Shah Maulin M, Gupta Gaurav, Rabbi Qaisur, Bohra Vikas, Wang Kemble K
Paediatric Orthopaedic Surgeon, OrthoKids Clinic, 7th Floor, Golden Icon, Opp. Medilink Hospital, Satellite, Ahmedabad, 380015 India.
House No. 12, Road 10, Block L, South Bonosree, Khilgaon, Dhaka, 1219 Bangladesh.
Indian J Orthop. 2020 Jul 4;55(1):109-115. doi: 10.1007/s43465-020-00168-6. eCollection 2021 Feb.
Radial neck fractures account for 5-10% of paediatric elbow trauma. Radial neck fractures have been classified by Judet into five types (I-IVb). There is a global agreement to reduce radial neck fractures with angulation more than 30° (Type III, IVa and IVb). Various maneuvers have been described but none of them uniformly achieved complete reduction in severely displaced radial neck fractures (Type IVa and Type IVb Judet). In this case series, we are presenting our experience with close reduction of ten severely displaced paediatric radial neck fractures to achieve complete anatomical reduction.
We attempted close reduction in ten consecutive children with average age of 8.59 ± 1.68 years (range, 6-12 years) who presented with severely displaced radial neck fracture (Type IVa and IVb Judet). There were five girls. All patients had close injuries and presented to us within 24-48 h. One of the patients had associated undisplaced lateral condyle fracture. We have excluded two patients with associated elbow dislocation. Close reduction was performed within 48 h of initial injury.
We were able to obtain complete anatomical reduction in all of our patients with this technique. None of the patients required fixation of fracture. At 1 year of follow-up, (12 ± 2.07 months, range 9-16 months) all patients demonstrated almost full range of elbow and forearm motion. Final radiographs revealed complete union without any evidence of avascular necrosis.
This technique offers an option of close reduction for the most severely displaced radial neck fractures, which were otherwise being treated by surgical intervention.
The online version of this article (10.1007/s43465-020-00168-6) contains supplementary material, which is available to authorized users.
桡骨颈骨折占儿童肘部创伤的5%-10%。Judet将桡骨颈骨折分为五种类型（I-IVb）。全球一致认为，对于成角超过30°的桡骨颈骨折（III型、IVa型和IVb型）应进行复位。已经描述了各种手法，但没有一种能一致地实现严重移位的桡骨颈骨折（Judet IVa型和IVb型）的完全复位。在本病例系列中，我们介绍了对10例严重移位的儿童桡骨颈骨折进行闭合复位以实现完全解剖复位的经验。
我们对10例连续的儿童进行了闭合复位，这些儿童平均年龄为8.59±1.68岁（范围6-12岁），均表现为严重移位的桡骨颈骨折（Judet IVa型和IVb型）。其中有5名女孩。所有患者均有闭合性损伤，并在24-48小时内前来就诊。其中1例患者合并无移位的外侧髁骨折。我们排除了2例合并肘关节脱位的患者。在初次受伤后48小时内进行了闭合复位。
通过该技术，我们在所有患者中均实现了完全解剖复位。所有患者均无需进行骨折固定。在1年的随访中（12±2.07个月，范围9-16个月），所有患者的肘关节和前臂活动范围几乎完全正常。最终的X线片显示骨折完全愈合，无任何缺血性坏死迹象。
该技术为最严重移位的桡骨颈骨折提供了一种闭合复位的选择，否则这些骨折需通过手术干预进行治疗。
本文的在线版本（10.1007/s43465-020-00168-6）包含补充材料，授权用户可获取。
