The Effect Of Two Internal Fixation Methods In The Treatment Of Radial Neck Fracture In Children

Background:Radial neck fractures are not common in children’s injuries,about 1%of all children’s fractures,5%to 10%in children’s elbow fractures.The age of the disease is usually at the age of 4～14.The number of Salter-Harris II epiphysis injuries is much more.Radial neck fractures in children are often caused by indirect violence,accompanied by vascular or nerve injuries,or fractures of the olecranon and the metaphysis of the humerus.The anatomy of the elbow is more complicated.When the treatment is not timely or the treatment is improper,it is easy to cause fracture nonunion,malunion,radial head ischemic necrosis and epiphyseal early closure,forearm rotation dysfunction and so on.So its treatment is still tricky.For the treatment of radial neck fracture in children,most scholars believe that the fracture angle<30 degree,displacement<2mm,at any age of children can be accepted and take conservative treatment,for the angle>60 degree of radial neck fracture,at any age can not be accepted,all need surgical treatment.For the treatment of radial neck fracture with angle of 30 to 60 degrees,there is a lot of controversy,the smaller the age,the stronger the shaping ability and the greater the acceptable angle of the radial head,which is generally accepted by most scholars.There is no uniform understanding of the relationship between the age of the child and the acceptable angle of fracture.At present,according to the damage degree of radial neck fracture,the methods of treatment are also varied.The common treatment methods are conservative treatment(plaster external fixation),closed reduction external fixation,Metaizeau treatment,percutaneous Kirschner ’wire leverage,and open reduction and internal fixation and so on.The most widely accepted surgical procedure is percutaneous internal fixation,which can protect the blood supply of the radial head as far as possible,and reduce the possibility of posterior interosseous nerve(PIN)injury.Objective:This study is a retrospective analysis of the cases of radial neck fracture treated by closed reduction with the percutaneous leverage technique and internal fixation with kirschner’s wire and treated with intramedullary elastic nail fixation with the help of percutaneous kirschner’s wire leverage in our hospital.By comparing the difference between the results of the two methods of operation,we can find out what kind of internal fixation is better,and provide suggestions for the treatment of radial neck fractures in children.Methods:A total of 27 cases of radial neck fracture admitted from June 2013 to June 2017 in the pediatric orthopedics department of Qilu Hospital of Shandong University were treated with two kinds of operations.The subjects were divided into two groups according to the internal fixation methods:A,B;group A,kirschner’s wire internal fixation group,15 people,and group B,intramedullary nail internal fixation group,12 people,and we carried out a retrospective study.The two groups were treated with plaster cast and external fixation after operation.The patients in group A reviewed X-ray plain film after 4 weeks of operation.Patients in group B were placed in intramedullary nailing after operation,and were reexamined for one week earlier than group A.It shows the formation of callus in the fracture of the radial neck.We removed the plaster cast in the outpatient clinic,and began to instruct the children and their families to perform functional exercises on the forearm and elbow of the affected limb.The two groups were reviewed at 4 weeks,8 weeks,12 weeks and 6 months after operation.They were reexamined every 6 months in the outpatient department.The Mayo elbow performance scores of two groups were recorded,including preoperative and postoperative reexamination.The short-term effects of two operative methods were evaluated based on operative time and postoperative neurological deficit.After six months of operation,the range of motion(ROM)of the elbow was measured by protractor as a standard for clinical evaluation.We used X ray film as imaging criteria to evaluate fracture healing.According to the Mayo elbow performance scoring standard,the long-term effect of the two surgical methods was evaluated.Results:The two groups were followed up for 10 months to 58 months,an average of 26 months of follow-up.X-ray films of 27 cases showed that all fractures healed well.There were no complications such as infection,nonunion,malunion,heterotopic ossification and so on in the two groups.In group A,there were 1 case of thumb extension limitation and 2 cases of needle tail irritation sign.In group B,there were 1 case of thumb extension limitation and 1 case of needle tail irritation sign.The patients with limited thumb extension were treated with nutritional neurotherapy for two weeks,and recovered to normal after 8 weeks follow-up.The symptoms of the patients with the tail end irritation sign were relieved after the internal fixation was taken out.The two groups had no long-term complications and recovered well.In group A,the operation time was 28.67 + 6.83 minutes,while in group B,the operation time was 38.83 + 5.12 minutes.The operation time of group A was shorter than that of group B(P<0.05),and the data were statistically significant.The preoperative MEPS scores of group A and group B were 25 + 7.07 and 24.17 + 7.36 respectively.The two sets of data(P>0.05)were not statistically significant.The MEPS scores of the two groups at 4 weeks and 8 weeks after operation were significantly higher than those before operation(P<0.05).MEPS scores in group B were higher than those in group A at 4 weeks and 8 weeks after operation(P<0.05).However,there was no significant difference in the MEPS scores between the two groups at 12 weeks and 6 months after operation.There was no significant difference between the two groups(P>0.05).According to Leung/Peterson evaluation standard,in group A,12 cases were excellent,2 cases were good,1 case was general,there was no poor case;and in group B,9 cases were excellent,2 cases were good,1 case was general,and there was no poor case.The fine rate of group A was 93.33%,the fine rate of group B was 91.67%,and the fine rate of two groups was compared(P>0.05).There was no statistical significance.Conclusion:The treatment of radial neck fractures in children with percutaneous pry reduction,Kirschner pin internal fixation,percutaneous pry reduction and intramedullary nail fixation can achieve satisfactory results.Prying reduction is a key procedure to correct the angle and displacement of fracture in children with radial neck fracture.Compared with elastic stable intramedullary nailing,we recommend the use of Kirschner wire for internal fixation.Because the latter is less damaged,it also prevents the fracture from being displaced again.It has no incision.It also avoids reoperation and costs less.No matter which kind of operation is used,careful operation is needed during operation to avoid multiple rotation and prying reduction,and reduce injury to epiphyseal plate,blood vessels and nerves.