ABSTRACT
Objective:To compare the clinical efficacy of ultrasound-guided closed reduction and bare-handed reduction on pediatric distal radius fractures.Methods:Clinical data of 118 consecutive pediatric patients with distal radius fracture treated in the Wuhan Children′s Hospital, Tongji Medical College, Huazhong University of Science & Technology from April 2018 to August 2019 were retrospectively analyzed.Patients treated with bare-handed reduction and ultrasound-guided closed reduction were respectively classified into group Ⅰ (58 cases) and group Ⅱ (60 cases). Baseline characteristics, treatment duration, out-patient treatment cost, postoperative pain and the modified Mayo wrist function score during the follow-up visits between groups were compared by the t test.The success rate of initial reduction, reduction times, hospitalization rate and complication between 2 groups were compared by the Chi- square test.The number of postoperative imaging scans between 2 groups was compared by the Mann- Whitney U test. Results:There were no significant differences in out-patient treatment cost and hospitalization rate between 2 groups (all P>0.05). There were significant differences in the length of stay [ (166.2±54.8) min vs.(142.6±49.2) min], success rate of initial reductions [72.4%(42/58 cases ) vs.88.3%(53/60 cases)], incidence of repeated reductions (27.6% vs.1.7%) and the incidence of postoperative repeated imaging scans (20.7% vs.1.7%) between groupⅠ and group Ⅱ (all P<0.05). A total of 104 patients (88.1%) were successfully treated with closed reduction and followed up, with a rate of success reductions.Among them, success rate of closed reduction in group Ⅰ and Ⅱ were 86.2% and 90.0%, respectively.The mean time of fracture healing was 43 (34-56) days.There were no significant differences in fracture healing time and pain score between 2 groups(all P>0.05). The modified Mayo wrist score was significantly lower in group Ⅰ than that of group Ⅱ[(97.3±4.1) points vs.(98.8±2.9) points, P<0.05]. Seven patients in group Ⅰ suffered fracture re-displacement, including 6 cases within 1 case week and 1 within 2 weeks, and 4 cases admitted to the surgical ward for further management.Five patients in group Ⅱ had re-displacement within 1 week of plaster fixation, of which 2 cases admitted to the surgical ward for further management, which was comparable between groups( P>0.05). Conclusions:Both ultrasound-guided closed reduction and bare-handed reduction are effective on the treatment of pediatric distal radius fractures, showing low incidence of complications and satisfactory functional results.Owing to its higher success rate of initial reduction, lower frequency of postoperative ra-diography and shorter length of stay, ultrasound-guided closed reduction should be recommended.
ABSTRACT
Objective:To investigate the curative effect of Doppler ultrasound-guided management of vascular injury of Gartland type Ⅲ supracondylar fractures of humerus in children.Methods:A prospective study on 18 children with vascular complications of pulseless Gartland type Ⅲ supracondylar humeral fracture who were admitted at Department of Pediatric Orthopedic Surgery, Wuhan Children′s Hospital from March 2017 to March 2018 was conducted.Among these children, 12 were male and 6 were female, with the age of 2.1-8.6 years (mean 4.4 years old), and 10 cases were injured on the left and 8 cases on the right.All patients were satisfied with closed reduction and internal fixation within 24 hours after injury.Before the operation, Doppler ultrasound was performed to determine the shape of brachial artery and it relationship with fracture.During reduction, Doppler ultrasound was used to assess brachial pulse and blood perfusion.Then, the brachial artery was assessed by palpable radial pulse and peripheral blood supply, and elbow joint function was evaluated with Mayo Elbow Performance Score and Flynn criteria.Results:Eighteen patients were followed up for 6 to 12 months (average 9 months) after operation.Before reduction, radial pulse disappeared and peripheral blood supply was good in 18 cases.Preoperative Doppler ultrasonography showed that the brachial artery was located in front of the proximal humerus fracture fragment.A proximal stream of the brachial artery was identified, but the distal blood vessels were compressed by the fragment.A stream of radial artery was identified in 5 patients with Doppler, and no stream was identified in 13 patients.After reduction, the peripheral blood supply of all the affected limbs was good, among which the peripheral blood supply, 1 case returned to normal after 5 minutes waiting.Specifically the palpable radial pulse was immediately restored in 14 patients.The palpable radial pulse did not restore but the peripheral blood supply was good in 4 cases.Intraoperative ultrasonography showed that brachial artery blood flow was good, and palpable radial pulse was restored between 3 to 5 weeks later.In patients with at average sixteen-week neurological follow-up, 5 patients had complete resolution of nerve palsy.No complications such as forearm compartment syndrome and elbow joint dysfunction occurred.Functional outcome as measured by Flynn criteria was excellent in 12 patients, good in 6 patients, the excellent and good rate was 100%.Functional outcome as measured by Mayo Elbow Performance Score was excellent in 17 patients, good in one patient, the excellent and good rate was 100%.Conclusion:Ultrasound-guided is a safe and reliable option to treat pulseless Gartland type Ⅲ supracondylar humeral fracture.