Slide 121 — Paediatric radial neck fracture

Clean FRCS notes with inline figures

Describe Xray: Fracture radial neck with >30deg angulation

Obrien classification

•I <30

•II 30-60

•III >60

•Median age is 9-10 years

•Usually associated with a valgus loading injury of the elbow

•Associated Conditions

•Elbow dislocation

•Medial epicondyle fracture

Xray

•Greenspan (radiocapitellar view: elbow 90deg flexion, thumb up, beam 45 from table)

Treatment:

•Depends on angulation

•<30deg: immobilization in situ

•>30deg: attempt close reduction

•Patterson (traction, varus stress at elbow, thumb direct pressure on radial head)

•Israeli (elbow supination + flexion, finger pressure at radial head, pronate to force radial head through)

•Chambers (Esmarch applied distal to proximal, reduction by circumferential pressure

If post reduction still >30deg:

•Percutaneous reduction with K wire (Joystick technique)

•Metaizeau technique: retrograde IM Kwire / TENS with bent tip to lever radial head fragment

•Open reduction has been associated with a greater loss of motion, increased rates of osteonecrosis and synostosis compared with closed reduction

Complication:

•Overgrowth (more common)

•Radial head AVN

•RU synostosis

•Myositis ossificans

•Normal radial neck angulation

•0-15 lateral

•5 post to 10 anterior

Direct Q&A

Q1 How is Paediatric radial neck fracture classified here?

•I <30

•II 30-60

•III >60

•Median age is 9-10 years

•Usually associated with a valgus loading injury of the elbow

•Associated Conditions

•Elbow dislocation

•Medial epicondyle fracture

Q2 What are the radiographic findings for Paediatric radial neck fracture?

•Greenspan (radiocapitellar view: elbow 90deg flexion, thumb up, beam 45 from table)

Q3 How is Paediatric radial neck fracture managed?

Depends on angulation

•<30deg: immobilization in situ

•>30deg: attempt close reduction

•Patterson (traction, varus stress at elbow, thumb direct pressure on radial head)

•Israeli (elbow supination + flexion, finger pressure at radial head, pronate to force radial head through)

•Chambers (Esmarch applied distal to proximal, reduction by circumferential pressure

Q4 What complications are listed for Paediatric radial neck fracture?

Overgrowth (more common)

•Radial head AVN

•RU synostosis

•Myositis ossificans

Raw speaker-note hierarchy audit

#	marL	indent	logical	original note line
1	None	None	0	Describe Xray: Fracture radial neck with >30deg angulation
2	None	None	0	Obrien classification
3	171450	-171450	1	I <30
4	171450	-171450	1	II 30-60
5	171450	-171450	1	III >60
6	None	None	0	Median age is 9-10 years
7	None	None	0	Usually associated with a valgus loading injury of the elbow
8	None	None	0	Associated Conditions
9	171450	-171450	1	Elbow dislocation
10	171450	-171450	1	Medial epicondyle fracture
11	0	0	0	Xray
12	0	0	0	Greenspan (radiocapitellar view: elbow 90deg flexion, thumb up, beam 45 from table)
13	0	0	0	Treatment:
14	0	0	0	Depends on angulation
15	0	0	0	<30deg: immobilization in situ
16	0	0	0	>30deg: attempt close reduction
17	171450	-171450	1	Patterson (traction, varus stress at elbow, thumb direct pressure on radial head)
18	171450	-171450	1	Israeli (elbow supination + flexion, finger pressure at radial head, pronate to force radial head through)
19	171450	-171450	1	Chambers (Esmarch applied distal to proximal, reduction by circumferential pressure
20	0	0	0	If post reduction still >30deg:
21	171450	-171450	1	Percutaneous reduction with K wire (Joystick technique)
22	171450	-171450	1	Metaizeau technique: retrograde IM Kwire / TENS with bent tip to lever radial head fragment
23	0	0	0	Open reduction has been associated with a greater loss of motion, increased rates of osteonecrosis and synostosis compared with closed reduction
24	0	0	0	Complication:
25	171450	-171450	1	Overgrowth (more common)
26	171450	-171450	1	Radial head AVN
27	171450	-171450	1	RU synostosis
28	171450	-171450	1	Myositis ossificans
29	0	0	0	==================================
30	0	0	0	Normal radial neck angulation
31	0	0	0	0-15 lateral
32	0	0	0	5 post to 10 anterior

lvl

marL

indent

logical

original note line

None

Describe Xray: Fracture radial neck with >30deg angulation

None

Obrien classification

171450

-171450

I <30

171450

-171450

II 30-60

171450

-171450

III >60

None

Median age is 9-10 years

None

Usually associated with a valgus loading injury of the elbow

None

Associated Conditions

171450

-171450

Elbow dislocation

171450

-171450

Medial epicondyle fracture

Xray

Greenspan (radiocapitellar view: elbow 90deg flexion, thumb up, beam 45 from table)

Treatment:

Depends on angulation

<30deg: immobilization in situ

>30deg: attempt close reduction

171450

-171450

Patterson (traction, varus stress at elbow, thumb direct pressure on radial head)

171450

-171450

Israeli (elbow supination + flexion, finger pressure at radial head, pronate to force radial head through)

171450

-171450

Chambers (Esmarch applied distal to proximal, reduction by circumferential pressure

If post reduction still >30deg:

171450

-171450

Percutaneous reduction with K wire (Joystick technique)

171450

-171450

Metaizeau technique: retrograde IM Kwire / TENS with bent tip to lever radial head fragment

Open reduction has been associated with a greater loss of motion, increased rates of osteonecrosis and synostosis compared with closed reduction

Complication:

171450

-171450

Overgrowth (more common)

171450

-171450

Radial head AVN

171450

-171450

RU synostosis

171450

-171450

Myositis ossificans

==================================

Normal radial neck angulation

0-15 lateral

5 post to 10 anterior

Improved semantic hierarchy used for the study notes

#	semantic level	section?	rewritten line
1	0	yes	Describe Xray: Fracture radial neck with >30deg angulation
2	0	yes	Obrien classification
3	1		I <30
4	1		II 30-60
5	1		III >60
6	1		Median age is 9-10 years
7	1		Usually associated with a valgus loading injury of the elbow
8	1		Associated Conditions
9	1		Elbow dislocation
10	1		Medial epicondyle fracture
11	0	yes	Xray
12	1		Greenspan (radiocapitellar view: elbow 90deg flexion, thumb up, beam 45 from table)
13	0	yes	Treatment:
14	1		Depends on angulation
15	1		<30deg: immobilization in situ
16	1		>30deg: attempt close reduction
17	1		Patterson (traction, varus stress at elbow, thumb direct pressure on radial head)
18	1		Israeli (elbow supination + flexion, finger pressure at radial head, pronate to force radial head through)
19	1		Chambers (Esmarch applied distal to proximal, reduction by circumferential pressure
20	0	yes	If post reduction still >30deg:
21	1		Percutaneous reduction with K wire (Joystick technique)
22	1		Metaizeau technique: retrograde IM Kwire / TENS with bent tip to lever radial head fragment
23	1		Open reduction has been associated with a greater loss of motion, increased rates of osteonecrosis and synostosis compared with closed reduction
24	0	yes	Complication:
25	1		Overgrowth (more common)
26	1		Radial head AVN
27	1		RU synostosis
28	1		Myositis ossificans
29	0		——
30	1		Normal radial neck angulation
31	1		0-15 lateral
32	1		5 post to 10 anterior

semantic level

section?

rewritten line

yes

Describe Xray: Fracture radial neck with >30deg angulation

yes

Obrien classification

I <30

II 30-60

III >60

Median age is 9-10 years

Usually associated with a valgus loading injury of the elbow

Associated Conditions

Elbow dislocation

Medial epicondyle fracture

yes

Xray

Greenspan (radiocapitellar view: elbow 90deg flexion, thumb up, beam 45 from table)

yes

Treatment:

Depends on angulation

<30deg: immobilization in situ

>30deg: attempt close reduction

Patterson (traction, varus stress at elbow, thumb direct pressure on radial head)

Israeli (elbow supination + flexion, finger pressure at radial head, pronate to force radial head through)

Chambers (Esmarch applied distal to proximal, reduction by circumferential pressure

yes

If post reduction still >30deg:

Percutaneous reduction with K wire (Joystick technique)

Metaizeau technique: retrograde IM Kwire / TENS with bent tip to lever radial head fragment

Open reduction has been associated with a greater loss of motion, increased rates of osteonecrosis and synostosis compared with closed reduction

yes

Complication:

Overgrowth (more common)

Radial head AVN

RU synostosis

Myositis ossificans

——

Normal radial neck angulation

0-15 lateral

5 post to 10 anterior

121. Paediatric radial neck fracture

Clean FRCS notes with inline figures

Describe Xray: Fracture radial neck with >30deg angulation

Obrien classification

Xray

Treatment:

If post reduction still >30deg:

Complication:

Direct Q&A

Depends on angulation

Overgrowth (more common)

Raw speaker-note hierarchy audit

Improved semantic hierarchy used for the study notes