Outcomes And Complication of Delayed Open Reduction and Kirschner Wire Fixation for Displaced Radial Neck Fractures in Children Aged 5-18 Years

Federico P. Aquino III, MD
Philippine Orthopedic Center

BACKGROUND Radial neck fractures are common in children. It accounts for five to ten percent of all elbow fractures in the pediatric age group1,2. Displaced radial neck fractures are particularly associated with problematic outcomes in older children. Delayed open reduction and pinning surgery as a potential treatment for displaced radial neck fractures in children is a subject that needs to be further studied. Most of the published literature on this topic is leaning towards conservative approaches. To help close the gap in understanding these injuries and its possible treatment option, we conducted the present study in a specialized orthopedic trauma hospital by determining the outcomes and complications of delayed open reduction and pinning surgery for displaced radial neck fractures.

MATERIALS AND METHODS: A retrospective (non-concurrent) cohort study of 18 children aged 5-18 years old with displaced radial neck fractures was conducted in the Department of Orthopedics. The study utilized review of medical records, patient interviews, clinical assessments, x-ray results, and the American Shoulder and Elbow Surgeons-Elbow (ASES-E) to collect study data at baseline (before surgery) and follow-up. Descriptive statistics were utilized for analyzing data.

RESULTS: The functional outcome of children with displaced radial neck fractures who underwent delayed open reduction and pinning surgery on follow-up significantly improved. Although there were limitations in the range of motion, elbows were fully functional. Heterotopic ossification occurred only in 11%. None had avascular necrosis or cubitus valgus.

CONCLUSION: In general, delayed open reduction and pinning surgery can be one treatment option for displaced radial neck fractures, as evidenced by the findings of our investigation. The results of this study imply the need for standardizing treatment approaches in managing radial neck fractures.

Keywords: open reduction, k-wire fixation, displaced radial neck fractures, children, ASES-E, functional outcome, complications