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Letter to the Editor
Reply to the letter related to the article “Radial head and neck fractures in children”
Repuesta a la carta al director acerca del artículo «Fracturas pediátricas de cabeza y cuello de radio»
L. Fuentes-Salguero
Ortopedia Infantil, Hospital de la Serranía, Ronda, Málaga, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Firstly&#44; we wish to thank the author&#47;s of the letter for their detailed reading of our article and also for their understanding in this controversial issue within child traumatology&#59; we will attempt to answer the questions raised&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">There has not been any bias regarding associated fractures&#46; A search request was submitted to the hospital archive&#44; yielding 42 medical histories&#44; of which only 21 were valid for the study &#40;19 had a wrongly coded diagnosis &#8211; the majority were distal radial fractures &#8211;&#44; and 2 histories were not included because they could not be located&#41;&#46; Twelve cases &#40;57&#37;&#41; presented an ipsilateral elbow lesion &#40;6 in the proximal or medial ulna&#44; 5 in the olecranon and 1 in the trochlea&#41; and 3 patients &#40;14&#46;2&#37;&#41; associated lesions in a different location&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Conservative treatment consisted of a brachio-palmar plaster splint&#44; with the elbow at 90&#176;&#44; the forearm in intermediate supination and the wrist in a functional position&#44; for a mean period of 3 weeks&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Regarding rehabilitation&#44; 10 patients did not require it since they presented full mobility&#46; Of the 11 patients who required rehabilitation&#44; 3 recovered full mobility&#46; The mean period to achieve full mobility&#44; or the highest degree of mobility among those who suffered some deficit&#44; was 4&#46;71 months&#44; with a mean duration of physical therapy of 3 months&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Six cases were initially treated by open reduction and 1 more case after secondary displacement in a patient treated by percutaneous reduction&#46; Of these 7 patients&#44; 4 suffered no complications and progressed to full joint balance&#46; The remaining 3 suffered complications such as&#58; loss of mobility in supination in all 3 cases&#44; 2 cases with neuropraxia of the posterior interosseous &#40;1 iatrogenic&#41; and 1 case with myositis ossificans&#46; The patient reoperated for displacement after percutaneous reduction presented valgus elbow and avascular necrosis&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The 2 cases of avascular necrosis occurred among patients with grade I fractures in the Steele-Graham classification&#44; but with grade E in the Chambers classification&#44; that is&#44; associated with elbow dislocation &#40;both cases involved Monteggia injuries&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Postoperative management consisted in immobilisation using a brachio-palmar splint for a period ranging between 4 and 5 weeks&#46; The osteosynthesis material was removed under general anaesthesia at the same time as the splint &#40;except in the case treated by the Feray technique&#44; which took place on an outpatient basis&#41;&#46; All intervened patients were evaluated by the rehabilitation service&#44; with a treatment period of approximately 3 months&#46;</p></span>"
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Article information
ISSN: 19888856
Original language: English
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