Article
Jeffery type II radial neck fracture in a child: lesion description and method for closed reduction
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Authors
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Ricardo Kaempf
- Hospital Santa Casa de Porto Alegre, Porto Alegre, Brazil
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João Farina Brunelli
- Hospital Santa Casa de Porto Alegre, Porto Alegre, Brazil
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Márcio Aita
- Faculdade de Medicina do ABC, São Paulo, Brazil
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Samuel Ribak
- Pontifícia Universidade Católica de Campinas, Campinas, Brazil
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Antônio Carlos Costa
- Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
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Pedro J. Delgado
- Hospital Universitário Montepríncipe, Madrid, Spain
| Published: | February 6, 2020 |
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Outline
Text
Objectives/Interrogation: Radial neck fractures in children (RNFC) are rare; represent approximately 1% of all pediatric fractures, and 10% of elbow fractures in childhood. Jeffery et al. described in 1950 the most common mechanism of RNFC as a fall onto an outstretched hand with valgus force, causing compression of the radial head against the capitellum. This laterally angulated radial head fracture was called a type I lesion. The type II lesion, which is rarer, occurs in association with posterior elbow dislocation. In these cases, either with spontaneous or provoked closed reduction of the dislocation, there is an impaction fracture of the anterior lip of the radial head caused by the capitellum, which gets trapped between the proximal radial metaphysis and the head fragment, that is rotated in 90°.
Open reduction has always been the treatment of choice. Furthermore, closed reduction was believed to be impossible and was classically contra-indicated due to the risk of fracture displacement and vascular compromise of the proximal radial epiphysis. There are less than 30 cases of type II Jeffery fractures described in literature, and only Chotel et al. had percutaneously treated those lesions, by means of a varus lateral space opening, manipulation of the fracture, conveying an easier reduction of the radial head to its anatomic site.
Methods: We describe a closed reduction technique of type II Jeffery fracture with the use of two K-wires, being the first inserted at the fracture site and working as guide and fulcrum to the fragment, so that it pushes the head towards its anatomic position (Figure 1 [Fig. 1]).
Results and Conclusions: We reckon this maneuver to be effective, reproducible, and less aggressive, thus decreasing the risk of iatrogenic chondral and ligament injuries. We also highlight that there is a risk of displacement and fragmentation of the head fragment after multiple attempts of reduction; therefore, we recommend proceeding to an open reduction after initial failure of the closed method.
