Open Reduction of Radial Neck Fractures in Children: Injury Severity Predicts the Radiographic and Clinical Outcomes.

BACKGROUND Radial neck fractures are the third most common elbow fracture in children. Open reduction may be required if closed or mini-open techniques are not successful in reducing the fracture. Previous reports on open reduction have noted poor outcomes and complications with this treatment approach. However, it is unknown whether it is the open procedure itself or the severity of the initial injury that leads to the poor results. The purpose of this study was to evaluate the correlation between intraoperative findings at the time of open reduction of radial neck fractures with the clinical and radiographic outcomes. METHODS Data from patients who underwent open reduction for an acute radial neck fracture between January 2009 through December 2018 were abstracted and reviewed. Patients undergoing open treatment for a nonunion or malunion and those with inadequate follow-up were excluded. Demographics, injury characteristics, treatment strategy, intraoperative findings, clinical and radiographic outcomes were assessed. RESULTS Twenty-two patients met the inclusion criteria. Fourteen were female, the mean age was 9.7±3 years, and the mean follow-up was 15.8 months. Fifteen patients had a Judet grade IV displacement. Twelve patients (55%) had a fair or poor outcome. Ten reoperations were recorded during the study period. Age, weight, and associated injuries were not predictive of poor outcomes. Intraoperative findings of soft-tissue stripping and radial head comminution was the only significant predictor of a fair/poor clinical outcome (P<0.001) and subsequent radiographic changes including fragmentation and collapse of the radial head and arthritic changes (P<0.001). Quality of reduction and the choice of hardware were not significantly associated with either clinical or radiographic outcomes. CONCLUSION Our findings support the notion that outcomes of open reduction of radial neck fractures are most closely correlated with the injury severity, with the intraoperative findings of complete soft tissue stripping or comminution of the radial head fragment being significant predictors of poor clinical and radiographic outcomes. The choice of hardware and the quality of reduction achieved at the time of surgery have less significance than injury severity.