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Radial Neck Fractures in Children and Adolescents : An Examination of Operative and Nonoperative Treatment and Outcomes

De Mattos, Camila B LU orcid ; Ramski, David E ; Kushare, Indranil V ; Angsanuntsukh, Chanika and Flynn, John M (2016) In Journal of Pediatric Orthopaedics 36(1). p.6-12
Abstract

BACKGROUND: Although most pediatric radial neck fractures can be treated with either immobilization alone or closed reduction and immobilization, a small subset result in permanent loss of motion despite surgical management. We sought to characterize the most problematic fractures and correlate final outcomes with both presenting fracture characteristics and the reduction achieved through surgical intervention.

METHODS: One hundred ninety-three consecutive children with a radial neck fracture, satisfactory initial treatment data, and follow-up range-of-motion (ROM) data presenting between 1999 and 2012 to our level 1 trauma center were evaluated. The O'Brien classification was used to evaluate angulation on radiographs. Final ROM... (More)

BACKGROUND: Although most pediatric radial neck fractures can be treated with either immobilization alone or closed reduction and immobilization, a small subset result in permanent loss of motion despite surgical management. We sought to characterize the most problematic fractures and correlate final outcomes with both presenting fracture characteristics and the reduction achieved through surgical intervention.

METHODS: One hundred ninety-three consecutive children with a radial neck fracture, satisfactory initial treatment data, and follow-up range-of-motion (ROM) data presenting between 1999 and 2012 to our level 1 trauma center were evaluated. The O'Brien classification was used to evaluate angulation on radiographs. Final ROM outcomes were categorized into excellent, good, fair, and poor. ROM data were not used in the operative group if follow-up was <12 weeks (<6 wk in the nonoperative group) or if there was no follow-up after cast removal.

RESULTS: Thirteen percent of all patients presenting with radial neck fractures required operative treatment (average age 9.1 y). Of patients treated operatively with adequate ROM data, 26.4% healed with fair or poor outcomes. Patients requiring open management were of older average age (average 10 y old, P=0.02) and had a significantly greater risk of a fair or poor ROM outcome than those treated with closed operative techniques (P=0.02). Patients treated nonoperatively were of a younger average age than those in the operative cohort (8.2 vs. 9.1 y, P=0.03). Patients treated operatively were more likely to develop complications (P=0.004); however, presence of a complication was not predictive of fair or poor outcomes in either the operative (P=0.117) or nonoperative (P=0.264) groups.

CONCLUSIONS: Older children are more likely to have more severely displaced radial neck fractures requiring open surgical management, thus resulting in a greater risk of fair or poor outcomes. In the series as a whole, more complications were seen when operative management was required. Final outcomes were not shown to be significantly related to preoperative displacement, postoperative reduction, presence of associated injuries, energy of injury, or treatment complications.

LEVELS OF EVIDENCE: Level III—therapeutic.

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author
; ; ; and
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Adolescent, Child, Child, Preschool, Female, Fracture Fixation/methods, Humans, Male, Radius Fractures/therapy, Retrospective Studies, Treatment Outcome
in
Journal of Pediatric Orthopaedics
volume
36
issue
1
pages
6 - 12
publisher
Lippincott Williams & Wilkins
external identifiers
  • scopus:84952802409
  • pmid:25812145
ISSN
0271-6798
DOI
10.1097/BPO.0000000000000387
language
English
LU publication?
no
id
5aafe240-fbe2-4be8-9adf-a463b69f2436
date added to LUP
2023-11-16 09:37:33
date last changed
2024-03-17 20:03:48
@article{5aafe240-fbe2-4be8-9adf-a463b69f2436,
  abstract     = {{<p>BACKGROUND: Although most pediatric radial neck fractures can be treated with either immobilization alone or closed reduction and immobilization, a small subset result in permanent loss of motion despite surgical management. We sought to characterize the most problematic fractures and correlate final outcomes with both presenting fracture characteristics and the reduction achieved through surgical intervention.</p><p>METHODS: One hundred ninety-three consecutive children with a radial neck fracture, satisfactory initial treatment data, and follow-up range-of-motion (ROM) data presenting between 1999 and 2012 to our level 1 trauma center were evaluated. The O'Brien classification was used to evaluate angulation on radiographs. Final ROM outcomes were categorized into excellent, good, fair, and poor. ROM data were not used in the operative group if follow-up was &lt;12 weeks (&lt;6 wk in the nonoperative group) or if there was no follow-up after cast removal.</p><p>RESULTS: Thirteen percent of all patients presenting with radial neck fractures required operative treatment (average age 9.1 y). Of patients treated operatively with adequate ROM data, 26.4% healed with fair or poor outcomes. Patients requiring open management were of older average age (average 10 y old, P=0.02) and had a significantly greater risk of a fair or poor ROM outcome than those treated with closed operative techniques (P=0.02). Patients treated nonoperatively were of a younger average age than those in the operative cohort (8.2 vs. 9.1 y, P=0.03). Patients treated operatively were more likely to develop complications (P=0.004); however, presence of a complication was not predictive of fair or poor outcomes in either the operative (P=0.117) or nonoperative (P=0.264) groups.</p><p>CONCLUSIONS: Older children are more likely to have more severely displaced radial neck fractures requiring open surgical management, thus resulting in a greater risk of fair or poor outcomes. In the series as a whole, more complications were seen when operative management was required. Final outcomes were not shown to be significantly related to preoperative displacement, postoperative reduction, presence of associated injuries, energy of injury, or treatment complications.</p><p>LEVELS OF EVIDENCE: Level III—therapeutic.</p>}},
  author       = {{De Mattos, Camila B and Ramski, David E and Kushare, Indranil V and Angsanuntsukh, Chanika and Flynn, John M}},
  issn         = {{0271-6798}},
  keywords     = {{Adolescent; Child; Child, Preschool; Female; Fracture Fixation/methods; Humans; Male; Radius Fractures/therapy; Retrospective Studies; Treatment Outcome}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{6--12}},
  publisher    = {{Lippincott Williams & Wilkins}},
  series       = {{Journal of Pediatric Orthopaedics}},
  title        = {{Radial Neck Fractures in Children and Adolescents : An Examination of Operative and Nonoperative Treatment and Outcomes}},
  url          = {{http://dx.doi.org/10.1097/BPO.0000000000000387}},
  doi          = {{10.1097/BPO.0000000000000387}},
  volume       = {{36}},
  year         = {{2016}},
}