Orthopaedic and Traumatology Unit, Azienda Ospedaliera di Faenza, Viale Stradone 9, 48018, Faenza, RA, Italy.
Department of Orthopaedic and Traumatology Surgery, Azienda Ospedaliero-Universitaria S. Anna Cona, University of Ferrara, Via Aldo Moro 8, 44124, Ferrara, Italy.
J Med Case Rep. 2020 Jun 25;14(1):78. doi: 10.1186/s13256-020-02390-0.
Displaced radial neck fractures in children are challenging to treat. The age of the patient and the degree of angulation are the main criteria to consider when managing these fractures in children. Various surgical techniques have been described in the literature for both indirect and direct reduction and for fixation. However, the best treatment is still debated.
The case presented is of a 6-year-old Caucasian boy with an impacted and displaced radial neck fracture. With the patient in lateral position, under general anesthesia, elbow arthroscopy was performed to better visualize the articular surface and to assist with reduction and fixation. The fracture was reduced and fixed with a single K-wire under direct arthroscopic visualization. No associated lesions were found. An above-elbow cast was applied after surgery. The cast and K-wire were removed 3 weeks later. At the 3-month follow-up, the patient showed a full recovery with complete range of movement without any postoperative and radiographic complications.
Traditionally, surgery for displaced radial neck fractures in children is performed by closed reduction with percutaneous pinning or elastic intramedullary nail fixation under fluoroscopic guidance. Direct visualization of the articular surface via an open approach allows better reduction in complex fracture patterns but is related to a higher risk of complications: elbow stiffness, instability, or avascular necrosis. Elbow arthroscopy in children could be a valid alternative to open fixation surgery for displaced radial neck fractures without the complications associated with articular exposure, allowing the direct visualization of the fracture and reducing radiation exposure. Although technically demanding, we believe elbow arthroscopy should be considered an alternative option because it is effective in assisting reduction and fixation and enables the detection of associated joint lesions.
儿童移位性桡骨颈骨折的治疗具有挑战性。在儿童中处理这些骨折时，主要考虑患者的年龄和角度。文献中已经描述了各种用于间接和直接复位以及固定的手术技术。然而，最佳治疗方法仍存在争议。
本例为 6 岁白人男孩，患有嵌顿性和移位性桡骨颈骨折。在全身麻醉下，患者取侧卧位，行肘关镜检查，以更好地观察关节面，并协助复位和固定。在直接关节镜下观察下，用单根 K 线将骨折复位并固定。未发现其他相关损伤。术后应用肘上石膏固定。3 周后拆除石膏和 K 线。3 个月随访时，患者完全恢复，活动范围完全，无术后和放射学并发症。
传统上，儿童移位性桡骨颈骨折的手术治疗是在透视引导下经皮穿针或弹性髓内钉固定进行闭合复位。通过开放入路直接观察关节面可以更好地复位复杂的骨折模式，但与更高的并发症风险相关：肘僵硬、不稳定或缺血性坏死。儿童肘关镜检查可以替代开放性固定手术治疗移位性桡骨颈骨折，而不会出现与关节暴露相关的并发症，允许直接观察骨折并减少辐射暴露。尽管技术要求较高，但我们认为肘关镜检查应该作为一种替代选择，因为它在协助复位和固定方面非常有效，并能发现相关的关节损伤。
