The Observation And Discussion On The Curative Effect Of Kirschner Wire Plus Closed Reduction And Elastic Intramedullary Nail Internal Fixation On Judet-Ⅳ Radial Neck Fracture In Children

Objective: In the incidence of elbow joint fracture in children,the probability of radial neck fractures in children was only lower than that of supracondylar fractures and humeral lateral condylar fractures in children.It accounts for about 5% of children’s epiphyseal injuries,and is common among children aged 4 to 13 and there is no gender difference.The severity of radial neck fractures in children was mostly classified according to the degree of displacement and angulation of the fractures;according to the Judet classification,radial neck fractures in children were classified into the following categories: type I 0°,only horizontal displacement,type II < 30°,type III 30°-60°,type IV > 60°.According to different diagnosis and classification,different treatments are often adopted,and so are children’s radial neck fractures.Judet type I radial neck fractures are usually treated by in situ plaster,and Judet type II and III radial neck fractures in children are treated by closed reduction plus plaster.For Judet type IV radial neck fractures with angular displacement greater than 60°,open reduction and other surgical methods are the traditional treatment.However,open reduction surgery has its own shortcomings: traumatic,easy to concurrent vascular and nerve injury,long-term joint function recovery is slow and poor function.In recent years,for Judet-IV radial neck fracture in children,Kirschner wire percutaneous pry closed reduction and elastic intramedullary nail internal fixation is a minimally invasive treatment program.The treatment program has the following characteristics: small surgical wounds,good joint function recovery,patients are satisfied with the overall effect.In this study,combined with many years of clinical experience in our department,through in-depth observation of Kirschner wire pry closed reduction and elastic intramedullary nail internal fixation after this minimally invasive treatment program for Judet type IV radial neck fractures in children.Finally,we sum up and make further discussions.Methods: The data in this study were 58 children with Judet-IV radial neck fractures admitted to our department from January 2014 to 2016.Among them,38 boys and 20 girls aged 4-13(mean 9.5 years).In this group,4 patients had fractures of the proximal ulna or distal humerus,and 2 suffered from radial nerve injury.Judet type IV radial neck fractures in children with angular displacement greater than 60 degrees were diagnosed by physical examination and radiography before operation.In clinical treatment,58 children were treated with percutaneous skin-Kirschner wire prizing,closed reduction and elastic intramedullary nail fixation under anesthesia in the operating room.After the operation,the elbow joint was fixed in a plaster position for 3 W.After 3 W,the plaster was removed after the initial formation of callus on the reexamination film.After that,the patient needed the parents to exercise until the patient recovered the original joint activity.At the 3-6 month after the operation,the radiographs were taken to see if the fracture was healed and the elastic intramedullary nail was removed after surgery.According to the evaluation standard of X after Metaizeau operation,the postoperative score was evaluated.According to Metaizeau criteria,the reduction and elbow movement of all cases were compared 3 months after screw removal.Results: According to the evaluation standard of X after Metaizeau operation,the pictures taken after operation were scored,the excellent: Complete anatomical reduction(30 cases);good: angle < 20 degrees(24 cases);middle: angle < 20 ~ 40 degrees(3 cases);poor: angle > 40 degrees(1 cases);total excellent and good rate 93.1%.No patient suffered from vascular and nerve injury after operation,and no incision infection occurred.The average length of stay was 5.3 days.Joint function was evaluated according to Metaizeau criteria 3 months after removal of internal fixation,the excellent: elbow flexion and extension and upper arm rotation function normal(38 cases);good: the sum of all directions of limited movement < 20°(17 cases);in: 20°-40 °(17 cases);poor: 40°(1 cases);the total excellent and good rate was 94.8%.Conclusions: The results indicated that: for Judet-IV radial neck fractures in children,the percutaneous skin Kirschner pin pry reduction + elastic intramedullary nail internal fixation + plaster therapy was very effective,Kirschner pin pry reduction belongs to minimally invasive treatment,and has little effect on the blood supply around the radial head.The operation can obtain good fracture reduction and firm fixation,and can reduce the surgical trauma and scar production,and the hospitalization period is short,because flexible intramedullary nail can ensure that fracture fracture easily displaced,after 3 W removal of plaster as early as possible to move the elbow joint,so the degree of postoperative joint function recovery is satisfactory.