![]() ![]() In these cases, a nondisplaced radial neck fracture is easily missed. However, since a part of the radial neck lies outside the joint capsule, joint effusion and fat pad signs may be absent in radial neck fractures. Fat pad signs may aid in diagnosing a nondisplaced fracture in combination with high clinical suspicion (Figure (Figure1 1). Nondisplaced radial neck fractures can be difficult to detect and are often occult on the initial radiograph. However, other studies dispute the added value of this view reporting only one additionally identified fracture in 32 and 125 patients.Ī bilateral radiograph of the wrist can be made to exclude additional injuries such as an ALRUD injury. Some studies have shown the effectiveness of the Greenspan view in identifying fractures which were occult on regular views, providing additional information in up to 21% of patients. In case of a high clinical suspicion of a fracture, such as a positive fat pad sign, but no fracture on standard radiographical views, an additional radial head-capitellum (Greenspan) view can be made to allow for easier visualization of the radial head. Anteroposterior and lateral views are made. Therefore, when assessing a child with a suspected fracture of the proximal radius, thorough examination of the wrist, shoulder and contralateral arm should be performed to exclude associated injuries.Ĭonventional radiographs are used for the diagnosis and grading of radial head and neck fractures in the pediatric patient. In general, fractures in the pediatric patient can be easily missed due to the unique characteristics of the pediatric bone and varying clinical presentation, with patients not always being able to clearly communicate their symptoms. ![]() In addition to concomitant fractures, other injury patterns can accompany a proximal radius fracture, such as elbow dislocation or acute longitudinal radioulnar disruption (ALRUD or Essex-Lopresti injury). Risk factors for concomitant fractures include joint effusion, young children, and complete or displaced proximal radius fractures. Less common are ulnar metadiaphyseal fractures, ulnar fractures as part of a Monteggia fracture-dislocation and medial epicondyle fractures. The most common concomitant injury is a fracture of the olecranon. A high index of suspicion of additional fractures is therefore required. In retrospect, 56% were visible, and 44% radiographically occult. A retrospective study of 494 proximal radius fractures showed that 25% of the concomitant fractures were missed on the initial analysis of radiographs. Adequate follow-up is therefore warranted.Ī concomitant fracture is seen in up to 39% of cases. 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. With proper management, good to excellent results are achieved in most cases, and long-term sequelae are rare. 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. 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. 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. In up to 39% of proximal radius fractures, there is a concomitant fracture, which can easily be overlooked on the initial standard radiographs. Radial head and neck fractures represent up to 14% of all pediatric elbow fractures and can be a difficult challenge in the pediatric patient. ![]()
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