title: Reduction and stabilization of radial neck fractures by intramedullary pinning: a technique not only for children.
abstract: BACKGROUND
  Isolated radial neck fractures occur only in rare cases. The majority of cases are non-displaced or minimally displaced and can be treated conservatively. Conservative treatment, however, might result in secondary displacement and/or malunion. On the other hand, open reduction and internal fixation (ORIF) as standard surgical approach in adults is associated with non-union, implant-related complications and reduced range of motion. For isolated radial neck fractures with an intact radial head, the procedure of centromedullary pinning--as widely used in the treatment of paediatric radial neck fractures--might be an alternative operative technique in adults as well. The purpose of this retrospective case series therefore was to evaluate the functional outcome of radial neck fractures treated by intramedullary pinning.
  
  
  METHODS
  Between 02/2009 and 12/2014, a total of eight patients with isolated radial neck fractures (Mason type-III; Judet Type II and III) were treated with centromedullary pinning using titanium elastic nails (TEN). The mean age of the patients was 39 years (range 23-90 years) with a mean interval from injury to surgery of 2.9 days (range 1-7 days). Subjective and objective criteria included patient's satisfaction, pain rating on a visual analogue scale (VAS) and active range of motion (ROM) compared to the contralateral armside. Functional scoring included the Morrey Elbow Score (MEPS), the QuickDASH and the Elbow Self Assessment Score (ESAS). Furthermore, follow-up radiographs were evaluated.
  
  
  RESULTS
  Seven of the eight patients were available for follow-up after a mean of 36 months (range 6-64 months). Patients' satisfaction was rated very good in four cases, good in two cases and sufficient in one case. An unrestricted active ROM compared to the contralateral side for extension-flexion arc and for pronation-supination-arc with full strength was rated in all cases. The Elbow Self Assessment Score was 98.52 ± 1.95 (range 96-100), the calculated Mayo elbow performance score was 95.71 ± 7.32 (range 85-100) and the QuickDASH score was 6.81 ± 10.42 (range 0-27). There were no complications as infection, non-union, heterotopic ossifications or secondary loss of reduction of the radial head. Only one patient complained about pain resulting from an affection of the superficial radial nerve.
  
  
  CONCLUSIONS
  In the present cohort, good to excellent results without relevant complications were seen. The technique of intramedullary pinning as described in the treatment of isolated radial neck fractures in children represents a suitable and reliable method in adults as well. In selected cases, this technique can be recommended as an alternative, minimal-invasive approach to the radial head plate osteosynthesis.
authors.affiliation: Department of Trauma Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Strasse 22, 81675, Munich, Germany.|BG Unfallklinik Tübingen, Eberhard-Karls- University, Tuebingen, Germany.
authors.forename: G H
authors.initials: GH
authors.lastname: Sandmann
authors.affiliation: Department of Trauma Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Strasse 22, 81675, Munich, Germany. moritz.croenlein@mri.tum.de.
authors.forename: M
authors.initials: M
authors.lastname: Crönlein
authors.affiliation: Department of Trauma Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Strasse 22, 81675, Munich, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Neumaier
authors.affiliation: Department of Trauma Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Strasse 22, 81675, Munich, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Beirer
authors.affiliation: Department of Trauma Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Strasse 22, 81675, Munich, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Buchholz
authors.affiliation: BG Unfallklinik Tübingen, Eberhard-Karls- University, Tuebingen, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Stöckle
authors.affiliation: Department of Trauma Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Strasse 22, 81675, Munich, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Biberthaler
authors.affiliation: Department of Trauma Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Strasse 22, 81675, Munich, Germany.|Department of Orthopaedic Sports Medicine, Klinikum Rechts Der Isar, Technische Universität München, Munich, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Siebenlist
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D002648:Child; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011884:Radius / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery*; D011885:Radius Fractures / Q000503:physiopathology / Q000601:surgery*; D016059:Range of Motion, Articular; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014025:Titanium; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D014025:Titanium
keywords: Intramedullary pinning; Radial head fractures; Radial neck fractures; Titanium elastic nail