title: Closed reduction using the percutaneous leverage technique and internal fixation with K-wires to treat angulated radial neck fractures in children-case report.
abstract: Pediatric radial neck fractures are uncommon. Severely displaced and angulated fractures usually require treatment. Our goals for treatment are to avoid incision, reduce the fracture adequately with no reduction loss, and achieve good postoperative function. We aimed to observe the clinical outcomes of closed reduction with the percutaneous leverage technique and internal fixation with Kirschner-wires (K-wires) to treat angulated radial neck fractures in children.From January 2011 to April 2013, we treated 16 cases of angulated radial neck fracture in 12 boys and 4 girls. Five fractures were type II and 11 fractures were type III using the O'Brien classification. One K-wire was percutaneously introduced into the fracture site using the leverage technique to attain good reduction. Two K-wires were introduced from the proximal to the distal areas of the fracture site. The elbow was immobilized by cast in 90° of flexion and the forearm in supination for 3 to 4 weeks. The K-wires were removed at 3 to 4 weeks postoperatively. All cases were followed up for a mean duration of 3 years 6 months.According to the Metaizeau reduction classification, 12 cases were excellent, and 4 cases were good. According to the Metaizeau clinical classification, 14 cases were excellent, and 2 cases were good. There was no necrosis of the radial head. There was no infection, radioulnar synostosis, and damage of the radial nerve deep branch. There was no limitation in the pronation and supination functions of the forearm.Closed reduction using the percutaneous leverage technique and internal fixation using K-wires is easy to perform. It is encouraged to use this approach as the clinical outcome is good.
  
  
  METHODS
  level IV-retrospective case, treatment study.
authors.affiliation: Department of Orthopedics, The First Affiliated Hospital of Xi'an Jiao Tong University Department of Pediatric Orthopedics, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shan'xi, China.
authors.forename: Hai
authors.initials: H
authors.lastname: Jiang
authors.forename: Yongtao
authors.initials: Y
authors.lastname: Wu
authors.forename: Youting
authors.initials: Y
authors.lastname: Dang
authors.forename: Yusheng
authors.initials: Y
authors.lastname: Qiu
mesh_terms: D001864:Bone Wires; D002648:Child; D000070628:Closed Fracture Reduction / Q000295:instrumentation / Q000379:methods; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods; D006801:Humans; D008297:Male; D011885:Radius Fractures / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D000092464:Elbow Injuries