Femur Fracture Diagnosis and Management Aided by Point-of-Care Ultrasonography

Ali, Afrah. A.; Solomon, David M.; Hoffman, Robert J.

doi:10.1097/pec.0000000000000732

“…In line with several previous studies [ 12 , 13 , 15 , 16 ], we also demonstrated the feasibility of surveillance US for the diagnosis and closed reduction of fractures in children. We have previously shown that US can improve the reduction of radial neck fractures in children [ 20 ].…”

Section: Discussionsupporting

confidence: 90%

“…It has the advantages of no radiation, dynamic monitoring, and easy learning and usage, as well as low cost and easy availability of equipment [ 11 – 14 ]. Recently, an increasing number of surgeons have also found US to be useful in the diagnosis of fractures, especially in young children, wherein the bone is not ossified and covered by cartilage, such as the forearm [ 13 ], radial head [ 12 ], femur [ 15 ], and metatarsal [ 16 ] fractures. It has also been found to be useful in the diagnosis of occult or missed fractures in children [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Surveillance ultrasonography for conservative treatment of femoral shaft fractures in young children

Gao

¹

,

Wang

²

,

Su

³

2020

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Background The treatment for femoral shaft fracture (FSF) depends on the age of the patient. While the Pavlik harness is the first choice for patients under 6 months of age, spica casting is preferred for patients over 6 months and under preschool age. Minimally-invasive surgery using elastic stable intramedullary nails is also used in some cases. Skin traction is another treatment choice for some patients who are not candidates for the above methods. This study aimed to evaluate the feasibility of surveillance ultrasonography (US) for the conservative treatment of FSFs in young children. Materials and methods This retrospective study included 92 children who were diagnosed with FSF in our hospital from April 2017 to May 2019. After applying the inclusion and exclusion criteria, they were divided into US surveillance (A) and control (B) groups. All patients received conservative treatment by skin traction. For group A, US was used to assess the femur fractures and adjust its reduction on days 1, 3, 5, 7, 10, and 14 until the fracture stabilized. For group B, the fractures were checked by radiographs on days 1, 3, 5, 7, 10, and 14 until the callus appeared. The FSF angle was measured using anteroposterior and lateral radiographs. Results All patients were followed up for 18 months. The radiographic evaluation of both groups at the final follow-up showed a significant difference in the FSF angle. The radiograph times and accumulated radiation also showed significant differences between the two groups. However, there was no significant difference in the incidence of complications. Conclusions For FSF closed reduction, surveillance US is a better option compared to radiographs in children treated by skin traction. This approach can significantly decrease exposure to X-ray radiation and improve the reduction. Level of evidence III

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“…MRI is available to display cartilage well, but it is impossible to determine fracture reduction quality in real-time during surgery. US nonionizing radiation has been reported in fracture diagnosis applications for children [21][22][23][24]. Very few scholars have reported the use of US-guided prying reduction for radial neck fractures [12].…”

Section: Discussionmentioning

confidence: 99%

Ultrasonography-Guided Combination with Elbow Arthrography-Assisted Minimally Invasive Treatment of Radial Neck Fractures in Young Children

Du

¹

,

Yu

²

,

Wu

³

et al. 2022

Computational and Mathematical Methods in Medicine

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Background. A radius neck fracture in children is a common fracture that not only affects the growth and development of children but also has a certain impact on the function of children’s elbow joints. Objective. To probe into the application value of ultrasonography- (US-) guided combination with elbow arthrography in the minimally invasive treatment of radial neck fractures in young children, summarize its clinical effect and provide a minimally invasive, safe, effective, and reliable method for treating radial neck fractures in young children. Methods. Seventy-three patients with type III or IV radial neck fractures were treated from June 2013 to December 2020 and were divided into the Métaizeau group ( n = 31 , treatment group) and Kirschner wire ( k -wire) k -wire group ( n = 42 , control group). The Métaizeau group was given US-guided combination with elbow arthrography-assisted modified Métaizeau technique, the k -wire group received open reduction and internal fixation with k -wire and compared the surgical effect of the two groups. Results. In comparison with the k -wire group, time of operation, intraoperative bleeding volume, and hospital stay were signally junior to those in the Métaizeau group ( P < 0.05 ). After surgery, in comparison with the k -wire group, the number of degrees to contralateral flexion or forearm rotation was visually lower in the Métaizeau group ( P < 0.05 ), and postoperative complication incidence in the Métaizeau group was visually lower than that in k -wire group ( P < 0.05 ). Conclusion. In the minimally invasive treatment of radial neck fractures, US-guided combination with elbow arthrography in young children has better efficacy and high safety. It can be widely promoted and applied clinically.

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“…One of the fundamental ALARA (‘as low as reasonably achievable’) principles is to minimize or avoid radiation whenever possible [ 17 ]. Use of US rather than radiography is a representative recommendation based on the ALARA principle, and its advantages for the diagnosis of pediatric fractures has been demonstrated [ 11 – 13 , 18 , 19 ]. Several reports demonstrated the efficacy and safety of US-guided reduction of fractures at the emergency department.…”

Section: Discussionmentioning

confidence: 99%

“…Fluoroscopy has limitations in identifying pediatric bone with incomplete ossification, especially the radial head of young children [ 10 ]. Fractures could be sonographically identified along with subperiosteal hematomas, deformities, cortical disruption, and reverberating echoes [ 18 ]. Several researches demonstrated high sensitivity (86.6%–97%) and specificity (86.6%–100%) for fractures of the forearm bone and humerus [ 12 , 13 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

Ultrasonography-guided reduction of pediatric radial neck fractures

Lee

¹

,

Kim

²

,

Choi

³

2017

BMC Musculoskelet Disord

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BackgroundTreatment 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.MethodsAmong 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/cm2) 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.ResultsOf 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° (range: 46°–76°). The mean postoperative radial angulation was 5.6° (range: 2°–9°). The mean fluoroscopy time was 31 s (range: 10–73 s), and the mean DAP was 10.7 mGy/cm2 (range: 7.2–18.7 mGy/cm2). The mean follow-up period was 18.3 months (range, 8–24 months). According to the Metaizeau criteria, 10 cases were excellent and 2 cases were good at the last follow-up.ConclusionsUS-guided reduction and percutaneous fixation is safe and reliable option to treat displaced radial neck fractures in children.

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Femur Fracture Diagnosis and Management Aided by Point-of-Care Ultrasonography

Cited by 7 publications

References 16 publications

Surveillance ultrasonography for conservative treatment of femoral shaft fractures in young children

Surveillance ultrasonography for conservative treatment of femoral shaft fractures in young children

Ultrasonography-Guided Combination with Elbow Arthrography-Assisted Minimally Invasive Treatment of Radial Neck Fractures in Young Children

Ultrasonography-guided reduction of pediatric radial neck fractures

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