Reduction of radial neck fractures: 9 Techniques

Before delving into methods of reduction of radial neck fractures, let’s know something about them.

These fractures are relatively rare. They comprise of about 1% of total pediatric fractures and about 1.7-5.4% of all adult fractures.

Two broad techniques, as all orthopaedicians know include close and open methods.

9 methods of closed reduction of radial neck fractures are:

1. Israeli Method
2. Neher-Torch method (since 2003)
3. Monson et. al. method (since 2009)
4. Esmarch Bandage technique
5. Kaufman et.al technique
6. Augustithis technique – for O’Brien type II
7. Percutaneous reduction with K-wire
8. Metazieu technique
9. Wallace technique

1. Israeli method: In this method, you flex the elbow to about 90 degrees. Then, supinate the forearm. Apply direct pressure over the radial head and concurrently pronate the forearm.

2. Neher-Torch Method

Use fluoroscopy to determine the rotation of forearm, where maximum angulation occurs. At this position, radial head appears as a long, thin, rectangle on AP view. Then, extend elbow in this position. Now, an assistant should apply laterally directed pressure on the proximal radial shaft with two thumbs. The main surgeon then applies varus stress on the elbow with one hand and pressurizes the radial head with the thumb of the other hand.

3. Monson method of reduction of radial neck fractures

In this method, under appropriate anesthesia and fluoroscopic control, flex the elbow to 90 degrees and fully supinate the forearm. Supinating the forearm brings the apex of the fracture anterior and locks the radial head beneath the annular ligament. And, in this position apply pressure over the proximal shaft of the radius to reduce the fracture.

4. Esmarch Bandage Technique

Hold the elbow in varus and apply Esmarch bandage from distal to proximal. Now, use soft tissue to push the fragment into this place. Rotate the forearm (supination or pronation) to reduce the fracture.

5. Kaufman et.al. technique 

In this method of reduction of radial neck fractures, fully supinate the elbow and flex it to 90 degrees. Now, apply pressure to the lateral epiphysis while rotating the forearm to full pronation.

6. Augustithis et.al. technique

1. For O’Brien type II fractures
2. Supinate and extend the elbow.
3. Apply traction with varus to decompress the lateral column. Now fully pronate in extension.
4. Radial head then locks into proximal radio-ulnar joint

7. Leverage with K-wire 

In this method,  insert the end of K-wire (preferably blunt) into the fracture site and direct it as shown in the figure above and below. This manuever will reduce the displaced fracture into the original position

8. METAZIEU TECHNIQUE 

In this technique, insert intramedullaryrod  from the distal to the proximal end until it engages the head.Use is as a lever to bring the displaced  fracture into its original position.

9. Wallace technique

References 

1. Neher, C. G., & Torch, M. A. (2003). New Reduction Technique for Severely Displaced Pediatric Radial Neck Fractures. Journal of Pediatric Orthopaedics, 626–628. doi:10.1097/00004694-200309000-00009 . Pubmed 
2. Pring, M. E. (2012). Pediatric Radial Neck Fractures. Journal of Pediatric Orthopaedics, 32, S14–S21. doi:10.1097/bpo.0b013e31824b251d. PUBMED 
3. Metaizeau JP, Lascombes P, Lemelle JL, Finlayson D, Prevot J. Reduction and fixation of displaced radial neck fractures by closed intramedullary pinning. J Pediatr Orthop 1993; 13:355–360.