Percutaneous leverage reduction for severely displaced radial neck fractures in children.

Purpose: To define the effectiveness of percutaneous pin leverage reduction for the severely displaced (angulated > 60 degrees) radial neck fracture in children. Methods: Between 1997 and 2011, a series of 12 severely displaced radial neck fractures of 73 radial neck fractures in children was prospectively analyzed. Twelve children with fractures angulated > 60 degrees and those who were followed up for > 1 year were evaluated. Angulation and translation of fractures were measured through anteroposterior, lateral, and both oblique radiographs of the injured elbow. In all the cases, fractures were reduced with the percutaneous pin leverage technique followed by advancing of the pin and application of a long arm cast. We analyzed radiographs and clinical results by criteria suggested by Metaizeau. Results: There were 3 boys and 9 girls, with a mean age of 8 years (range, 4 to 13 y). The mean angulation of the fractures was 68 degrees (range, 60 to 90 degrees), and the mean translation was 90.8% (range, 60% to 100%) at initial presentation. All fracture were reduced successfully and did not develop into angulation and translation of the fracture The mean follow-up period was 7 years and 4 months (range, 1 y 5mo to 13 y 9 mo). Excellent results were observed in 7 and good results in 5 at the last follow-up. Transient posterior interosseous nerve palsy was observed in 1, and the patient recovered spontaneously at 2 weeks after the operation. Mild cubitus valgus deformity was observed in 1 patient at last follow-up. There were 12 consecutive cases with angulation of > 60 degrees, and all of them were successfully reduced and obtained excellent or good result. Conclusion: Percutaneous pin leverage reduction followed by fixation with advancing of the pin is a safe and effective method to treat severely displaced radial neck fractures (> 60 degrees) without serious complications.