Stepwise Percutaneous Leverage Technique to Avoid Posterior Interosseous Nerve Injury in Pediatric Radial Neck Fracture.
OBJECTIVE
To introduce a stepwise percutaneous leverage technique to avoid posterior interosseous nerve (PIN) injury in pediatric patients with radial neck fractures and to evaluate the clinical outcome and the predisposing factors affecting the outcome.


METHODS
Retrospective case series study.


METHODS
University level 1 trauma center.


METHODS
Thirty-four children with a radial neck fracture, who were treated using a stepwise percutaneous leverage technique, were included in the study.


METHODS
The radial head fragment was reduced by pulling the first Steinmann pin proximally as a lever. Then, the kinked soft tissue was released by removal of the Steinmann pin with buttressing the radial head by the operator's thumb. The second Steinmann pin was inserted into relaxed soft tissue for fixation of the radial head.


METHODS
We used the Métaizeau classification as a radiologic result and Mayo Elbow Performance Score (MEPS) as a clinical outcome. Regression analysis was performed to identify the predisposing factors affecting the outcome.


RESULTS
There was no occurrence of PIN palsy. According to the Métaizeau classification, 23 cases were classified as excellent, 9 as good, 1 as fair, and 1 as poor. The average MEPS was 97.6 points. Based on the regression analysis, only the postoperative Métaizeau classification was confirmed as a risk factor of a relatively poor outcome.


CONCLUSIONS
The stepwise percutaneous leverage technique can be considered a good option in the treatment of pediatric radial neck fractures, because it ensures excellent results by avoiding injury to soft tissues including the PIN.


METHODS
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
*Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, Korea; and †Department of Anatomy, Graduate School, Ajou University School of Medicine, Suwon, Korea.
Wan-Sun
WS
Choi
Kyeong-Jin
KJ
Han
Doo-Hyung
DH
Lee
Ga-Eun
GE
Lee
Heon-Ju
HJ
Kweon
Jae-Ho
JH
Cho
D000293:Adolescent; D001858:Bone Nails; D002648:Child; D002675:Child, Preschool; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D059348:Peripheral Nerve Injuries / Q000209:etiology / Q000517:prevention & control*; D011885:Radius Fractures / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome