Ultrasound-guided treatment for pediatric phalangeal and metatarsal fractures

This study aimed to compare the effectiveness of ultrasound-guided closed reduction and fixation versus traditional techniques in managing pediatric phalangeal and metatarsal fractures.

This retrospective study included 112 pediatric patients with phalangeal or metatarsal fractures treated between January 2020 and December 2023. The participants were categorized into two groups: the ultrasound-guided group (US-guided; n = 50, including 37 with phalangeal and 13 with metatarsal fractures) and the conventional fluoroscopy-guided group (C-group; n = 62, including 32 with phalangeal and 30 with metatarsal fractures). The collected data included surgical time, frequency of X-ray examinations, radiation exposure, closed reduction rate, complication rate, and postoperative function. Postoperative functional outcomes were assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system.

Surgical time was significantly shorter in the US-guided group (average 44.36 ± 15.23 min) than in the C-group (average 59.15 ± 18.85 min; p < 0.001). Additionally, the US-guided group required approximately four fewer X-ray examinations (2.98 ± 0.94 vs. 7.31 ± 1.47, p < 0.001). Radiation exposure was significantly lower in the US-guided group (1.73 ± 0.54 mGy) than in the C-group (4.24 ± 0.85 mGy, p < 0.001). In the US-guided group, the surgical time for phalangeal fractures was shorter than that for metatarsal fractures (41.08 ± 14.17 min vs. 53.69 ± 14.74 min, p = 0.009). However, there were no significant differences in the closed reduction rate (US-guided group vs. C-group; 92% vs. 80.6%, p = 0.08), AOFAS score (93.6 ± 7.81 vs. 94.16 ± 5.27, p = 0.65), or complication rate (2% vs. 3.2%, p = 0.69).

Ultrasound-guided closed reduction and fixation significantly shortened surgical time, reduced X-ray frequency and radiation exposure versus fluoroscopy-guided treatment. With additional advantages in efficiency, simplicity and reproducibility, this approach appears to be a safe and effective option for pediatric phalangeal and metatarsal fractures.