Jeffery Type II Fracture of the Radial Neck of a Child: Description of the Lesion and Novel Method of Closed Reduction

IF 4.5 Q1 EDUCATION & EDUCATIONAL RESEARCH Techniques in Shoulder and Elbow Surgery Pub Date : 2020-11-18 DOI:10.1097/BTE.0000000000000201
Ricardo Kaempf de Oliveira, M. Aita, J. P. Farina Brunelli, S. Ribak, Pedro José Delgado Serrano
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Abstract

The authors describe the treatment of a 13-year-old patient with a severe, posteriorly dislocated, epiphysiolysis fracture of the proximal radius. This is called a Jeffery type II lesion when the epiphysiolysis fracture takes place at the radial neck during the reduction of elbow posterior dislocation, thus causing radial head posterior displacement. There are <30 cases described in the literature about such kind of lesion, and only. Chotel and colleagues has carried out the percutaneous form of treatment. He advocated a varus stress onto the elbow joint so that its subluxation would open the lateral space to facilitate manipulation and head reduction toward its anatomic position. The authors also describe a closed reduction technique for such fracture by using 2 Kirschner wires, whereas the first is inserted into the fracture site, thus acting as a guide and fulcrum, so that the second wire would push the radial head toward its anatomic position. The authors regard that such modification of Chotel and colleagues’ technique is an effective and less aggressive maneuver that reduces the risk of iatrogenic ligament and chondral injuries. The purpose is to demonstrate the surgical technique of the novel, effective, and safe method of treatment to Jeffery type II radial neck pediatric fractures.
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儿童桡骨颈的Jeffery II型骨折:病变描述和闭合复位的新方法
作者描述了一名13岁患者的治疗方法,该患者患有严重的桡骨近端后脱位骨骺溶解性骨折。当肘部后脱位复位过程中桡骨颈骨骺溶解性骨折,从而导致桡骨头部后移位时,这被称为Jeffery II型病变。文献中对此类病变的描述仅有<30例。Chotel及其同事已经进行了经皮治疗。他主张对肘关节施加内翻应力,使其半脱位可以打开外侧空间,以便于操作和将头部缩小到解剖位置。作者还描述了一种通过使用2根克氏针对这种骨折进行闭合复位的技术,而第一根针插入骨折部位,从而起到引导和支点的作用,从而使第二根针将桡骨头推向其解剖位置。作者认为,对Chotel及其同事的技术进行这种修改是一种有效且攻击性较小的操作,可以降低医源性韧带和软骨损伤的风险。目的是证明一种新的、有效的、安全的治疗Jeffery II型桡骨颈骨折的手术技术。
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期刊介绍: Published quarterly, Techniques in Shoulder & Elbow Surgery escorts the reader into the operating room and supplies step-by-step details of exciting and advanced techniques. It explains the evolution of and rationale for the procedures, identifies the pitfalls and possible complications, provides invaluable tips for improving surgical results and it is illustrated cover to cover with high-quality intraoperative photographs and drawings, many in full color.
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