Radial neck fractures are more prevalent at ages 09 to 10 years. At this age, the radial proximal physis is not close. Damage to this physis most often determines a Salter-Harris type 2 injury [1,3]. The Salter-Harris type 4 (epiphyso-metaphyseal) injury remains exceptional [3]

The mechanism of injury is usually a fall on an outstretched hand with a valgus compressive force across the elbow joint. There can also be a torsional component to the injury. Neurological examination is important as the posterior interosseous nerve is at risk due to its proximity to the radial neck. Complications of this fracture are elbow stiffness (most common) or partial physeal arrest which can affect the length and alignment of the radius in the future (cubitus valgus) [2].

Angulation and translation in radial neck fracture determine the type of treatment. If angulation is less than 30° and translation is less than 03 mm, closed reduction with immobilization in a long-arm cast is acceptable. Operative repair is usually indicated when the fracture angulation is greater than 30 degrees (following attempts at a closed reduction), translation of greater than 3 mm, and the reduced range of supination and pronation of under 45 degrees [2].

This operative repair of this injury (Salter-Harris type 4) means is:

• Closed percutaneous reduction using a K-wire or the Metaizeau technique using an elastic retrograde intramedullary nail [1,2].
• Open reduction by lateral skin incision (5-6 cm gently curved skin incision over the lateral condyle, elbow at 90 degrees or alternatively) or a posterolateral incision (behind the supracondylar ridge to the lateral border of the ulna) followed by a K-wire fixation or elastic stable intramedullary nailing (Metaizeau technique) [1,2].

Open reduction should only be used if closed procedure fails because open procedure, complications such as avascular necrosis, non-union, and radio-ulnar synostosis can occur [1,3].