Radial neck fractures in children: A surgical tip using the Metaizeau technique to improve stability of the reduction

Abstract

Aim: To evaluate early results of management of radial neck fractures with Métaizeau technique in the paediatric age group and to elaborate on a surgical tip to improve stability of the fixation.

Method: A retrospective analysis of 21 patients, with fracture radial neck, who underwent closed reduction and internal fixation with elastic intramedullary nailing (Métaizeau technique), was performed. Mean age at injury was eight years, and the average follow-up was 4.5 months (range: 3-6 months). Follow up Clinical and radiological evaluation was performed at first and sixth postoperative weeks. At six weeks following removal of the nail, a clinical assessment was conducted to record the outcomes, and any later follow-up was arranged based on pain and range of motion.

Results: We recorded five excellent, eight good, one fair, results for type 3 fractures. For type 4 fractures, we had one excellent, five good and one fair, results. Altogether, we recorded 20 (90.5%) excellent or good results, and 2 (9.5%) fair results. Complications noted were superficial skin infection at the entry site in one patient that required a course of oral antibiotics. Prominent metal work was noticed in 14 cases, which didn't need any further intervention as it did not cause any functional discomfort.

Conclusion: With Metaizeau technique, there were reported poor results of about 10% in literature. In our study, with the modification of the shape of the nail tip, we have managed to achieve stable fixation of the reduction without any loss of position and consequently, better outcomes.

Keywords: Metaizeau technique; Open reduction; Paediatric; Radial neck fractures.

Fig. 1

Pre-op AP and Lateral views of elbow depicting displaced and angulated radial neck fracture.

Fig. 2

Post op AP with anatomical reduction and stable fixation with reshaped nail.

Fig. 3

Post op Lateral view with reduced fracture and nail.

Fig. 4

Pre-op AP with angulated and displaced fracture.

Fig. 5

Pre-op Lateral view with angulated and displaced fracture.

Fig. 6

Post op AP with nail tip in the subchondral bone facilitating anatomical reduction and stable fixation of the fracture.

Fig. 7

Post op Lateral view with nail tip in the subchondral bone facilitating anatomical reduction and satisfactory alignment of the fracture.

Fig. 8

Lateral view Pre-op X ray showing angulated and displaced fracture.

Fig. 9

Pre-op AP X ray showing angulated and displaced fracture.

Fig. 10

Pre-op AP X ray showing angulated and displaced fracture.

Fig. 11

Post op AP with stable fixation.

Fig. 12

Post op Lateral view showing the position of (modified) tip of the nail in the subchondral bone of radial head.

Fig. 13

Post op AP with stable fixation of fracture with acceptable (<30 deg) residual angulation.

Fig. 14

Lateral view depicting stable fixation of fracture.

Fig. 15

AP view demonstrating escape of blunt nail tip through the fracture site and loss of reduction (nail with non-modified tip).

Fig. 16

Manual reshaping of the tip of a Nail into a rhombus/diamond shape using a pliers (for illustration purpose only; normally done intraoperatively under sterile conditions with gloves on).

Fig. 17

Cutting a piece of a nail from the inside of the curve of a nail tip using a pliers.

Fig. 18

Tip of the nail in a Rhombus shape, without changing the proximal curve of the nail.

Fig. 19

Side on view of the tip of the nail.

Fig. 20

Face on view of the cut tip of the nail.

Fig. 21

Schematic diagram of the tip of nail on frontal profile.