The Functional Results of Surgical Percutaneous Joystick Reduction Therapy for Isolated Severely Angulated Radial Neck Fracture in Children

Abstract

Background: Radial neck fractures in children account for 5 to 10% of all elbow fractures in children. They are extra-articular fractures of the radius proximal to the bicipital tuberosity. The physis is typically involved as a Salter-Harris I or II pattern. Alternatively, the fracture sometimes is extraphyseal, through the metaphysis. In children there is considerable potential for remodeling after these fractures. Up to 30° of radial head tilt and up to 3 mm of transverse displacement are acceptable. Many modalities of treatment are available regarding Surgical &Non-Surgical treatments. Objectives: To evaluate the functional outcome after surgical percutaneous joystick reduction therapy of severely angulated radial neck fracture in children. Type of the study: A prospective study. Methods: During the period between February/2012 and May/2015, we made a prospective study of (18) patients suffered from O′Brien type II&III radial neck fracture with severe angulation that require surgery seen at Al-Kindy Teaching Hospitals. However, we select a group of children who had more than 30° of Radial head angulation really cannot treated by conservative method. Angulated radial neck fractures in children reduced with a percutaneous Kirschner wire. We select of surgical procedure after failure of thumbing intraoperatively. The primary indication for surgery was changing type II&III to typeI which can go on in manage conservatively. Results: All the (18) patients treated with percutaneous pinning techniques were followed-up, clinically and radiographically evaluated pre-surgery, post-surgery and finally (6) months after surgery. The mean angulation of the fractures was 64° (30° - 90°) before reduction and 10°(0° - 22°) after reduction. Mean fracture displacement after reduction in all cases was less than 3 mm. Range of Motion (ROM) in flexion, extension, pronation and supination was the functional parameter in our study as graded by (the grading system of Steele). We obtained an outcome of excellent results in 15 patient (83%), good results in 3 patients (17%) and we have no fair or poor results. Conclusions Percutaneous Joystick Reduction Techniqueusing K-wire in children with radial neck fractures is a safe, short, easy procedure requires only good technical measures, minimally invasive in nature with minimal hospitalization time, has a minimal morbidity and complication rates, it is recommended surgical treatment that can achieve recovery of normal radial neck angulation, elbow motion and yielding excellent results.