PERCUTANEOUS Kirschner WIRE POKING REDUCTION AND ELASTIC STABLE INTRAMEDULLARY NAILING FIXATION FOR SEVERE DISPLACED RADIAL NECK FRACTURES IN CHILDREN

OBJECTIVE: To assess the effectiveness of percutaneous Kirschner wire poking reduction and elastic stable intramedullary nailing fixation for treating severe displaced radial neck fractures in children. METHODS: Between November 2010 and August 2014, 17 children with severe displaced radial neck fractures were treated with percutaneous Kirschner wire poking reduction and elastic stable intramedullary nailing fixation. There were 13 boys and 4 girls with an average age of 8.7 years (range, 6-14 years). The right side was involved in 9 cases, and the left side was involved in 8 cases. The causes of injury were falling in all cases. The angular deformity at fracture was 64-102° (mean, 84°). According to the Judet classification, 7 cases were classified as grade IVa and 10 cases as grade IVb. The time from injury to operation was 4.2 days (range, 1-7 days). Metaizeau classification and Tibone-Stoltz elbow performance score were used to access the radiological and clinical results, respectively. RESULTS: The operation time was 20-50 minutes (mean, 30 minutes). All incisions healed by first intention. The patients were followed up 12-46 months (mean, 20 months). All fractures healed at 2 months after operation. There was no complication of malunion, early epiphyseal closure, avascular necrosis, enlargement of the radial head epiphysis, cubitus varus and valgus deformities, or proximal radioulnar joint synostosis. One case had elbow extension limitation. At last follow-up, the elbow range of motion in flexion, extension, pronation, and supination showed no significant difference between affected side and normal side (P>0.05). The clinical results were excellent in 16 cases and good in 1 case, with an excellent and good rate of 100%. The angulation was 0-12° (mean, 3.7°) on the X-ray film; anatomic reduction or nearly anatomic reduction was obtained, and the radiological results were excellent in 13 cases and good in 4 cases, with an excellent and good rate of 100%. CONCLUSION: Percutaneous Kirschner wire poking reduction followed by fixation with elastic stable intramedullary nailing is a simple, safe, minimally invasive, and effective method to treat severe displaced radial neck fractures in children.