Anatomic Study On Puncturing Points For Pediatric Radial Neck Fractures Using Joystick Reduction

Objective: To investigate the clinical results of percutaneous joystick reduction and elastic intramedullary nailing in the treatment of pediatric radial neck fractures with closure reduction failures and find the safe puncturing points.Methods: From March 2013 to May 2016,a total of 27 cases of pediatric radial neck fractures with closure reduction failures were treated by percutaneous joystick reduction and elastic intramedullary nailing.A cast immobilization was applied for 4 weeks postoperatively.There were 19 cases,12 males and 7 females,who need anatomic measurements.On the elbow,make a line between the humeral capitellum edge to the ulnar crest,and mark its midpoint.Make a square with this line as one of the edges to distal end.Divide this square into four equal smaller squares.And the center of the big square will be the puncturing point.Measure the length of the line,the distance from the puncturing point to the connecting ling between the the humeral capitellum edge and the ulnar crest,and the distance from the puncturing point to the gap between the anconeus and the extensor carpi ulnaris..Results: All the 27 patients were followed up for an average of 12.5 months(ranging from 5 to 33 months).Bone healing was achieved in all cases,with an average bone healing duration of 4.6 weeks(ranging from 4 to 6 weeks).According to the Métaizeau criteria,all the 27 patients were excellent upon postoperative X-ray inspection.According to the Tibone and Stoltz function scale,the score was excellent in 20 cases,good in 6 cases and acceptable in 1 case.Nail end skin and soft tissue irritation was observed in 2 cases.The average measured edge length was 29.4mm(ranging from 24 to 36mm).The average measured distance from the puncturing point to the connecting ling between the humeral capitellum edge and the ulnar crest was 14.7mm(ranging from 12 to 18mm).The average measured distance from the puncturing point to the gap between the anconeus and the extensor carpi ulnaris was 0.2mm(ranging from-3 to 4mm).No nerve injury was observed in all the 27 cases treated with Joystick reduction from this puncturing point.Conclusion: Make a square with the line between the humeral capitellum edge to the ulnar crest as one of the edges to distal end,divide this square into four equal smaller squares,and the center of the big square will be the puncturing point.