Radial Neck Fractures in Children

Purpose. To review records of 108 children with radial neck fractures and develop an algorithm for treatment. Methods. Records of 50 girls and 58 boys aged 2 to 14 (mean, 8.7) years with radial neck fractures were reviewed. The most common injury mechanism was tripping and falling on an outstretched hand while running (n=44), followed by falling from monkey bars (n=11). Fractures were classified into grade 1 (n=25), grade 2 (n=60), grade 3 (n=16), grade 4a (n=6), and grade 4b (n=1). 21 patients had associated fractures involving the olecranon, proximal ulna, and/or the humeral supracondyle. The time from injury to treatment ranged from 0 to 7 days. Treatments included casting without manipulation (n=86), closed reduction and casting (n=8), percutaneous Kirschner wire–assisted reduction and casting (n=7), and open reduction and casting (n=7). Results. Patients were followed up for a mean of 2.7 (range, 1–5) years. Outcome was excellent in 93 patients, good in 11, and fair in 4. Higher fracture grades correlated positively with poorer outcomes (p=0.001) and more invasive treatment (p=0.001). Nonetheless, the post-reduction angles of all the patients were not significantly different (p>0.05). Older children sustained more severe fractures (p=0.04) and had poorer outcomes, even after correction for fracture grade (p=0.007). Patients with associated fractures had significantly poorer outcomes (p<0.05). Two patients developed synostosis of the proximal radioulnar joint. One of whom had an associated olecranon fracture and underwent open reduction and casting. The other had an associated proximal ulnar fracture and underwent repeated percutaneous Kirschner wire–assisted reduction owing to loss of reduction. Five patients developed heterotopic ossification. Four of whom had associated fractures (3 involved the olecranon and one the proximal ulna). 14 patients developed cubitus valgus deformity of 3° to 10°. Conclusion. Open reduction should only be performed after more conservative treatments fail to achieve reduction.