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World J Orthop. Mar 18, 2022; 13(3): 238-249
Published online Mar 18, 2022. doi: 10.5312/wjo.v13.i3.238
Diagnosis, treatment and complications of radial head and neck fractures in the pediatric patient
Arno A Macken, Denise Eygendaal, Christiaan JA van Bergen
Arno A Macken, Christiaan JA van Bergen, Department of Orthopedic Surgery, Amphia Hospital, Breda 4818 CK, Noord-Brabant, Netherlands
Arno A Macken, Denise Eygendaal, Department of Orthopedic Surgery and Sports medicine, Erasmus Medical Centre, Rotterdam 3015 GD, South-Holland, Netherlands
Author contributions: van Bergen CJ coordinated the paper; Macken AA performed the literature search, wrote the initial manuscript, and prepared the tables and figures; All authors contributed to the conception and outline of the paper, and provided substantial contribution to writing, reviewing, editing, and approved the final manuscript.
Conflict-of-interest statement: All authors declare no conflict of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Christiaan JA van Bergen, MD, PhD, Surgeon, Department of Orthopedic Surgery, Amphia Hospital, Molengracht 21, Breda 4818 CK, Noord-Brabant, Netherlands. cvanbergen@amphia.nl
Received: May 30, 2021
Peer-review started: May 30, 2021
First decision: July 28, 2021
Revised: August 11, 2021
Accepted: February 12, 2022
Article in press: February 12, 2022
Published online: March 18, 2022
Processing time: 290 Days and 16.9 Hours
Abstract

Radial head and neck fractures represent up to 14% of all pediatric elbow fractures and can be a difficult challenge in the pediatric patient. In up to 39% of proximal radius fractures, there is a concomitant fracture, which can easily be overlooked on the initial standard radiographs. The treatment options for proximal radius fractures in children range from non-surgical treatment, such as immobilization alone and closed reduction followed by immobilization, to more invasive options, including closed reduction with percutaneous pinning and open reduction with internal fixation. The choice of treatment depends on the degree of angulation and displacement of the fracture and the age of the patient; an angulation of less than 30 degrees and translation of less than 50% is generally accepted, whereas a higher degree of displacement is considered an indication for surgical intervention. Fractures with limited displacement and non-surgical treatment generally result in superior outcomes in terms of patient-reported outcome measures, range of motion and complications compared to severely displaced fractures requiring surgical intervention. With proper management, good to excellent results are achieved in most cases, and long-term sequelae are rare. However, severe complications do occur, including radio-ulnar synostosis, osteonecrosis, rotational impairment, and premature physeal closure with a malformation of the radial head as a result, especially after more invasive procedures. Adequate follow-up is therefore warranted.

Keywords: Radial head; Proximal radius; Fracture; Pediatrics; Closed fracture reduction; Open reduction fracture; Fracture fixation; Synostosis; Osteonecrosis

Core Tip: This article presents the latest evidence-based insights in pediatric proximal radius fractures. A stepwise progression of treatment is warranted, starting with closed reduction and immobilization, and progressing to more invasive measures in case of unsuccessful reduction. Open reduction with internal fixation is left as the last option due to the high risk of complications and inferior functional results.