Application of elbow arthrography in the treatment of severe radial neck fractures in children under 6 years old

Objective To introduce the application value of elbow arthrography in severe radial neck fractures in children younger than 6 years old and to summarize its clinical efficacy. Methods From May 2012 to December 2016, 18 children under 6 years old with severe radial neck fractures were treated in our hospital, including 11 males and 7 females, aged 40 to 70 months, with an average of 59.7 months. The preoperative radiographs did not show any obvious ossification center and only a thin bone slice displaced from metaphysis could be seen. According to O'Brien classification, there were 8 cases of type Ⅱ and 10 cases of type Ⅲ. Under anesthesia, routine lateral elbow arthrography and manual reduction with Metaizeau technique were conducted. If manual reduction is unsatisfactory, percutaneous pin prying reduction with Metaizeau technique or open reduction was conducted. After the operation, the long arm plaster was used for fixation for 4 weeks. Postoperative evaluation was based on Tibone and Stotz scoring system. Radial head ischemic necrosis, epiphyseal premature closure, intra-articular calcification and joint fusion were evaluated by X-ray films of the healthy and the injured side. Results One child had minor skin allergy during operation, and the others did not have adverse effects. Elbow arthrography can clearly reveal the articular surface and the degree of fracture displacement. All the patients were successfully repositioned by closed and/or pin prying reduction without open reduction. X-ray examination showed that the fracture healed well. There was no malunion at the fracture site, no premature epiphyseal closure and necrosis of the radius head. According to Tibone and Stotz criteria, 13 cases were excellent and 4 cases were good. Conclusion The intraoperative arthrography can provide a clear judgment of the displacement degree of fracture and evaluation of reduction quality for the patients with severe radial neck fractures under 6 years old. The method is simple and effective, and the clinical effect is satisfactory. It is worth promoting. Key words: Fractures,bone; Child; Arthrography; Metaizeau technique