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Outcome of Transcapitellar K-wire Fixation for Radial Neck Fractures

Author: Ali A. Ali
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2014 Volume: 13 Issue: 1 Pages: 26-32
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: Fractures of the radial neck are mainly seen in children and require meticulous management to avoid elbow disabilities. Age, grade of the fracture and association with other elbow injuries affect the surgical approach to be used for treatment. Aim: This study was performed to detect the outcome of using transcapitellar K-wire fixation for treatment of radial neck fractures. Patients & Methods: Twelve patients with displaced (Broberg-Morrey II, III & IV) radial neck fractures were included. Eight patients (Group A) were children below skeletal maturity (10-18 years) and four patients were over 18 years of age (Group B) who achieved full skeletal maturity. Kaplan’s approach for open reduction and internal fixation using K-wires was used, and the patients were followed up for 6 months. Each patient was assessed for outcome according to predefined criteria ranging from excellent to good, fair and poor. Results: In group A, two patients had excellent outcome, one patient had fair outcome and the rest had good outcome. In group B, two patients had good outcome while the other two had fair outcome; however, none of the patients had poor outcome. Valgus deformity of >10oand elbow stiffness of >20o developed in three patients, with stiffness mainly affecting supination & extension. Of the patients with fair outcome, one developed implant failure due to poor compliance, while another patient developed neuropraxia of the posterior interosseous nerve that resolved spontaneously. Conclusion: Several surgical methods have been proposed for treatment of radial neck fractures with variable results and outcomes. While open reduction and K-wire fixation may not be the first line of these methods, it remains a safe method and provides advantages like short operative time, no exposure to image intensifier, less blood loss and less risk of neurovascular injury. However, for optimal results with minimal complications, the procedure requires early intervention, good patient compliance and prolonged follow-up.

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