Complete dislocation of the radial head following fracture of the radial neck in children: the Jeffery type II lesion

Abstract

The authors report four cases of Jeffery type 2 lesions in children. Despite the probable mechanism of such lesions, none of the cases reported here displayed a dislocation of the elbow. In the first observation the diagnosis was suspected only 15 days after injury. Two other cases were initially treated by closed external manipulations, one with percutaneous Kirschner wire leverage and the other with closed intramedullary pinning, but both cases displayed a 180 degree reversal of the radial head, suspected only secondarily. The first exhaustive review of the literature on the subject, shows that this complication is classical in Jeffery type 2 fractures. In fact none of the 22 cases described in the literature had successfully been reduced by external manipulations. Interposition of the lateral condyle, pathognomonic of the Jeffery type 2 fracture, hampers reduction. Attempts at reduction by external manipulation in nine cases therefore led to two non-reduction and seven reversal of the radial head. Knowledge of this particular fracture will allow an early diagnosis and an immediate surgical treatment.