Jiang Hai, Wu Yongtao, Dang Youting, Qiu Yusheng
Department of Orthopedics, The First Affiliated Hospital of Xi'an Jiao Tong University Department of Pediatric Orthopedics, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shan'xi, China.
Medicine (Baltimore). 2017 Jan;96(1):e5806. doi: 10.1097/MD.0000000000005806.
Pediatric radial neck fractures are uncommon. Severely displaced and angulated fractures usually require treatment. Our goals for treatment are to avoid incision, reduce the fracture adequately with no reduction loss, and achieve good postoperative function. We aimed to observe the clinical outcomes of closed reduction with the percutaneous leverage technique and internal fixation with Kirschner-wires (K-wires) to treat angulated radial neck fractures in children.From January 2011 to April 2013, we treated 16 cases of angulated radial neck fracture in 12 boys and 4 girls. Five fractures were type II and 11 fractures were type III using the O'Brien classification. One K-wire was percutaneously introduced into the fracture site using the leverage technique to attain good reduction. Two K-wires were introduced from the proximal to the distal areas of the fracture site. The elbow was immobilized by cast in 90° of flexion and the forearm in supination for 3 to 4 weeks. The K-wires were removed at 3 to 4 weeks postoperatively. All cases were followed up for a mean duration of 3 years 6 months.According to the Metaizeau reduction classification, 12 cases were excellent, and 4 cases were good. According to the Metaizeau clinical classification, 14 cases were excellent, and 2 cases were good. There was no necrosis of the radial head. There was no infection, radioulnar synostosis, and damage of the radial nerve deep branch. There was no limitation in the pronation and supination functions of the forearm.Closed reduction using the percutaneous leverage technique and internal fixation using K-wires is easy to perform. It is encouraged to use this approach as the clinical outcome is good.
level IV-retrospective case, treatment study.
小儿桡骨颈骨折并不常见。严重移位和成角骨折通常需要治疗。我们的治疗目标是避免切开，充分复位骨折且无复位丢失，并获得良好的术后功能。我们旨在观察经皮撬拨技术闭合复位及克氏针内固定治疗儿童成角桡骨颈骨折的临床疗效。
2011年1月至2013年4月，我们治疗了16例成角桡骨颈骨折患儿，其中男12例，女4例。采用奥布赖恩分类法，5例为Ⅱ型骨折，11例为Ⅲ型骨折。采用撬拨技术经皮将1根克氏针插入骨折部位以实现良好复位。从骨折部位近端至远端插入2根克氏针。肘关节用石膏固定于屈曲90°，前臂旋后，固定3至4周。术后3至4周取出克氏针。所有病例平均随访3年6个月。
根据梅泰佐复位分类法，12例为优，4例为良。根据梅泰佐临床分类法，14例为优，2例为良。桡骨头无坏死。无感染、桡尺骨融合及桡神经深支损伤。前臂旋前和旋后功能无受限。
经皮撬拨技术闭合复位及克氏针内固定操作简便。因其临床疗效良好，故鼓励采用此方法。
IV级——回顾性病例治疗研究。
