingworth Kenneth David, Thompson Kirk, Lovell Matthew, McGinty Jasmin
Division of Orthopaedic Surgery Southern Illinois University School of Medicine P.O. Box 19679 , Springfield, IL 62794-9679 , USA.
Iowa Orthop J. 2013;33:221-4.
Fractures of the radial neck in children have shown to account for 5-10% of traumatic elbow injuries in the pediatric population. Chronic dislocation of the radial head with concomitant fracture has been shown to result in progressive deformity and unacceptable loss of motion.
In this case report, we describe a patient who sustained a type 2 radial neck fracture with 100% displacement. The patient's clinical and surgical management will be discussed and a review of the literature is provided as it relates to this particular case.
The patient underwent open reduction and percutaneous pin fixation of her displaced, dislocated left radial neck fracture in the operating room after multiple failed attempts at closed reduction due to interposition of the annular ligament. Three months after her operation radiographs revealed a well-healed radial neck with no signs of avascular necrosis with an anterior dislocation of her radial head, which was a new finding from her previous radiographs. Fourteen months after her initial injury and operation, radiographs taken at this visit revealed a radial neck fracture that was completely remodeled and had spontaneous relocated and was now aligned with the capitellum without any reduction attempt.
Closed reduction of displaced radial neck fractures may be unsuccessful and open reduction may be warranted. Excess callus formation post-operatively may have resulted in the radial head subluxation; however there was spontaneous reduction with conservative treatment without a reduction attempt, most likely related to remodeling of the excel callus formation.
儿童桡骨颈骨折占小儿肘部创伤性损伤的5%-10%。已证实桡骨头慢性脱位伴骨折会导致渐进性畸形和不可接受的活动度丧失。
在本病例报告中，我们描述了一名发生2型桡骨颈骨折且移位100%的患者。将讨论该患者的临床和手术治疗情况，并提供与该特定病例相关的文献综述。
由于环状韧带嵌入，多次闭合复位尝试失败后，该患者在手术室接受了切开复位及经皮穿针固定其移位、脱位的左桡骨颈骨折。术后三个月的X线片显示桡骨颈愈合良好，无缺血性坏死迹象，桡骨头前脱位，这是其之前X线片上未出现的新情况。初次受伤及手术后14个月，此次就诊时拍摄的X线片显示桡骨颈骨折已完全重塑，且自行复位，现在与肱骨小头对齐，未进行任何复位操作。
移位桡骨颈骨折的闭合复位可能不成功，可能需要切开复位。术后过多的骨痂形成可能导致了桡骨头半脱位；然而，未进行复位尝试，经保守治疗后自行复位，很可能与过多骨痂形成的重塑有关。
