Injury. 2026 May 26;57(8):113386. doi: 10.1016/j.injury.2026.113386. Online ahead of print.
ABSTRACT
BACKGROUND: Pediatric radial neck fractures, though rare, pose significant management challenges with several treatment options. Open reduction is typically used for more complex cases, where greater fracture severity may contribute to higher complication rates and poorer outcomes. This study aims to evaluate functional outcomes, complications, and risk factors in a large cohort of pediatric patients treated with open reduction, performed after unsuccessful closed reduction.
METHODS: A retrospective cohort study was conducted on 53 pediatric patients (mean age 8 years) with radial neck fractures (Judet 4) treated surgically with open reduction, performed after unsuccessful closed reduction, at a single institution between March 2014 and October 2024. Data on surgical delay, complications, and functional outcomes (Oxford Elbow Score) were collected. Statistical analyses included correlation tests, t-tests, and multivariate regression models to assess predictors of outcomes and complications.
RESULTS: The mean Oxford Elbow Score was 96, indicating excellent functional outcomes. Complications occurred in 13.5% of patients, including heterotopic ossification (9.6%), posterior interosseous nerve injury (1.9%), and avascular necrosis (1.9%). Surgical delay was significantly longer in patients with complications (p = 0.038). Multivariate analysis revealed that complications were the most significant predictor of poorer functional outcomes (β = -17.12, p < 0.001), while the surgical delay did not significantly impact outcomes or complication rates.
CONCLUSION: Open reduction, performed after unsuccessful closed reduction, for pediatric severe radial neck fractures yields excellent functional outcomes with a low complication rate. Complications, such as heterotopic ossifications, are the primary determinant of poor outcomes, whereas surgical delay and age do not significantly affect results.
LEVEL OF EVIDENCE: Level III – Retrospective cohort study.
PMID:42224787 | DOI:10.1016/j.injury.2026.113386
