A 5-year-old boy sustained a fracture of the radial neck with 60° of angulation. After closed reduction under general anesthesia, there was 30° of residual angulation. Pronation of the forearm was 70° and supination was 80°. The next step in treatment should be (AIPG 20009)
|A||Immobilization in 90° elbow flexion|
|B||Further closed manipulation and immobilization|
|C||Closed reduction and percutaneous pinning|
|D||Open reduction of the radial neck|
Immobilization in 90° elbow flexion
a. In uncomplicated fractures of the radial neck with up to 60° of angulation, a satisfactory result can usually be achieved by closed reduction. In the young child, anatomic reduction need not be obtained, as up to 45° of residual angulation is tolerated without significant loss of function.
b. Repeated manipulation is usually no more successful than the initial attempt. One method for testing the adequacy of closed reduction is to test the range of supination and pronation of the forearm. If it is at least 60° in both directions, the reduction is adequate regardless of the radiographic appearance.