title: Intra-articular Radial Head Fractures In the Skeletally Immature Patient: Complications and Management.
abstract: BACKGROUND
  Intra-articular (IARH) and extra-articular (EARH) radial head fractures in skeletally immature patients are rare injuries that have not been well studied. The objective of this study was to investigate the rate of complications associated with IARH fractures relative to EARH fractures in pediatric patients treated at a tertiary referral children's hospital.
  
  
  METHODS
  With IRB approval, Current-Procedural Terminology codes were used to identify all patients who underwent management of radial head and/or neck fractures between 2005 and 2012. A retrospective chart review was used to collect variables related to: demographics, fracture type, treatment method(s), complications, need for physical/occupational therapy, and the need for subsequent surgery. Mid-P exact tests and logistic regression analyses were used to compare differences in the incidence of complications, need for physical therapy (PT), and need for revision surgery between the IARH and EARH fracture groups.
  
  
  RESULTS
  Among the 311 patients included in the cohort, 12 (3.86%) were affected by IARH fractures and 299 (96.14%) were affected by EARH fractures. The mean age at the time of injury was 11.46 (±3.09) years and 8.32 (±3.31) years in the IARH and EARH group, respectively. The estimated incidence of complications was significantly (P<0.0001) higher in the IARH group (50 per 100) compared with the EARH group (1.34 per 100). A significantly (P<0.0001) greater proportion of the subjects with IARH fractures also required revision surgery (25% IARH vs. 0% EARH) and PT (50% IARH vs. 19.59% EARH).
  
  
  CONCLUSIONS
  Compared with EARH fractures, IARH fractures were associated with a significantly higher rate of complications, greater need for PT, and greater need for surgical intervention. The significant complication rate associated with pediatric IARH fractures necessitates an increased awareness of this fracture pattern and prompt, aggressive diagnostic and treatment modalities.
  
  
  METHODS
  Therapeutic studies: Level III.
authors.affiliation: *Department of Orthopedic Surgery, University of Colorado, Anschutz Medical Campus ‡Department of Orthopedic Surgery †The Musculoskeletal Research Center, The Children's Hospital Colorado, Aurora, CO.
authors.forename: Richard
authors.initials: R
authors.lastname: Ackerson
authors.forename: Amy
authors.initials: A
authors.lastname: Nguyen
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Carry
authors.forename: Breanna
authors.initials: B
authors.lastname: Pritchard
authors.forename: Nancy
authors.initials: N
authors.lastname: Hadley-Miller
authors.forename: Frank
authors.initials: F
authors.lastname: Scott
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000601:surgery; D004838:Epiphyses / Q000254:growth & development; D005260:Female; D005592:Fracture Fixation / Q000009:adverse effects / Q000379:methods; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D015994:Incidence; D008297:Male; D026741:Physical Therapy Modalities; D011183:Postoperative Complications / Q000453:epidemiology*; D011859:Radiography; D011884:Radius / Q000293:injuries / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome