The role of elastic intramedullary nailing with or without Kirschner wire fixation in pediatric radial neck fractures: a retrospective cohort study

Objective To compare the clinical and functional outcomes of elastic intramedullary nailing (EN) alone vs. elastic intramedullary nailing combined with Kirschner wire fixation (EN + K) in the treatment of pediatric radial neck fractures. Methods A retrospective cohort study was conducted including 52 pediatric patients with radial neck fractures treated between September 2013 and December 2024 at Wuhan Fourth Hospital. Patients were divided into two groups according to the surgical technique: EN group ( n = 16) and EN + K group ( n = 36). Baseline characteristics, perioperative parameters, fracture union time, follow-up duration, complications, and functional outcomes were collected and analyzed. Functional outcomes were evaluated at the final follow-up using Mayo Elbow Performance Score–based grading. Continuous variables were compared using the independent-samples t -test, and categorical variables were analyzed using the chi-square test. Results There were no significant differences between the two groups in baseline characteristics, including age, sex, time from injury to surgery, Judet classification, or fracture angulation ( P > 0.05). The EN + K group had a significantly longer operation time ( P < 0.001) but a shorter immobilization period ( P < 0.001) and significantly shorter fracture union time compared with the EN group (10.22 ± 2.91 vs. 13.13 ± 2.53 weeks, P = 0.001). No postoperative complications were observed in either group. At the final follow-up, the proportion of patients achieving excellent or good functional outcomes was significantly higher in the EN + K group than in the EN group (86.1% vs. 50.0%, P = 0.012). Conclusion Elastic intramedullary nailing combined with Kirschner wire fixation provides superior fracture stability, promotes faster fracture union, and leads to better functional outcomes compared with elastic intramedullary nailing alone in pediatric radial neck fractures. Despite a longer operation time, the combined technique appears to be a safe and effective treatment option for this patient population.