Open Reduction and Stabilization Without Internal Fixation for the Treatment of Displaced Radial Neck Fractures

TL;DR

This study shows that treating displaced radial neck fractures without internal fixation can lead to good recovery outcomes in both children and adults.

Contribution

The study introduces a method of open reduction and stabilization without internal fixation for radial neck fractures, avoiding risks like nerve palsy.

Findings

All patients maintained anatomical position post-surgery with no malalignment or complications.

Good functional outcomes were achieved, with minimal pain and full range of motion recovery.

Artificial bone grafts helped stabilize fractures when instability was present.

Abstract

Background

Radial neck fractures are a rare injury in both adults and children. In adults, dislocated fractures of the radial neck are commonly treated using open reduction and internal fixation with headless compression screws or plate osteosynthesis. In children, isolated fractures are most commonly treated using percutaneous fixation. However, these methods are associated with the risk of posterior interosseous nerve palsy and the need for wire removal. Thus, firm fixation without the use of internal fixation is preferable. In this study, we aimed to evaluate open reduction and stabilization of displaced radial neck fractures without internal fixation.

Methods

Eight patients who underwent surgery for radial neck fractures were recruited from the institutional registry. Using a chisel, the fracture line was gently reduced from the fracture site where the radial head was maximally displaced. If a bone defect occurred and instability was observed, the defect was filled with an artificial bone graft substitute. Reduction was maintained with cast immobilization for two weeks. The angulation and translation of the fracture line was assessed.

Results

The median age of the study participants was 18.4 years. The mean follow-up period was 33.8 months. The distribution of Judet types was as follows: type II in three cases, type III in four cases, and type IV in one case. Artificial bone was used in six cases and not used in two cases. The mean preoperative tilt angle was 33.4°, and the mean preoperative lateral shift angle was 5.6 mm. Immediately after surgery, the anatomical position was successfully maintained in all patients. The mean bone union period was 62.1-80.3 days. The mean Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score was 1.1. The final range of motion (ROM) achieved was 152° of flexion, +4° of extension, 86° of supination, and 84° of pronation. The mean pain levels at rest and during motion, as assessed using the visual analog scale (VAS), were 0.6. No cases of malalignment, avascular necrosis, nerve palsy, premature physeal closure, or cubitus valgus were observed.

Conclusions

Position maintenance is achieved without internal fixation in both children and adults. Good fixation without internal fixation depends on the intraoperative stability. If instability is observed, artificial bone filling should be the first choice, and if instability persists, the use of an internal fixative should be considered without hesitation.

In this study, we demonstrated that open reduction and stabilization of displaced radial neck fractures without internal fixation yields satisfactory clinical and radiological outcomes.

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