{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,20]],"date-time":"2025-09-20T06:25:45Z","timestamp":1758349545366,"version":"3.44.0"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T00:00:00Z","timestamp":1758240000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Radial neck fractures in children can easily become complicated if not managed properly. Percutaneous reduction using the leverage technique with or without internal fixation with a Kirschner wire (K-wire) is a minimally invasive approach for treating angulated radial neck fractures in children. The study aims to evaluate the radiological and clinical outcomes of percutaneous leverage reduction assisted by elbow arthrography for pediatric radial neck fractures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>From January 2016 to June 2020, we treated 47 children with angulated radial neck fractures, including 35 boys and 12 girls. The patient's age ranged from 2 to 13 years, with an average age of 6 years 9 months. According to Judet classification, 21 cases were classified as Type III, 15 cases as Type IVa and 11 cases as Type IVb. To overcome the difficulty of reduction caused by the absence of the ossified radial head centers in young children, we used intraoperative elbow arthrography to assist with the reduction. After achieving satisfactory reduction, one or two K-wires were inserted percutaneously to fix the fracture site and prevent reduction loss.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>All cases were followed up for an average of 43 months, ranging from 24 months to 90 months. No radial head necrosis or synostosis of the proximal ulna and radius was observed during the long-term follow-up. No epiphyseal arrest or valgus of the elbow was noted at the end of the follow-up. According to the Metaizeau reduction classification, 42 cases were rated excellent, and 5 cases as good. Based on the Metaizeau clinical classification, 45 cases were excellent and 2 were good.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Closed reduction assisted by intraoperative elbow arthrography, combined with percutaneous leverage technique and internal fixation with K-wires, achieved satisfactory reduction and functional outcomes in children with angulated radial neck fractures, even in cases where the radial head ossification centers were not yet visible.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2025.1571774","type":"journal-article","created":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T05:27:25Z","timestamp":1758259645000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Percutaneous leverage reduction with kirschner-wire fixation assisted by elbow arthrography for pediatric radial neck fractures"],"prefix":"10.3389","volume":"13","author":[{"given":"Hai","family":"Jiang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tao","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,19]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"239","DOI":"10.5397\/cise.2021.00402","article-title":"Outcome of open reduction and kirschner wire fixation in pediatric radial neck fracture","volume":"24","author":"Rouhani","year":"2021","journal-title":"Clin Shoulder Elb"},{"key":"B2","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1097\/BPO.0000000000001699.","article-title":"Pediatric radial neck fractures: which ones can be successfully closed reduced in the emergency department?","volume":"41","author":"Kong","year":"2021","journal-title":"J Pediatr Orthop"},{"key":"B3","doi-asserted-by":"publisher","first-page":"2418","DOI":"10.1016\/j.jse.2021.04.037","article-title":"Open reduction of radial neck fractures in children: injury severity predicts the radiographic and clinical outcomes","volume":"30","author":"Baghdadi","year":"2021","journal-title":"J Shoulder Elbow Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"613","DOI":"10.29271\/jcpsp.2022.05.613","article-title":"Metaizeau closed reduction technique and open reduction technique for the surgical treatment of pediatric radial neck fractures","volume":"32","author":"Yilmaz","year":"2022","journal-title":"J Coll Physicians Surg Pak"},{"key":"B5","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1007\/s00068-021-01604-4","article-title":"Nonunion of the radial neck in children: a rare but severe complication after fractures of the radial neck","volume":"47","author":"Fernandez Fernandez","year":"2021","journal-title":"Eur J Trauma Emerg Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"238","DOI":"10.5312\/wjo.v13.i3.238","article-title":"Diagnosis, treatment and complications of radial head and neck fractures in the pediatric patient","volume":"13","author":"Macken","year":"2022","journal-title":"World J Orthop"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e35507","DOI":"10.1097\/MD.0000000000035507","article-title":"A comparative study: ultrasound-guided leverage reduction with internal fixation using kirschner wires or elastic stable intramedullary nailing for severely displaced radial neck fractures in children","volume":"102","author":"Wu","year":"2023","journal-title":"Medicine (Baltimore)"},{"key":"B8","doi-asserted-by":"publisher","first-page":"18632521241300878","DOI":"10.1177\/18632521241300878","article-title":"The long-term results of treating radial neck fractures in children with the metaizeau technique","volume":"19","author":"Kanar","year":"2024","journal-title":"J Child Orthop"},{"key":"B9","doi-asserted-by":"publisher","first-page":"e23.00076","DOI":"10.2106\/JBJS.ST.23.00076","article-title":"Closed intramedullary pinning of displaced radial neck fracture (metaizeau technique)","volume":"14","author":"Kozin","year":"2024","journal-title":"JBJS Essent Surg Tech"},{"key":"B10","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1302\/1863-2548.14.190130","article-title":"Percutaneous leverage technique for reduction of radial neck fractures in children: technical tips","volume":"14","author":"Watkins","year":"2020","journal-title":"J Child Orthop"},{"key":"B11","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1097\/BPB.0000000000001080","article-title":"Percutaneous K-wire reduction and cast immobilization for severely displaced radial neck fractures in children","volume":"33","author":"Zhang","year":"2024","journal-title":"J Pediatr Orthop B"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1463","DOI":"10.1007\/s00264-023-05965-w","article-title":"Clinical and radiological evaluation of radial neck factures in children and adolescents treated by percutaneous leverage reduction with kirschner wire stabilization","volume":"48","author":"Guzikiewicz","year":"2024","journal-title":"Int Orthop"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1049","DOI":"10.3390\/children9071049","article-title":"Pediatric radial neck fractures: a systematic review regarding the influence of fracture treatment on elbow function","volume":"9","author":"Langenberg","year":"2022","journal-title":"Children (Basel)"},{"key":"B14","doi-asserted-by":"publisher","first-page":"A75","DOI":"10.1016\/j.injury.2004.12.016","article-title":"Reduction and osteosynthesis of radial neck fractures in children by centromedullary pinning","volume":"36","author":"Metaizeau","year":"2005","journal-title":"Injury"},{"key":"B15","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1097\/01241398-199305000-00015","article-title":"Reduction and fixation of displaced radial neck fractures by closed intramedullary pinning","volume":"13","author":"Metaizeau","year":"1993","journal-title":"J Pediatr Orthop"},{"key":"B16","doi-asserted-by":"publisher","first-page":"988372","DOI":"10.3389\/fped.2022.988372","article-title":"Radial head and neck fractures in children and adolescents","volume":"20","author":"Kalbitz","year":"2023","journal-title":"Front Pediatr"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1287","DOI":"10.1016\/j.otsr.2020.05.014","article-title":"Prognostic factors for intramedullary nailing in radial neck fracture in children","volume":"106","author":"Hemmer","year":"2020","journal-title":"Orthop Traumatol Surg Res"},{"key":"B18","doi-asserted-by":"publisher","first-page":"542","DOI":"10.1302\/0301-620x.83b4.10945","article-title":"Arthrography for reduction of a fracture of the radial neck in a child with a non-ossified radial epiphysis","volume":"83","author":"Javed","year":"2001","journal-title":"J Bone Joint Surg Br"},{"key":"B19","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1097\/01241398-198801000-00009","article-title":"Radial head and neck fractures in children","volume":"8","author":"Steinberg","year":"1988","journal-title":"J Pediatr Orthop"},{"key":"B20","doi-asserted-by":"publisher","first-page":"698","DOI":"10.1097\/BPO.0b013e3181b76895","article-title":"Evaluation of severely displaced radial neck fractures in children treated with elastic stable intramedullary nailing","volume":"29","author":"Klitscher","year":"2009","journal-title":"J Pediatr Orthop"},{"key":"B21","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1007\/s10195-013-0252-0","article-title":"Management of displaced radial neck fractures in children: percutaneous pinning vs. Elastic stable intramedullary nailing","volume":"14","author":"Tarallo","year":"2013","journal-title":"J Orthop Traumatol"},{"key":"B22","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1177\/18632521241233444","article-title":"Comparison of elastic stable intramedullary nailing versus kirschner wires in treatment of pediatric radial neck fractures","volume":"18","author":"Tian","year":"2024","journal-title":"J Child Orthop"},{"key":"B23","doi-asserted-by":"publisher","first-page":"9317837","DOI":"10.1155\/2022\/9317837","article-title":"The effects of using K-wire or Titanium elastic nails on clinical and radiological outcomes in the metaizeau closed reduction technique","volume":"27","author":"Aydin","year":"2022","journal-title":"Int J Clin Pract"},{"key":"B24","doi-asserted-by":"publisher","first-page":"250","DOI":"10.1055\/s-0030-1249104","article-title":"Intramedullary nailing for the treatment of dislocated pediatric radial neck fractures","volume":"20","author":"Eberl","year":"2010","journal-title":"Eur J Pediatr Surg"},{"key":"B25","doi-asserted-by":"publisher","first-page":"569","DOI":"10.1186\/s13018-022-03472-z","article-title":"Intraoperative arthrography favorably impacts the early outcome of operatively managed fractures of the lateral humeral condyle displaced 1\u20135mm in children","volume":"17","author":"Lari","year":"2022","journal-title":"J Orthop Surg Res"},{"key":"B26","doi-asserted-by":"publisher","first-page":"505","DOI":"10.1097\/BPO.0000000000002459","article-title":"Pediatric lateral humeral condyle fractures: reliability of a modified jakob classification system and its impact on treatment planning with or without arthrography","volume":"43","author":"Miller","year":"2023","journal-title":"J Pediatr Orthop"},{"key":"B27","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1097\/BPB.0000000000000928","article-title":"Does an elbow arthrogram change management after closed reduction of mildly displaced lateral condyle fractures in children?","volume":"31","author":"Rehm","year":"2022","journal-title":"J Pediatr Orthop B"},{"key":"B28","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1016\/j.injury.2019.11.038","article-title":"Long-term outcomes of distal humeral epiphyseal separations treated via closed reduction and pinning under arthrogram","volume":"51","author":"Cha","year":"2020","journal-title":"Injury"},{"key":"B29","doi-asserted-by":"publisher","first-page":"472","DOI":"10.5435\/JAAOS-22-08-472","article-title":"The use of arthrography in pediatric orthopaedic surgery","volume":"22","author":"Nowicki","year":"2014","journal-title":"J Am Acad Orthop Surg"},{"key":"B30","doi-asserted-by":"publisher","first-page":"S80","DOI":"10.1016\/j.injury.2014.10.028","article-title":"Paediatric radial neck fractures: one-step percutaneous reduction and fixation","volume":"45","author":"Cossio","year":"2014","journal-title":"Injury"},{"key":"B31","doi-asserted-by":"publisher","first-page":"931","DOI":"10.1007\/s00590-020-02654-x","article-title":"Percutaneous k-wire leverage reduction and retrograde transphyseal k-wire fixation of angulated radial neck fractures in children","volume":"30","author":"Massetti","year":"2020","journal-title":"Eur J Orthop Surg Traumatol"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1571774\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T05:27:26Z","timestamp":1758259646000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1571774\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,19]]},"references-count":31,"alternative-id":["10.3389\/fped.2025.1571774"],"URL":"https:\/\/doi.org\/10.3389\/fped.2025.1571774","relation":{},"ISSN":["2296-2360"],"issn-type":[{"type":"electronic","value":"2296-2360"}],"subject":[],"published":{"date-parts":[[2025,9,19]]},"article-number":"1571774"}}