Treatment of Radial Neck Fractures using Percutaneous Reduction
Fractures of the radial neck in the pediatric population account for 5%- 10% of traumatic lesions of the elbow. Conservative methods of reduction are used for less severely displaced fractures. Open reduction is associated with significant rate of complications. Several techniques have been described for percutaneous reduction, including pins or K-wire insertion to the radial epiphysis ("joystick technique") , elastic nail introduced retrogradely from distal radius and manipulated to reduce the radial head (Metaizeau).
We present our method – used for a period of 12 years. This technique is attempting minimal impairment of the physis or the epiphysis.
A small stab wound is made in the skin directly over the radial head- under fluoroscopy. A blunt instrument preferably curved mosquito or pean forceps is inserted just distal to the displaced radial epiphysis. Location should be where the maximal angulation is observed. Using the convex side of the instrument to push the epiphysis to align properly. Then a thin K-wire is inserted at a proximal entry point, obliquely to the radial cortex to buttress the radial head, without penetrating it.
We encountered no complications like nonunion, radial head deformities or growth disturbances. Some patients had a loss of elbow motion, mostly recovered completely.
Using this method, which is easily performed and taught, we achieve a quick and easy reduction, avoid harm to the still growing proximal radius and relatively pain free recovery.
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