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Ultrasonography-guided reduction of pediatric radial neck fractures
Jung Eun Lee1, Jung Bong Kim1, Eun Seok Choi2
1Department of Orthopaedic Surgery, Gachon University Gil Hospital, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, South Korea.
Insights
Ultrasonography (US)-guided reduction and fixation is a safe and effective method for treating displaced pediatric radial neck fractures. This technique minimizes radiation exposure while achieving excellent clinical outcomes.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Medical Imaging
Background:
- Displaced and angulated radial neck fractures in children present treatment challenges.
- Current treatments often rely on fluoroscopy, but ultrasonography (US)-guided reduction has not been previously reported.
- This study investigates the novel application of US-guided techniques for these fractures.
Purpose of the Study:
- To evaluate the safety and efficacy of ultrasonography (US)-guided reduction and percutaneous fixation for pediatric radial neck fractures.
- To compare US-guided methods with traditional fluoroscopy-based approaches in terms of outcomes and radiation dose.
Main Methods:
- A retrospective study of 12 pediatric patients with Judet type III or IV radial neck fractures treated between 2014 and 2016.
- Ultrasonography (US) was used for reduction monitoring, followed by percutaneous Kirschner wire fixation.
- Fluoroscopy confirmed fixation, and radiation dose (DAP) was measured. Outcomes were assessed using Metaizeau criteria after a minimum 6-month follow-up.
Main Results:
- The mean preoperative angulation of 62.5° was significantly reduced to a mean postoperative angulation of 5.6°.
- Mean fluoroscopy time was 31 seconds with a mean radiation dose of 10.7 mGy/cm².
- At a mean follow-up of 18.3 months, 10 cases showed excellent and 2 showed good results per Metaizeau criteria.
Conclusions:
- Ultrasonography (US)-guided reduction and percutaneous fixation offer a safe and reliable treatment option for displaced pediatric radial neck fractures.
- This technique demonstrates excellent clinical outcomes and potentially reduces radiation exposure compared to traditional methods.
Background:
Treatment of displaced and angulated radial neck fractures in children is controversial and challenging. Numerous studies have been conducted regarding treatment algorithms and surgical techniques that use fluoroscopy. However, ultrasonography (US)-guided reduction of pediatric radial neck fractures has not been reported yet. We aimed to determine the safety and efficacy of US-guided reduction and fixation of radial neck fractures in children.
Methods:
Among 28 cases of radial neck fracture from 2014 to 2016, 12 were classified as type III or IV according to the Judet classification. All 12 patients underwent US-guided reduction and percutaneous fixation with Kirschner wire and follow-up for more than 6 months. US was used primarily to monitor the angulation and reduction of the radial neck. Fluoroscopy was applied to confirm the fixation with Kirschner wire. Dose area product (DAP; mGy/cm2) was measured to assess per-procedure radiation dose. Radiological and clinical results were evaluated at 6 months after the surgery by using the Metaizeau criteria.
Results:
Of the patients, 4 were boys and 8 were girls, with a mean age of 7.7 years (range, 5-11 years). Judet type III fractures accounted for 83% of all injuries. The mean preoperative radial angulation was 62.5° (range: 46°-76°). The mean postoperative radial angulation was 5.6° (range: 2°-9°). The mean fluoroscopy time was 31 s (range: 10-73 s), and the mean DAP was 10.7 mGy/cm2 (range: 7.2-18.7 mGy/cm2). The mean follow-up period was 18.3 months (range, 8-24 months). According to the Metaizeau criteria, 10 cases were excellent and 2 cases were good at the last follow-up.
Conclusions:
US-guided reduction and percutaneous fixation is safe and reliable option to treat displaced radial neck fractures in children.
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