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paediatric

Pediatric Radial Neck Fracture

advanced
6 min
28 marks
6 questions
Clinical Scenario
A 9-year-old girl falls onto her outstretched left hand while playing. She has immediate elbow pain with swelling over the lateral aspect. She is unable to fully extend or supinate the forearm. On examination, there is tenderness over the radial head/neck region. Attempted pronation and supination produce pain. Finger movements are normal with intact radial pulse and sensation.
AP and lateral radiographs of a 9-year-old's left elbow demonstrating a radial neck fracture with approximately 45 degrees of angulation. The radial head is tilted laterally. The physis is visible, confirming this is a Salter-Harris type II equivalent. The capitellum appears normal with intact radiocapitellar alignment. This degree of angulation requires closed reduction.
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AP and lateral radiographs of a 9-year-old's left elbow demonstrating a radial neck fracture with approximately 45 degrees of angulation. The radial head is tilted laterally. The physis is visible, confirming this is a Salter-Harris type II equivalent. The capitellum appears normal with intact radiocapitellar alignment. This degree of angulation requires closed reduction.

Source: Displaced Radial Neck Fractures in Children • PMC3828489 • CC-BY

Questions

Question 1 (4 marks)

Describe the radiographic findings and classification system.

Question 2 (5 marks)

What is the mechanism of injury and relevant anatomy?

Question 3 (6 marks)

Describe the treatment algorithm including reduction techniques.

Question 4 (5 marks)

What are the complications of radial neck fractures?

Question 5 (4 marks)

How does this differ from nursemaid's elbow?

Question 6 (4 marks)

What is the prognosis and expected outcomes?

Exam Day Cheat Sheet

Must Mention

  • •Judet classification (I: <30°, II: 30-60°, III: 60-90°, IV: >90°)
  • •<30° non-operative, 30-60° closed reduction
  • •Patterson technique (pressure + supination + varus)
  • •Metaizeau ESIN technique
  • •Blood supply through neck (AVN risk)
  • •Stiffness most common complication

Common Pitfalls

  • •Wrong Judet thresholds
  • •Not knowing Patterson
  • •Missing Metaizeau
  • •Confusing with nursemaid's
  • •Wrong blood supply
  • •Missing stiffness as main complication