Ultrasonography-guided reduction of pediatric radial neck fractures

Abstract

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/cm(2)) 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 degrees (range: 46 degrees-76 degrees). The mean postoperative radial angulation was 5.6 degrees (range: 2 degrees-9 degrees). The mean fluoroscopy time was 31 s (range: 10-73 s), and the mean DAP was 10.7 mGy/cm(2) (range: 7.2-18.7 mGy/cm(2)). The mean follow-up period was 18.3 months (range, 824 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.