Unusual presentation of a radial neck fracture in a child
A 12-year-old male child presented to our emergency room with an injury to the elbow following a fall on the outstretched hand. He had a diffuse swelling around the elbow, with no external wounds. On examination there was diffuse swelling with a hard bony lump on medial aspect of the elbow. The radial head was not in place clinically. He had weakness of the flexors of the fifth and fourth digits of the hand with a hypoaesthesia in the distribution of the ulnar nerve.\nA radiograph of the elbow showed a fracture of the radial neck with dislocation of the radial head onto the medial side. However radial head was intact [].\nThe patient was taken up for open reduction on an emergency basis. The radial head was palpable in the subcutaneous plane and it was approached through a short curvilinear incision on the medial side centered over the displaced radial head, and the head could be delivered out. A separate lateral Kocher incision was used to approach the proximal radius; the radial head was repositioned anatomically and fixed with a mini fragment T plate, and the annular ligament was repaired. The stability was checked in the elbow. The ulnar nerve was not explored A posterior above elbow slab was used to protect the elbow for 3 weeks followed by active elbow mobilization.\nPostoperatively, an ulnar nerve injury was confirmed on detailed examination once pain had come down and the child was more cooperative. The patient was started on indomethacin 25 mg empirically twice a day for 3 weeks. The patient was lost to followup from this time onward for the next few months. He reported back to the outpatient department at 6 months for review. He had a range of motion at the elbow from 30° to 130° with no supination and good pronation. He was satisfied with function. The ulnar nerve had not recovered [Figures -]. The X-ray taken showed a suspicious developing proximal radioulnar synostosis and union of the fracture site. The implants were removed. He was advised an electromyography and nerve conduction study which he did not get done.