Judet type-IV radial neck fractures in children: Comparison of the outcome of fractures with and without bony contact

Figures & data

Figure 1. A 9-year-old boy sustained a radial neck fracture (Judet type-IV) with remaining bony contact of the radial neck, after falling on a level surface (panels a and b). Panels c and d show radiographs 16 days after elastic stable intramedullary nailing (ESIN). After implant removal 3 months postoperatively, there was correct positioning of the radial head and neck (panels e and f). At clinical follow-up 2.3 years after the initial trauma, the patient was free of symptoms and had full range of motion.

Figure 2. A 7-year-old girl had a type-B lesion after falling on a level surface (panels a and b). Note the hardly visible radial head on conventional radiographs (arrow). A CT scan (panels c and d) revealed the location of the radial head. Open reduction and elastic stable intramedullary nailing (ESIN) was necessary. 19 months later, there were signs of shortening and angulation but no evidence of avascular necrosis (panels e and f). Clinically, the patient was free of symptoms, with full range of motion and a Linscheid-Wheeler score of I.

Table 1. Comparison of age, gender distribution, and additional injuries in group A (bony contact) and group B (no bony contact)

	Group A (n = 9)	Group B (n = 10)	p-value
Median age (range)	9.1 (7–12)	9.9 (4–13)	0.4
Gender (female/male)	4/5	4/6	0.8
Additional injuries^a, n	1	7	0.009
Elbow fracture dislocations, n	2	3	0.7
Reduction (open/closed)^b	0/9	5/5	0.01

a Additional injuries (n = 1) in group A involved avulsion of the medial humeral epicondyle and elbow fracture dislocation in 1 child. In group B, 7 children sustained additional injuries including 4 olecranon fractures, 2 radial head fractures, and 1 fracture of the ulna. 2 children in group B also sustained a transient lesion of the radial and ulnar nerve, respectively.

b The median age was 10.8 years (4–13) for open reduction and 9.4 years (5–13) for closed reduction; this difference was not statistically significant.

Table 2. Demographic data, gender distribution, fracture type, treatment, Linscheid and Wheeler score, and length of follow-up

Age (years)	Gender	Fracture type	Type of reduction	Linscheid-Wheeler score	Follow-up (years)
4.0	F	B	Open	I	1.8
5.0	F	B	Closed	II	2.0
7.0	F	B	Closed	I	4.4
7.3	F	B	Open	I	2.2
7.4	M	A	Closed	I	3.5
7.9	F	A	Closed	I	7.5
8.0	F	A	Closed	I	7.6
8.5	F	A	Closed	I	8.3
9.1	M	A	Closed	I	2.3
9.6	M	B	Closed	IV	1.5
10.0	F	B	Closed	I	6.7
10.8	M	B	Open	IV	2.0
11.0	F	A	Closed	I	1.1
11.7	M	A	Closed	I	5.6
12.6	M	A	Closed	I	3.6
12.7	M	B	Closed	IV	1.8
12.8	M	B	Open	II	5.8
12.9	M	A	Closed	II	4.7
13.5^a	M	B	Open	IV	2.4

a patient with AVN and radial head resection.

Table 3. Outcome in 19 children with radial neck fractures

			Group B (n = 10)^a
Linscheid-Wheeler	Group A	Total	Open reduction	Closed reduction
score	(n = 9)^a	(n = 10)	(n = 5)^b	(n = 5)^b
Excellent	8	4	2	2
Good	1	2	1	1
Fair	0	0	0	0
Poor	0	4	2	2

a Comparing results of groups A and B, we found a significantly higher rate of poor results in group B (p = 0.03) and a significantly higher rate of excellent outcomes in group A (p = 0.02).

b The outcome within group B showed no significant differences between open and closed reduction (p = 1.0).