Spontaneous reduction of a chronic radial head subluxation after open reduction and percutaneous pin fixation of a radial neck fracture: a case report and review of the literature

Abstract

Background: Fractures of the radial neck in children have shown to account for 5-10% of traumatic elbow injuries in the pediatric population. Chronic dislocation of the radial head with concomitant fracture has been shown to result in progressive deformity and unacceptable loss of motion.

Methods: In this case report, we describe a patient who sustained a type 2 radial neck fracture with 100% displacement. The patient's clinical and surgical management will be discussed and a review of the literature is provided as it relates to this particular case.

Results: The patient underwent open reduction and percutaneous pin fixation of her displaced, dislocated left radial neck fracture in the operating room after multiple failed attempts at closed reduction due to interposition of the annular ligament. Three months after her operation radiographs revealed a well-healed radial neck with no signs of avascular necrosis with an anterior dislocation of her radial head, which was a new finding from her previous radiographs. Fourteen months after her initial injury and operation, radiographs taken at this visit revealed a radial neck fracture that was completely remodeled and had spontaneous relocated and was now aligned with the capitellum without any reduction attempt.

Conclusion: Closed reduction of displaced radial neck fractures may be unsuccessful and open reduction may be warranted. Excess callus formation post-operatively may have resulted in the radial head subluxation; however there was spontaneous reduction with conservative treatment without a reduction attempt, most likely related to remodeling of the excel callus formation.

Figure 1. A) Lateral and B) anterior to posterior radiograph of the left elbow demonstrating 100% displacement of a radial head fracture. c) lateral and D) anterior to posterior radiograph 2 weeks postoperatively demonstrating open reduction and pin fixation of radial neck fracture.

Figure 2. A) Three months postoperative lateral radiography of the left elbow demonstrating well healing radial neck fracture with good alignment, with postoperative complication of anterior dislocation of radial head. B) Fourteen months postoperative lateral radiograph of the left elbow demonstrating completely remodeled and healed radial neck fracture with spontaneous reduction of the radial head subluxation as evident by its alignment with the capitellum.