Shlykov Maksim A, Milbrandt Todd A, Abzug Joshua M, Baldwin Keith D, Hosseinzadeh Pooya
Instr Course Lect. 2019;68:375-382.
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.
小儿桡骨头和颈部骨折是少见的损伤。骨折根据Judet系统进行分类，该系统基于骨折的成角和移位情况。Judet I型和II型骨折可通过短期使用石膏或夹板固定进行非手术治疗，无需闭合复位。这些患者大多预后良好，功能结局佳。Judet III型和IV型损伤，以及存在运动机械性障碍的损伤，应在患者清醒镇静或全身麻醉下进行闭合复位。闭合复位失败的患者需要在手术室进行闭合或切开复位。闭合复位方法包括使用克氏针、斯氏针或髓内钉的推压和杠杆技术。仅在骨折碎片被判定为不稳定时才需要用钢丝或钢针进行经皮固定，而髓内钉则留在原位，需要二次手术取出。两种方法对患者的结局相似，总体预后良好。如果可能，应尽量避免切开复位内固定，因为其广泛并发症的发生率较高。
