Minimally invasive management of a judet 4b radial neck fracture using combined K-wire leverage and métaizeau technique: A rare case report

Abstract

Background: Radial neck fractures in children are uncommon and can be challenging to manage when severely displaced. Judet type 4B fractures, characterised by angulation greater than 80°, are especially difficult to reduce by closed methods. Open reduction increases the risks of avascular necrosis, synostosis, and stiffness. Minimally invasive strategies such as the Métaizeau technique, supported by temporary percutaneous K-wire leverage, provide an attractive alternative with the advantage of preserving vascularity.Case Presentation: A 13-year-old male presented with a Judet 4B radial neck fracture following a fall. Closed manipulation was unsuccessful, and a minimally invasive combined technique was employed.Methods: Through a percutaneous approach, a 2.0 mm K-wire was introduced into the radial head–neck interval to assist with levering the displaced fragment into partial alignment. Subsequently, a Titanium Elastic Nail was advanced across the fracture using the Métaizeau principle and rotated to achieve stable anatomical reduction.Results: Radiographs at one-year follow-up demonstrated complete union with full recovery of elbow flexion–extension and forearm rotation. No complications such as avascular necrosis, synostosis, or growth disturbance were observed.Conclusion: The combination of percutaneous K-wire leverage and the Métaizeau technique offers a reliable minimally invasive option for treating Judet 4B radial neck fractures, avoiding the morbidity of open reduction while achieving excellent functional outcomes.