Fractures of the proximal radial head and neck in children with emphasis on those that involve the articular cartilage

This is a review of 116 children who had a fracture of the proximal radial head or neck over a 15-year period. Of 33 teenagers with closed physes, 17 (52%) had intraarticular involvement. Of 83 younger children with an open p roximal radial physis, six (7%) had an intraarticular fracture (Salter-Harr is type III or IV). Of the 17 patients with closed physes and intraarticula r fracture, 13 had adequate follow-up. There were eight excellent, three go od, one fair, and one poor results. Of the six children with open physes an d intraarticular fracture, there were one good and five poor results. This study confirms that intraarticular fracture of the radial head is much more common if the proximal radial physis is closed. In addition, this review i ndicates that the prognosis is extremely poor for children who have a radia l head intraarticular fracture that also involves an open physis (Salter-Ha rris types III and TV), particularly when the fracture is treated initially nonoperatively. Displaced proximal radial fractures that involve both phys eal and articular cartilage may be occult, and as with all physeal and intr aarticular fractures, anatomic reduction (open if necessary) is mandatory.