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 proximal radial physis, six (7%) had an intraarticular fracture (Salter-Harris type III or IV). Of the 17 patients with closed physes and intraarticular fracture, 13 had adequate follow-up. There were eight excellent, three good, one fair, and one poor results. Of the six children with open physes and 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 indicates that the prognosis is extremely poor for children who have a radial head intraarticular fracture that also involves an open physis (Salter-Harris types III and IV), particularly when the fracture is treated initially nonoperatively. Displaced proximal radial fractures that involve both physeal and articular cartilage may be occult, and as with all physeal and intraarticular fractures, anatomic reduction (open if necessary) is mandatory.