Background: Displaced radial neck fractures in children are challenging to treat. The age of the patient and the degree of angulation are the main criteria to consider when managing these fractures in children. Various surgical techniques have been described in the literature for both indirect and direct reduction and for fixation. However, the best treatment is still debated. Case presentation: The case presented is of a 6-year-old Caucasian boy with an impacted and displaced radial neck fracture. With the patient in lateral position, under general anesthesia, elbow arthroscopy was performed to better visualize the articular surface and to assist with reduction and fixation. The fracture was reduced and fixed with a single K-wire under direct arthroscopic visualization. No associated lesions were found. An above-elbow cast was applied after surgery. The cast and K-wire were removed 3 weeks later. At the 3-month follow-up, the patient showed a full recovery with complete range of movement without any postoperative and radiographic complications. Conclusion: Traditionally, surgery for displaced radial neck fractures in children is performed by closed reduction with percutaneous pinning or elastic intramedullary nail fixation under fluoroscopic guidance. Direct visualization of the articular surface via an open approach allows better reduction in complex fracture patterns but is related to a higher risk of complications: elbow stiffness, instability, or avascular necrosis. Elbow arthroscopy in children could be a valid alternative to open fixation surgery for displaced radial neck fractures without the complications associated with articular exposure, allowing the direct visualization of the fracture and reducing radiation exposure. Although technically demanding, we believe elbow arthroscopy should be considered an alternative option because it is effective in assisting reduction and fixation and enables the detection of associated joint lesions.

Radiocapitellar plica is a vestigial lateral portion of elbow synovial fold which may cause pain and snap in some cases.. Plica is a difficult and misleading diagnosis and it could be easily confused with a common lateral epicondylitis however, they are different conditions. Pathology full understanding and proper diagnosis is essential to achieve patient’s pain relief and functional recovery therefore, we reviewed the most relevant literature about radiocapitaller plica. The aim of this study is to provide the best and current concepts about: clinical evaluation, imaging findings and surgical treatments of radiocapitellar plica.(www.actabiomedica.it)

Introduction: This study aimed to quantitatively evaluate the effect of the trauma to surgery time interval (Tt-Ts) and the type of tendon retraction (unretracted vs. coiled) in distal biceps tendon ruptures (DBTRs) on the choice between primary tendon repair (PR) and tendon reconstruction with graft (RG). Materials and Methods: In total, 123 patients with surgically treated DBTRs were analyzed. Patients were divided into three groups: Group I—acute (75 patients with Tt-Ts < 21 days), Group II—subacute (20 patients with Tt-Ts between 21 and 45 days), and Group III—chronic (28 patients with Tt-Ts > 45 days). The type of surgical treatment (PR vs. RG) was evaluated in each group. The type of tendon retraction (unretracted vs. coiled) was analyzed in subacute and chronic lesions. A statistical analysis was performed. Results: The mean Tt-Ts interval in the overall sample was 59.3 days; in Group I, it was 9 days (range, 2–20); in Group II, it was 29 days (range, 22–42); and in Group III, it was 196 days (range, 45–1095). PR was performed in 100%, 90%, and 29% of the patients in Groups I, II, and III, respectively. Coiled tendons were found in 60% and 71% of patients in Groups II and III, respectively. Among patients with coiled tendons, 2 and 20 received RG in Groups II and III, respectively. The Tt-Ts and the type of retraction were significantly associated with the choice of surgical treatment (PR vs. RG), with statistical differences between Group III and the other two groups (p < 0.05). A cut-off of 43.5 days following injury was found to predict the need to perform RG with an accuracy, sensitivity, and specificity of 94%, 100%, and 92%, respectively. The likelihood of receiving RG rather than PR increased each day by 6%. Conclusions: Treatment delay significantly affects the choice of surgical technique in DBTRs. PR is feasible in 98% of acute and subacute ruptures, whereas RG is necessary in 70% of chronic ruptures. The type of tendon retraction affects the choice of treatment only in chronic lesions, as coiled tendons always require RG.