From the Guidelines
The Metaizeau technique of retrograde intramedullary pinning is not the gold standard for displaced fractures, as the current evidence supports closed reduction and percutaneous Kirschner wire pinning as the preferred treatment for most displaced supracondylar fractures of the humerus. This technique is favored due to its more favorable outcomes regarding cubitus varus and Flynn’s elbow criteria, as demonstrated by a meta-analysis 1. The number needed to treat (NNT) for cubitus varus is 20, and the NNT for Flynn’s elbow criteria is 7, indicating a significant benefit of this approach over other methods.
Key advantages of closed reduction and percutaneous Kirschner wire pinning include:
- Reduced risk of iatrogenic ulnar nerve injury, with a number needed to harm (NNH) of 108 1
- Improved outcomes in terms of range of motion and carrying angle, as measured by Flynn’s criteria 1
- Lower risk of limb-threatening ischemia compared to casting the arm in hyperflexion 1
In contrast, the Metaizeau technique, while offering benefits such as minimal soft tissue disruption and excellent cosmetic outcomes, is not supported by the most recent and highest quality evidence as the gold standard for treating displaced fractures. Therefore, closed reduction and percutaneous Kirschner wire pinning should be considered the preferred treatment for most displaced supracondylar fractures of the humerus, based on the current evidence 1.
From the Research
Displaced Radial Neck Fractures
- The Metaizeau technique of retrograde intramedullary pinning has been reported as an effective method for treating displaced radial neck fractures in children 2, 3, 4, 5.
- This technique involves the insertion of a Kirschner wire or other intramedullary device into the distal radius and advancing it proximally to reduce and stabilize the fracture.
- Studies have shown excellent results with this technique, including high rates of excellent or good outcomes and low rates of complications 2, 4, 5.
Comparison with Other Techniques
- One study compared antegrade intramedullary pinning with retrograde intramedullary pinning for displaced fifth metacarpal neck fractures and found some clinical advantages with antegrade pinning during the early recovery period, but no differences at 6 months postoperatively 6.
- However, this study did not specifically address radial neck fractures, and its findings may not be directly applicable to this type of fracture.
Evidence for the Metaizeau Technique
- A study published in the Journal of Pediatric Orthopedics in 1997 reported excellent results in 94% of cases using the Metaizeau technique for displaced radial neck fractures in children 2.
- Another study published in the American Journal of Orthopedics in 2014 reported that the Metaizeau technique is an effective method for minimally invasive surgical management of pediatric radial neck fractures, but noted that repeated intraoperative attempts can result in compartment syndrome 3.
- A video article published in JBJS Essential Surgical Techniques in 2024 demonstrated the technique of closed intramedullary pinning (the Metaizeau technique) for displaced radial neck fractures and reported excellent or good results in 90.5% of cases 4.
- A study published in the Turkish Journal of Trauma and Emergency Surgery in 2007 reported full functional recoveries with excellent results in all cases but one using the Metaizeau technique for displaced radial neck fractures in children 5.