Radial neck fracture

Simplifying fracture of the radial neck. All information taken from authentic sources.

1. Radial neck fracture Dr. Ashiqur Rahman Resident Orthopedics Dhaka Medical college Hospital

2. Introduction In adults a displaced fracture of the radial neck may need open reduction. if so, a pre-contoured locking plate can be applied, carefully placed to avoid the articular surface during rotation. If undisplaced , non-operative management can produce acceptable results despite a relatively high rate of non-union . Most are asymptomatic.

3. In children with radial neck # usually are 04 to 14 years old. Primarily because, ossification of the radial head usually does not begin before 5 years of age.

4. The normal anatomical angulation of the radial neck in children has been erroneously diagnosed as a buckle fracture in this area. In AP Radiograph lateral angulation varies from 0-15° And in lateral radiograph 10° anterior to 5° posterior.

5. How does angulation affect treatment? ( i ) < 30° -No manipulation needed (ii) 30-60° - Usually responds to closed reduction (iii) >60 ° - May require surgical intervention Most fractures in children are of the radial neck and not the radial head.

6. Clinical feature: - Palpation over the radial head and neck is painful. - Passive forearm pronation and supination is painful. - A young child may primarily complains wrist pain and the pressure over the proximal radius may accentuate the referred wrist pain. - Wrist pain is secondary to radial shortening and distal radio ulnar dysfunction.

7. O’Brien classification of Radial neck #

8. Treatment option of Radial neck # 1 . Immobilization with no manipulation. 2 . Manipulative closed reduction 3 . Percutaneous pin reduction 4 . Intramedullary pin reduction 5 . Open reduction with or without internal fixation 6 . Excision of radial head. Or a small head fragment.

9. Non operative methods: - Younger children angulation less than 20 to 30 degrees. - A collar and cuff or a simple posterior long cast is enough. Manipulative closed reduction: - Angulation up to 40 to 45 degrees.

10. Patterson’s Classic Manipulation Technique ( Courtesy : Prof. Dr. R R Kairy )

11. The Kaufman (Israeli) Technique

12. Metaizeau’s technique for IM reduction of Radial neck #

13. Reduction with the help K-wire

14. Complication: 1 . Loss of motion 2 . Radial head overgrowth 3 . Non union 4 . Avascular necrosis.