The Therapeutic Effect Analysis Of Three Different Internal Fixations Treating Radial Neck Fractures In Children

Background:The complex anatomy of the elbow and its vascular blood supply makes treatment challenging.The radial head and its blood supply can be damaged by the original trauma and/or by surgical trauma,such as open reduction or forceful manipulations.Radial neck fracture is still a difficult problem until today. There are many reports of small series in the literature.Each report emphasized a single treatment modality,with different fracture classification and outcomes measures. Thus it is very important to analyse the therapeutic effect of different internal fixations.Objectives:To compare the results of closed reduction with elastic intramedullary nailing with open reduction using Kirschner wire or absorbable pin fixation in treatment of radial neck fractures in children.Methods:From July2007to July2012.78children with radical neck fractures were enrolled in our study.45patients were type Ⅲ、type Ⅳa、type Ⅳb according to Judet Classification.24cases were fixed with elastic intramedullary,12with Kirschner wire and9with absorbable pin nailing. The45cases were distributed into A,B,C three groups averagely. JO A scores of each patient, operation time and incision length were recorded. All the results were analyzed with SPSS13.0.Results:45cases were followed up for mean14.6months. No infection, nonunion and heterotopic ossification occurred.3patients got early closure of epiphysis,4cases of necrosis of radial head,1case of irritation of the needle end,1case of numbness of radialis skin. No significant difference were found in elbow pain score among the groups and in instability between group A and B. There is significant difference between A and B in elbow function,ROM, deformity,total score,and incision length and no significant difference in elbow function deformity and operation time. There is significant difference between A and C in elbow ROM, deformity,total score,and incision length and no significant difference in function instability deformity and operation time.Group A is much better than Group B and C.Conclusions: Closed reduction and internal fixation by elastic intramedullary nail protects the blood supply around the fractrue and provides stable reduction to non-severe radial neck fracture of children which is much better than that of open reduction and internal fixation by Kirschner wire or absorbable pin.