Clinical and Radiographic Outcomes of Pediatric Radial Head Fractures

Abstract

Background: The treatment of pediatric radial head fracture (RHF) is controversial, and the outcome is unpredictable. We aimed to evaluate the long term clinical and radiographic outcomes of patients with pediatric RHF.

Materials and methods: 24 patients with pediatric RHFs operated between January 2004 and 2012 were included in this retrospective study. 17 patients had extra articular radial head (EARH) fractures and 7 had intraarticular radial head (IARH) fractures. The Mayo Elbow Performance Score (MEPS), Tibone and Stoltz classification, range of motion (ROM), and carrying angle (CA) were evaluated. The radial head diameter (RHD) and radial head height (RHH), neck shaft angle (NSA), and distance from the radial head to the radial tuberosity (RHRT) were measured and compared with the other side in simple anteroposterior views of elbow radiographs.

Results: At the last followup, the mean MEPS was 100 and 97.9 in groups EARH and IARH, respectively. There were no clinically and radiographically significant differences between the groups. The injured elbows showed smaller ROMs than the uninjured elbows in flexion, supination, and pronation with statistically significant differences. However, the injured elbows showed larger extension ranges than the uninjured elbows with a statistical significance (all P = 0.000). CA, RHD, and RHH were higher in the injured elbows than in the uninjured elbows with statistically significant differences (P = 0.006, 0.000, and 0.011) However, NSA and RHRT of both elbows were similar, with no statistically significant difference (P = 0.810 and 0.752).

Conclusion: All patients with pediatric RHF were satisfied with the long term clinical results. The injured elbows showed restricted ROMs compared with the uninjured elbows; however, the extension range increased.

Keywords: Child; Pediatrics; elbow; fracture; prognosis; radius; range of motion.

Figure 1

Flowchart of subjects enrollment

Figure 2

(a) Initial AP and lateral radiographs of elbow of a 5-year-old patient. Injured Rt side and uninjured Lt side. (b) Cast immobilization after reduction using the K-wire leverage technique. (c) AP and lateral radiographs of the same patient at 7 years of followup. The RHD and RHH of the injured Rt side are slightly enlarged compared to the uninjured Lt side. (d) Clinical photographs of the same patient showing the ROM of the elbow. The injured Rt side shows an increased extension and decreased flexion compared to the uninjured Lt side (AP = Anteroposterior, Rt = Right, Lt = Left; RHD = Radial head diameter, RHH = Radial head height)

Figure 3

(a) Initial AP and lateral radiographs of elbow joint of a 6-year-old patient. Injured Lt side and uninjured Rt side. (b) Cast immobilization after open reduction and K-wire fixation. (c) AP and lateral radiographs of elbow joint of the same patient at 3 years of followup. The RHD and RHH of the injured Lt side are slightly enlarged compared to the uninjured Rt side. (d) Clinical photograph of the same patient showing the ROM of the elbow. The injured Lt side and uninjured Rt side show similar range of flexion and extension. AP = Anteroposterior, Rt = Right, Lt = left, RHD = Radial head diameter, RHH = Radial head height

Figure 4

A line diagram showing (a) Angulation was measured between the fracture lines of proximal and distal fragment. (b) Displacement was measured as the extent of lateral shift of the fragment by the distance from the center of the radial head to a line along the axis of the upper radius