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Radial Head Fracture (Peds)

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Other Names

  • Radial Neck Fracture Pediatrics

Background

  • This page refers to both Radial Head and Radial Neck fractures of the proximal Radius in children

Epidemiology

  • Relatively common pediatric elbow injury
  • Typically occurs in children age 9-10 (need citation)
  • Represents 5-10% of all pediatric elbow fractures[1]
  • 1% of pediatric fractures[2]

Pathophysiology

  • Typically involves fall onto an outstreched arm with elbow extended, valgus force vector[3]
  • When the physis is open, tend to see Salter Harris I or II fractures
  • Rarely extends into joint

Associated Injuries

Ossification Centers of the Elbow

Ossification center Age of Appearance on Xray Age of fusion
Capitellum 1 12
Radial Head 3 15
Medial Epicondyle 5 17
Trochlea 7 12
Olecranon 9 15
Lateral Epicondyle 11 12

Risk Factors

  • Unknown

Differential Diagnosis


Clinical Features

  • General: Physical Exam Elbow
  • History
    • Should describe episode of trauma
    • Will report pain, swelling, refuse to move or range elbow
  • Physical
    • Swelling laterally
    • Pain worsened with range of motion

Evaluation

  • Radiographs
    • AP and lateral view
    • Radiocapitellar View
    • May see nondisplaced fracture
    • Posterior Fat Pad Sign
    • Radial head does not start to ossify until 5, may not be visible in younger children
  • MRI
    • If suspicion is high enough, MRI with arthrogram may be needed to better visualize structures

Classification

O'Brien Classification

  • Type I: < 30°
  • Type II: 30-60°
  • Type III: > 60°

Judet Classification

  • Type I: Undisplaced
  • Type II: < 30°
  • Type III: 30-60°
  • Type IVa: 60-80°
  • Type IVb: > 80°

Chambers Classification

  • No longer used

Management

  • Overall excellent prognosis

Nonoperative

Operative

  • Indications
    • < 30° angulation despite closed reduction
    • > 3 mm translation
    • Loss of pronation or supination
  • Techniques
    • Closed Reduction
    • Closed reduction, percutaneus pinning
    • Open reduction

Return to Play

  • Variable
  • Non-op can be cleared by 6 weeks
  • Surgical at discretion of surgeon

Complications


See Also


References


  1. D’Souza S, Vaishya R, Klenerman L. Management of radial neck fractures in children: a retrospective analysis of one hundred patients. J Pediatr Orthop. 1993;13:232–238
  2. Ursei M, Sales de Gauzy J, Knorr J, et al. Surgical treatment of radial neck fractures in children by intramedullary pinning. Acta Orthop Belg. 2006;72:131–137
  3. Malmvik J, Herbertsson P, Josefsson PO, et al. Fracture of the radial head and neck of Mason types II and III during growth: a 14-25 year follow-up. J Pediatr Orthop B. 2003;12:63–68
  4. Dormans JP, Rang M. Fractures of the olecranon and radial neck in children. Orthop Clin North Am. 1990;21:257–268
  5. https://www.orthobullets.com/pediatrics/4011/radial-head-and-neck-fractures--pediatric
  6. Bernstein SM, McKeever P, Bernstein L. Percutaneous reduction of displaced radial neck fractures in children. J Pediatr Orthop. 1993;13:85–88
Created by:
John Kiel on 18 June 2019 01:16:46
Authors:
Last edited:
11 November 2020 14:41:25
Categories:
Trauma | Pediatrics | Elbow | Upper Extremity | Fractures | Acute