Surgical Techniques for Displaced Radial Neck Fractures: Predictive Factors of Functional Results.

Background: Fractures of the radial neck represent about 1% of all childhood fractures and 5% to 10% of childhood traumatic lesions involving the elbow. Management of these fractures in children is still controversial. Intramedullary percutaneous nail reduction (Metaizeau technique) is considered the most effective surgical technique because of its excellent results and easy learning curve. Complications may arise, however, especially in Bohler technique, in which a percutaneous pin is placed over the radial head. When this technique does not provide correct reduction, open reduction must be performed. Because open reduction is traditionally associated with a high risk of complications, however, its use is restricted to severely displaced fractures and only when the percutaneous techniques have failed or their application contraindicated because of associated injuries to the distal radius. Methods: In this retrospective study, we evaluated 51 children between the ages of 6 and 15 years who presented to our institution from 1996 to 2012 with Metaizeau-modified Judet grades 3, 4a, and 4b radial head fractures. The surgical techniques used were closed reduction and casting under general anesthesia (n = 7), closed reduction and intramedullary nailing using Metaizeau technique (n = 27), and Metaizeau technique and open reduction with intramedullary nailing (n = 17). Functional results of the 3 surgical techniques were evaluated using the Mayo Elbow Performance Score (MEPS) and compared by modified Judet classification using chi(2) analysis. Results: No statistic significant association was found between type of surgery and final MEPS was observed (P = 0.110). However, a significant association was found between initial modified Judet grade and final MEPS. Conclusions: In the present study, final functional outcome seems to be not affected by open reduction but was significantly associated with initial modified Judet grade. Level of Evidence: Level III-retrospective study comparing closed and open reduction techniques, performed at the same institution.