Radial neck fractures most commonly occur in children ages 4-14 years old due to incomplete ossification of the radial head. Undisplaced fractures in adults can be treated non-operatively, while displaced fractures may require open reduction and internal fixation with a locking plate. In children, treatment depends on the degree of angulation, with non-operative immobilization used for less than 30 degrees, closed manipulation for 30-60 degrees, and possible surgical intervention for over 60 degrees. Clinical features include pain over the radial head and neck with forearm rotation.

1. Radial neck fracture
Dr. Ashiqur Rahman
Resident Orthopedics
Dhaka Medical college Hospital

2. Introduction
 In adults a displaced fracture of the radial neck may need open
reduction.
 if so, a pre-contoured locking plate can be applied, carefully placed to
avoid the articular surface during rotation.
 If undisplaced, non-operative management can produce acceptable
results despite a relatively high rate of non-union. Most are
asymptomatic.

3.  In children with radial neck # usually are 04 to 14 years old.
 Primarily because, ossification of the radial head usually
does not begin before 5 years of age.

8.  The normal anatomical angulation of the radial neck in children has
been erroneously diagnosed as a buckle fracture in this area.
 In AP Radiograph lateral angulation varies from 0-15°
 And in lateral radiograph 10° anterior to 5° posterior.

9. How does angulation affect treatment?
(i) < 30°
-No manipulation needed
(ii) 30-60°
- Usually responds to closed reduction
(iii) >60°
- May require surgical intervention
 Most fractures in children are of the radial neck and not the radial
head.

10. Clinical feature:
- Palpation over the radial head and neck is painful.
- Passive forearm pronation and supination is painful.
- A young child may primarily complains wrist pain and the
pressure over the proximal radius may accentuate the referred
wrist pain.
- Wrist pain is secondary to radial shortening and distal radio
ulnar dysfunction.

11. O’Brien classification of Radial neck #

13. Treatment option of Radial neck #
1. Immobilization with no manipulation.
2. Manipulative closed reduction
3. Percutaneous pin reduction
4. Intramedullary pin reduction
5. Open reduction with or without internal fixation
6. Excision of radial head. Or a small head fragment.

14. Non operative methods:
- Younger children angulation less than 20 to 30 degrees.
- A collar and cuff or a simple posterior long cast is enough.
Manipulative closed reduction:
- Angulation up to 40 to 45 degrees.

15. Patterson’s Classic Manipulation Technique (Courtesy:
Prof. Dr. R R Kairy)

16. The Kaufman (Israeli) Technique

17. Metaizeau’s technique for IM reduction of Radial neck #

18. Reduction with the help K-wire

20. Complication:
1. Loss of motion
2. Radial head overgrowth
3. Non union
4. Avascular necrosis.