Flexible intramedullary nailing versus Kirschner wire fixation in the treatment of paediatric radial neck fractures: a minimum 2-year follow-up study.

INTRODUCTION

The aims of this study were to compare the clinical outcomes of flexible intramedullary nailing (FIN) and Kirschner wire (KW) fixation in the surgical treatment of paediatric radial neck fractures to provide evidence-based guidance for optimising therapeutic strategies.

METHODS

In this retrospective comparative study, the cases of 68 paediatric patients with Judet III-IV radial neck fractures between February 2018 and March 2023 were analysed; 37 patients underwent FIN, and 31 KW. Comparative parameters included operative time, time to implant removal, complications, and functional recovery, which were evaluated using forearm rotation loss, the Mayo Elbow Performance Score (MEPS), and the Métaizeau radiographic classification.

RESULTS

All patients were followed for a minimum of 24 months postoperatively. Baseline characteristics were comparable between the groups. No significant difference in operative time was observed between the two groups. The time to implant removal was significantly longer in the FIN group (262.05 ± 49.16 days) than in the KW group (32.06 ± 3.63 days; P < 0.05). Functional outcomes, as assessed by the MEPS, were significantly better in the FIN group, with 97.3% of patients achieving excellent or good results, compared to 83.9% in the KW group (P < 0.05). Additionally, the FIN group exhibited significantly less forearm rotation loss (6.03 ± 8.44° vs. 17.06 ± 19.04°, P < 0.05). Although complication rates were generally low, the KW group had a slightly higher incidence, primarily due to pin tract infections.

CONCLUSIONS

FIN fixation offers superior functional outcomes, less forearm rotation loss, and a lower risk of superficial infection compared to KW fixation for paediatric radial neck fractures. While KW allows for earlier implant removal, it is associated with a greater risk of infection. Therefore, FIN is recommended as the preferred surgical option in clinical practice.