Publications

Multiple strategies exist for the reduction and fixation of unstable pediatric extraarticular radial neck fractures,
but consensus remains elusive. Although various techniquesfor stabilization have been proposed, each carries its own set
of associated challenges.Closed reduction technique for radial neck fracture may fail in a subset of cases.1 The percutaneous Kapandji
leverage technique2 effectively reduces the fracture but may not provide sufficient stabilization, often necessitating
additional pinning and carries the risk of posterior interosseous nerve (PIN) injury. Transcapitellar K-wire fixation
carries the risk of wire failure, including bending or breakage, particularly in the case of highly unstable fractures.3 This modality of fixation also predisposes the
radial head to avascular necrosis.4 The violation of the
radiocapitellar joint is also an unattractive feature of this
technique, thereby increasing the risk of poor outcomes,
including joint stiffness and posttraumatic arthrosis. Intramedullary
fixation, as advocated by Metaizeau et al,5 allows
for closed reduction of radial neck fractures, thereby
minimizing the complications associated with open reduction,
such as joint stiffness and avascular necrosis (AVN) of
the radial head. However, the fixation achieved through this
technique may be insufficient and can potentially be
associated with secondary displacement and loss of reduction
(Fig. 1). This poses a significant risk to union, which
has adverse effects on the range of motion of the elbow and
functional outcome.6,7 In addition, distally based flexible
nail insertion sites carry risk to the dorsal radial sensory
nerve or the extensor pollicis longus (EPL) injury, depending
on the chosen technique.8
To address these challenges, we propose a novel
intramedullary technique designed to stabilize the radial
neck fracture adequately while minimizing disruption to the
adjacent periosteum, blood supply, and radiocapitellar joint,
thereby possibly limiting the known complications associated
with the aforementioned techniques.