Department of Pediatric Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China.
Rehabilitation Medicine Centre, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China.
Injury. 2022 Oct;53(10):3310-3316. doi: 10.1016/j.injury.2022.07.016. Epub 2022 Jul 9.
Radial neck fracture is a less common injury in childhood and many factors are associated with the final functional outcomes. This study aimed to describe the clinical and radiological results of the patients with radial neck fractures treated surgically and assess the potential risk factors for poor functional outcomes.
This study enrolled 101 children with radial neck fracture and treated surgically at our department. Patients were followed up at least three years and assessed clinically and radiographically. The primary outcome of this study was the functional outcome assessed by using Metaizeau criteria and the secondary outcome was complications of radial head necrosis, postoperative radial nerve palsy, bone union, infection, and skin irritation. Related risk factors for unsatisfactory functional outcomes were recorded and analyzed by multivariable logistic regression.
In total, 101 patients with 101 elbows (44 on the left side, 57 on the right side) were evaluated in our study, including 55 females (54.5%) and 46 males (45.5%), with a mean age of 7.5±2.7 years old (range, 3 to 14 years). There were 65.3% excellent (66 cases), 18.8% good (19 cases), 11.9% fair (12 cases), and 4.0% bad (4 cases) results in these patients. The rate of satisfactory outcome was 65.3% (66/101) and the rate of "unsatisfactory outcome" was 34.7% (35/101). Complications included postoperative radial nerve palsies in 15 cases (14.9%), radial head necrosis in 4 cases (4.0%), skin irritation due to the nail-end in 5 cases (5.0%), infection in 2 cases (2.0%), and bone nonunion in 1 patient (1.0%). Only Judet type (OR, 5.78; CI, 1.72-19.39, p=0.005) and surgical method (OR, 12.68; CI, 2.55-63.06, p=0.002) were independent risk factors for the unsatisfactory functional outcomes.
Closed reduction with intramedullary fixation is a primary treatment for type III and IV radial neck fractures in children. Fracture severity classified as Judet type IV and open surgical method were independent predictors for unsatisfactory functional outcomes.
桡骨颈骨折在儿童中较为少见，许多因素与最终的功能结果有关。本研究旨在描述手术治疗桡骨颈骨折患者的临床和影像学结果，并评估功能结果不良的潜在危险因素。
本研究纳入了 101 例在我科接受手术治疗的桡骨颈骨折患儿。患者至少随访 3 年，进行临床和影像学评估。本研究的主要结局是使用 Metaizeau 标准评估的功能结局，次要结局是桡骨头坏死、术后桡神经麻痹、骨愈合、感染和皮肤刺激的并发症。记录并通过多变量逻辑回归分析与不满意功能结局相关的危险因素。
本研究共评估了 101 例 101 肘（左侧 44 例，右侧 57 例）患儿，其中女性 55 例（54.5%），男性 46 例（45.5%），平均年龄为 7.5±2.7 岁（3 至 14 岁）。这些患者中，65.3%（66 例）为优秀，18.8%（19 例）为良好，11.9%（12 例）为可，4.0%（4 例）为差。患者的满意结局率为 65.3%（66/101），“不满意结局”率为 34.7%（35/101）。并发症包括术后桡神经麻痹 15 例（14.9%），桡骨头坏死 4 例（4.0%），钉子末端引起皮肤刺激 5 例（5.0%），感染 2 例（2.0%），骨不愈合 1 例（1.0%）。只有 Judet 分型（OR，5.78；CI，1.72-19.39，p=0.005）和手术方法（OR，12.68；CI，2.55-63.06，p=0.002）是功能结局不满意的独立危险因素。
闭合复位髓内固定是儿童 III 型和 IV 型桡骨颈骨折的主要治疗方法。Judet 分型为 IV 型和开放性手术方法是功能结果不良的独立预测因素。
