Treatment of displaced radial neck fractures under ultrasonographic guidance in children
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ORIGINAL PAPER
Treatment of displaced radial neck fractures under ultrasonographic guidance in children Yuxi Su 1 & Chen Jin 2 & Xiaokun Duan 3 & Jing Wang 4 & Kuang Li 2 Received: 20 March 2020 / Accepted: 12 May 2020 # SICOT aisbl 2020
Abstract Purpose This study aimed to evaluate the feasibility of reduction under ultrasonographic (US) guidance with Kirschner wires (Kwires) and fixation with elastic stable intramedullary nails (ESINs) in the treatment of radial neck fractures (RNFs). Methods This retrospective study included 50 children treated for Judet types III and IV RNFs at our hospital from September 2015 to November 2018. Patients were divided into two groups: group A (without US) and group B (with US). Group A patients were treated using the Métaizeau technique; one K-wire was used for reduction under the guidance of X-ray fluoroscopy. Group B patients were treated using the same technique, but under the guidance of US. Post-operative radiographs, elbow function, and complications were analyzed. Results All patients were followed up over a period of 12 months. Five patients in group A had posterior interosseous nerve (PIN) injury, whereas no patient in group B had PIN injury (p = 0.016). The use of US guidance resulted in lower radiation exposure and shorter operation time. According to the Mayo Elbow Performance Index, there was no significant difference between the two groups (p = 0.814), including post-operative complications (radial head necrosis, fracture displacement, or stiffness). Conclusion US guidance during surgery is feasible to treat Judet type III and IV RNFs. US guidance can significantly reduce Xray radiation exposure and the risk of PIN injury. Keywords Close reduction . Kirschner wires . Radial neck fracture . Ultrasound
Introduction Radial neck fractures (RNF) account for approximately 1–3% of all fractures in children [1]. RNFs are usually caused by falls during the age of eight to 12 years. Although there is still
some controversy regarding the optimum treatment, in recent years, a consensus was achieved that RNFs should be treated conservatively if the displacement is less than 3 mm and the angle is less than 30° [1]. In addition, most surgeons favour conservative treatment because the elbow function is regained
Level of Evidence: III * Kuang Li [email protected]
1
Department II of Orthopaedics, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
2
Pediatric Surgery, The Second Affiliated Hospital of Shandong First Medical University Shandong, Changcheng Road 619#, Taian City, Shandong Province, China
3
Pediatric Orthopedics, Shandong Wendeng Osteopathic Hospital, Weihai, Shandong, China
4
Ultrasound Department, The Second Affiliated Hospital of Shandong
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