[Closed reduction guided with ultrasound for distal radius metaphysis fracture in children]

To explore the applications of ultrasound guidance in the closed reduction of distal radius metaphysis fracture (DRM) in children.

A retrospective analysis was conducted on 74 children of completely displaced DRM, who were admitted between October 2019 and March 2024 and met the selective criteria. All cases were made an attempt of closed reduction and plaster cast fixation. If closed reduction failed, the patient was readmitted for reduction under anesthesia and Kirschner wires fixation. The ultrasound group consisted of 25 cases reduced under ultrasound guidance. The fluoroscopy group consisted of 22 cases reduced under fluoroscopy guidance. The control group consisted of 27 cases reduced without any imaging device. There was no significant difference in the baseline data among the three groups ( P>0.05), including age, gender, involved side, cause of injury, interval from injury to reduction, and proportion of concomitant distal ulnar fracture. The reduced time, fluoroscopy frequency, and complication of the three groups were recorded, as well as the successful reduction rate, the re-displacement rate, and the ultimate reduction rate. At last follow-up, modified Green-O'Brien score was used to assess the recovery of the function in involved wrists.

The successful reduction rates and ultimate reduction rates were significantly higher in ultrasound group and fluoroscopy group than in control group ( P<0.05). But no significant difference was found between ultrasound group and fluoroscopy group ( P>0.05). The re-displacement rates and reduced time showed no significant difference among the three groups ( P>0.05). The fluoroscopy frequency was significantly higher in fluoroscopy group than in ultrasound group and control group ( P<0.05). But no difference was found between ultrasound group and control group ( P>0.05). All patients were followed up 13-16 months (mean, 14 months). All fractures healed within 4 to 6 weeks after the final reduction/operation. At last follow-up, the functions of involved wrists were all evaluated as excellent according to modified Green-O'Brien score in the three groups.

Satisfactory outcomes of DRM in children treated with closed reduction under ultrasound guidance and plaster cast fixation can be achieved with radiation-free advantage compared with reduction under fluoroscopy and a higher successful reduction rate compared with reduction without imaging device.