Reply

Dear Sir,

Re: Displaced Fracture of the Radius with Complete 180° Rotation of the Radial Head during Closed Reduction. Navali A.M., Sadigi A. Journal of Hand Surgery 2006; 31B: 689–691.

We read with interest this article about a further radial head reversal after a Jeffery Type II fracture in children. This iatrogenic complication is due to lack of knowledge of this very rare fracture, best known by the name ‘Jeffery Type II fracture’. We would like to correct the wrong author reference (Jefferey) that has been used in Tachdjian’s book (Herring, 2002) (and by the authors of this paper as well), not only to render unto Caesar what is Caesar’s (in this case, an English surgeon from Birmingham, UK) but also, and mostly, to facilitate a complete literature analysis. Using such a key word during their research, the authors would have found a recent and exhaustive review of the literature on this topic (Chotel et al., 2004).

As pointed out by the authors, we agree that the reversal of the radial head must be treated by open reduction. Preserving the radial head, even without any blood supply, is probably the best option of treatment. In such a location, necrosis is still compatible with a good functional outcome. Moreover, some late revascularisation has been described (Chotel et al., 2004).

In this letter, we would, especially, like to focus on the prevention of this iatrogenic complication as it could have medicolegal implications. Unfortunately, it is classical and common following treatment of the Jeffery’s Type II fracture. Nine attempts at closed reduction are described in the twenty-two of these fractures which have been reported in the literature. Seven led to radial head reversal and two resulted in a failure of reduction. Considering these problems, most authors agree that open reduction is necessary, if not essential, in such fractures. More recently, we proposed an alternative to open reduction and described a specific percutaneous technique for reduction of the radial head (Chotel et al., 2006). This technique uses a percutaneous K-wire pushing manoeuvre during manual subluxation of the elbow. The principle of this subluxation procedure is to remove the capitellum interposition between the head fragment and the metaphysis. The K-wire is used to reduce the radial head while preserving the posterior epiphyso-metaphyseal periosteal bridge (Fig. 1). In two cases, this simple procedure avoided the complication of reversal of the head, allowing early rehabilitation and resulting in an excellent clinical result.