title: Judet type-IV radial neck fractures in children: Comparison of the outcome of fractures with and without bony contact.
abstract: Background and purpose - Heavily displaced radial neck fractures in children are sometimes associated with poor outcome. A substantial number of these fractures require open reduction. We hypothesized that Judet type-IV fractures with a completely displaced radial head would result in a worse outcome than radial neck fractures with remaining bony contact. Patients and methods - We analyzed 19 children (median age 9.7 (4-13) years) who were treated for Judet type-IV radial neck fractures between 2001 and 2014. The outcome was assessed at the latest outpatient visit using the Linscheid-Wheeler score at a median time of 3.5 (1-8) years after injury. The patients were assigned either to group A (9 fractures with remaining bony contact between the radial head and the radial neck) or to group B (10 fractures without any bony contact). Results - The 2 groups were similar concerning age and sex. The rate of additional injuries was higher in group B (7/10 vs. 1/9 in group A; p = 0.009). The rate of open reduction was higher in group B (5/10 vs. 0/9 in group A; p = 0.01). Poor outcome was more common in group B (4/10 vs. 0/9 in group A; p = 0.03). In group B, the proportion of children with poor outcome (almost half) was the same irrespective of whether open or closed reduction had been done. Interpretation - The main causes of unfavorable results of radial neck fracture in children appear to be related to the energy of the injury and the amount of displacement-and not to whether open reduction was used.
authors.affiliation: a Department of Paediatric and Adolescent Surgery , Medical University of Graz , Graz , Austria.
authors.forename: Margarita
authors.initials: M
authors.lastname: Kaiser
authors.affiliation: a Department of Paediatric and Adolescent Surgery , Medical University of Graz , Graz , Austria.
authors.forename: Robert
authors.initials: R
authors.lastname: Eberl
authors.affiliation: a Department of Paediatric and Adolescent Surgery , Medical University of Graz , Graz , Austria.
authors.forename: Christoph
authors.initials: C
authors.lastname: Castellani
authors.affiliation: a Department of Paediatric and Adolescent Surgery , Medical University of Graz , Graz , Austria.
authors.forename: Tanja
authors.initials: T
authors.lastname: Kraus
authors.affiliation: a Department of Paediatric and Adolescent Surgery , Medical University of Graz , Graz , Austria.
authors.forename: Holger
authors.initials: H
authors.lastname: Till
authors.affiliation: a Department of Paediatric and Adolescent Surgery , Medical University of Graz , Graz , Austria.
authors.forename: Georg
authors.initials: G
authors.lastname: Singer
mesh_terms: D000293:Adolescent; D001858:Bone Nails; D002648:Child; D002675:Child, Preschool; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008297:Male; D011884:Radius / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D011885:Radius Fractures / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D000092464:Elbow Injuries