Displaced Radial Neck Fractures: What Are My Options?

Pediatric radial head and neck fractures are uncommon injuries. Fractures are classified using the Judet system based on fracture angulation and displacement. Judet type I and II fractures can be managed nonsurgically with a short course of immobilization in a cast or splint without closed reduction. Most of these patients have an excellent prognosis and functional outcomes. Judet type III and IV injuries, as well as injuries that demonstrate a mechanical block to motion, should be closed reduced with the patient under conscious sedation or general anesthesia. Patients who undergo an unsuccessful closed reduction require closed or open reduction in the operating room. Closed reduction methods include the push and lever techniques with the use of Kirschner wires or Steinmann pins or intramedullary nails. Percutaneous fixation with wires or pins is needed only if the fracture fragment is determined to be unstable, whereas nails are left in place and require a second surgery for removal. Both methods have similar outcomes and an overall positive prognosis for patients. Open reduction and internal fixation should be avoided if at all possible given the higher incidence of wide-ranging complications.