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Judet type-IV radial neck fractures in children

View Article: PubMed Central - PubMed

ABSTRACT

Background and purpose: Heavily displaced radial neck fractures in children are sometimes associated with poor outcome. A substantial number of these fractures require open reduction. We hypothesized that Judet type-IV fractures with a completely displaced radial head would result in a worse outcome than radial neck fractures with remaining bony contact.

Patients and methods: We analyzed 19 children (median age 9.7 (4–13) years) who were treated for Judet type-IV radial neck fractures between 2001 and 2014. The outcome was assessed at the latest outpatient visit using the Linscheid-Wheeler score at a median time of 3.5 (1–8) years after injury. The patients were assigned either to group A (9 fractures with remaining bony contact between the radial head and the radial neck) or to group B (10 fractures without any bony contact).

Results: The 2 groups were similar concerning age and sex. The rate of additional injuries was higher in group B (7/10 vs. 1/9 in group A; p = 0.009). The rate of open reduction was higher in group B (5/10 vs. 0/9 in group A; p = 0.01). Poor outcome was more common in group B (4/10 vs. 0/9 in group A; p = 0.03). In group B, the proportion of children with poor outcome (almost half) was the same irrespective of whether open or closed reduction had been done.

Interpretation: The main causes of unfavorable results of radial neck fracture in children appear to be related to the energy of the injury and the amount of displacement—and not to whether open reduction was used.

No MeSH data available.


Related in: MedlinePlus

A 7-year-old girl had a type-B lesion after falling on a level surface (panels a and b). Note the hardly visible radial head on conventional radiographs (arrow). A CT scan (panels c and d) revealed the location of the radial head. Open reduction and elastic stable intramedullary nailing (ESIN) was necessary. 19 months later, there were signs of shortening and angulation but no evidence of avascular necrosis (panels e and f). Clinically, the patient was free of symptoms, with full range of motion and a Linscheid-Wheeler score of I.
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Figure 0002: A 7-year-old girl had a type-B lesion after falling on a level surface (panels a and b). Note the hardly visible radial head on conventional radiographs (arrow). A CT scan (panels c and d) revealed the location of the radial head. Open reduction and elastic stable intramedullary nailing (ESIN) was necessary. 19 months later, there were signs of shortening and angulation but no evidence of avascular necrosis (panels e and f). Clinically, the patient was free of symptoms, with full range of motion and a Linscheid-Wheeler score of I.

Mentions: We therefore compared the outcome of Judet-IV radial neck fractures with bony contact (Figure 1) to the outcome of such fractures without any bony contact (Figure 2) in a consecutive series of children. We hypothesized that Judet type-IV fractures with a completely displaced radial head would result in a worse outcome than radial neck fractures with some remaining bony contact.


Judet type-IV radial neck fractures in children
A 7-year-old girl had a type-B lesion after falling on a level surface (panels a and b). Note the hardly visible radial head on conventional radiographs (arrow). A CT scan (panels c and d) revealed the location of the radial head. Open reduction and elastic stable intramedullary nailing (ESIN) was necessary. 19 months later, there were signs of shortening and angulation but no evidence of avascular necrosis (panels e and f). Clinically, the patient was free of symptoms, with full range of motion and a Linscheid-Wheeler score of I.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5016914&req=5

Figure 0002: A 7-year-old girl had a type-B lesion after falling on a level surface (panels a and b). Note the hardly visible radial head on conventional radiographs (arrow). A CT scan (panels c and d) revealed the location of the radial head. Open reduction and elastic stable intramedullary nailing (ESIN) was necessary. 19 months later, there were signs of shortening and angulation but no evidence of avascular necrosis (panels e and f). Clinically, the patient was free of symptoms, with full range of motion and a Linscheid-Wheeler score of I.
Mentions: We therefore compared the outcome of Judet-IV radial neck fractures with bony contact (Figure 1) to the outcome of such fractures without any bony contact (Figure 2) in a consecutive series of children. We hypothesized that Judet type-IV fractures with a completely displaced radial head would result in a worse outcome than radial neck fractures with some remaining bony contact.

View Article: PubMed Central - PubMed

ABSTRACT

Background and purpose: Heavily displaced radial neck fractures in children are sometimes associated with poor outcome. A substantial number of these fractures require open reduction. We hypothesized that Judet type-IV fractures with a completely displaced radial head would result in a worse outcome than radial neck fractures with remaining bony contact.

Patients and methods: We analyzed 19 children (median age 9.7 (4–13) years) who were treated for Judet type-IV radial neck fractures between 2001 and 2014. The outcome was assessed at the latest outpatient visit using the Linscheid-Wheeler score at a median time of 3.5 (1–8) years after injury. The patients were assigned either to group A (9 fractures with remaining bony contact between the radial head and the radial neck) or to group B (10 fractures without any bony contact).

Results: The 2 groups were similar concerning age and sex. The rate of additional injuries was higher in group B (7/10 vs. 1/9 in group A; p = 0.009). The rate of open reduction was higher in group B (5/10 vs. 0/9 in group A; p = 0.01). Poor outcome was more common in group B (4/10 vs. 0/9 in group A; p = 0.03). In group B, the proportion of children with poor outcome (almost half) was the same irrespective of whether open or closed reduction had been done.

Interpretation: The main causes of unfavorable results of radial neck fracture in children appear to be related to the energy of the injury and the amount of displacement—and not to whether open reduction was used.

No MeSH data available.


Related in: MedlinePlus