Skip to main content

Advertisement

SpringerLink
Log in

Ultrasound assistance in treatment with elastic stable intramedullary nail fixation in radial and ulnar fractures in children

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

Radial and ulnar fractures are one of the most common fractures in children. When closed reduction of fractures fails, elastic stable intramedullary nail (ESIN) fixation can mostly be used under the guidance of fluoroscopy. In this study, we evaluated the effect of ultrasound (US) as assistance for radial and ulnar fracture reduction and the insertion of ESINs.

Methods

There were 56 patients with midshaft radial and ulnar fractures included in our hospital from March 2019 to August 2021. After applying the inclusion and exclusion criteria and according to the treatment method, they were divided into the US group (patients treated with US assistance) and the conventional group (C-group, patients treated with fluoroscopy guidance). All patients’ clinical data were collected. Operation time, fluoroscopy times, radiation dose, and post-operative complications were analyzed. The elbow function was evaluated using the Mayo Elbow Performance Index.

Results

There were 26 patients in the US group and 30 in the C-group. The average operation time was 44.5±19.4 min in the US group and 65.1±16.2 min in the C-group. There were significant differences regarding the surgery time, fluoroscopy time, and radiation dose between the groups (all p = 0.001). The average follow-up time was 13.5±3.1 months. No significant difference was found regarding radial nerve injury, extensor pollicis longus rupture, non-union or delayed union, ulnar nerve injury, or acute compartment syndrome. There was no difference in elbow function at the final follow-up.

Conclusion

US guidance can be adopted for the treatment of displaced radial and ulnar fracture reduction and the insertion of ESINs. It can significantly decrease fluoroscopy times, radiation doses, and duration of surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Cheng JC, Shen WY (1993) Limb fracture pattern in different pediatric age groups: a study of 3,350 children. J Orthop Trauma 7:15–22

    Article  CAS  PubMed  Google Scholar 

  2. Soumekh L, Sylvanus T, Karlen A, Wahl C, Huser AJ, Truong WH (2021) Refracture rate of both bone forearm fractures: a retrospective comparison of casting alone versus casting and extended functional bracing. J Pediatr Orthop 41:267–272

    Article  PubMed  Google Scholar 

  3. Ho CA (2021) Radius shaft fractures-what alignment is acceptable at what age? Plates or flexible nails. J Pediatr Orthop 41:S14–S19

    Article  PubMed  Google Scholar 

  4. Li Y, James C, Byl N, Sessel J, Caird MS, Farley FA, Robbins C (2020) Obese children have different forearm fracture characteristics compared with normal-weight children. J Pediatr Orthop 40:e127–e130

    Article  PubMed  Google Scholar 

  5. Kosuge D, Barry M (2015) Changing trends in the management of children’s fractures. Bone Joint J 97-B:442–448

    Article  CAS  PubMed  Google Scholar 

  6. Perhomaa M, Kyrö A, Niinimäki J, Sinikumpu JJ (2022) Retrograde intramedullary nailing of the radius in children: a pilot magnetic resonance imaging study of soft-tissue findings. J Child Orthop 16:269–275

    Article  PubMed  PubMed Central  Google Scholar 

  7. Li J, Wu J, Zhang Y, Gou P, Li X, Shi M, Zhang M, Wang P, Liu X (2021) Elastic stable intramedullary nailing for pediatric humeral shaft fractures under ultrasonographic guidance: a retrospective study. Front Pediatr 9:806100

    Article  PubMed  Google Scholar 

  8. Korhonen L, Perhomaa M, Kyrö A, Pokka T, Serlo W, Merikanto J, Sinikumpu JJ (2018) Intramedullary nailing of forearm shaft fractures by biodegradable compared with titanium nails: results of a prospective randomized trial in children with at least two years of follow-up. Biomaterials 185:383–392

    Article  CAS  PubMed  Google Scholar 

  9. Sinikumpu JJ, Keränen J, Haltia AM, Serlo W, Merikanto J (2013) A new mini-invasive technique in treating pediatric diaphyseal forearm fractures by bioabsorbable elastic stable intramedullary nailing: a preliminary technical report. Scand J Surg 102:258–264

    Article  PubMed  Google Scholar 

  10. Lascombes P, Prevot J, Ligier JN, Metaizeau JP, Poncelet T (1990) Elastic stable intramedullary nailing in forearm shaft fractures in children: 85 cases. J Pediatr Orthop 10:167–171

    Article  CAS  PubMed  Google Scholar 

  11. Furlan D, Pogorelić Z, Biočić M, Jurić I, Budimir D, Todorić J, Šušnjar T, Todorić D, Meštrović J, Milunović KP (2011) Elastic stable intramedullary nailing for pediatric long bone fractures: experience with 175 fractures. Scand J Surg 100:208–215

    Article  CAS  PubMed  Google Scholar 

  12. Weiss JM, Mencio GA (2012) Forearm shaft fractures: does fixation improve outcomes. J Pediatr Orthop 32(Suppl 1):S22–S24

    Article  PubMed  Google Scholar 

  13. Fernandez FF, Langendörfer M, Wirth T, Eberhardt O (2010) Failures and complications in intramedullary nailing of children’s forearm fractures. J Child Orthop 4:159–167

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Toor R, Antao N, Ghag N (2021) Rare presentation of ulnar nerve palsy in closed both bone forearm fracture in pediatric population. J Orthop Case Rep 11:62–66

    PubMed  PubMed Central  Google Scholar 

  15. Federer AE, Murphy JS, Calandruccio JH, Devito DP, Kozin SH, Slappey GS, Lourie GM (2018) Ulnar nerve injury in pediatric midshaft forearm fractures: a case series. J Orthop Trauma 32:e359–e365

    Article  PubMed  Google Scholar 

  16. Martus JE, Preston RK, Schoenecker JG, Lovejoy SA, Green NE, Mencio GA (2013) Complications and outcomes of diaphyseal forearm fracture intramedullary nailing: a comparison of pediatric and adolescent age groups. J Pediatr Orthop 33:598–607

    Article  PubMed  Google Scholar 

  17. Menachem S, Sharfman ZT, Perets I, Arami A, Eyal G, Drexler M, Chechik O (2016) Does fluoroscopy improve outcomes in paediatric forearm fracture reduction. Clin Radiol 71:616.e1–616.e5

    Article  CAS  PubMed  Google Scholar 

  18. Lee MC, Stone NE 3rd, Ritting AW, Silverstein EA, Pierz KA, Johnson DA, Naujoks R, Smith BG, Thomson JD (2011) Mini-C-arm fluoroscopy for emergency-department reduction of pediatric forearm fractures. J Bone Joint Surg Am 93:1442–1447

    Article  PubMed  Google Scholar 

  19. Malahias MA, Manolopoulos PP, Kadu V, Shahpari O, Fagkrezos D, Kaseta MK (2018) Bedside ultrasonography for early diagnosis of occult radial head fractures in emergency room: a CT-comparative diagnostic study. Arch Bone Jt Surg. 6:539–546

    PubMed  PubMed Central  Google Scholar 

  20. Rowlands R, Rippey J, Tie S, Flynn J (2017) Bedside ultrasound vs X-ray for the diagnosis of forearm fractures in children. J Emerg Med. 52:208–215

    Article  PubMed  Google Scholar 

  21. Scheier E, Balla U (2022) Ultrasound-guided distal forearm fracture reduction by pediatric emergency physicians: a single center retrospective study. Pediatr Emerg Care 38:e756–e760

    Article  PubMed  Google Scholar 

  22. Kotlarsky P, Feldman O, Shavit I, Eidelman M (2022) The use of real-time sonography-assisted fracture reduction in children with displaced forearm fractures. J Pediatr Orthop B 31:303–309

    Article  PubMed  Google Scholar 

  23. Auten JD, Naheedy JH, Hurst ND, Pennock AT, Hollenbach KA, Kanegaye JT (2019) Comparison of pediatric post-reduction fluoroscopic- and ultrasound forearm fracture images. Am J Emerg Med 37:832–838

    Article  PubMed  Google Scholar 

  24. Singh A, Khalil P (2021) Point-of-care ultrasound-guided hematoma block for forearm fracture reduction. Pediatr Emerg Care 37:533–535

    Article  PubMed  Google Scholar 

  25. Su Y, Jin C, Duan X, Wang J, Li K (2020) Treatment of displaced radial neck fractures under ultrasonographic guidance in children. Int Orthop 44:2337–2342

    Article  PubMed  Google Scholar 

  26. Broberg MA, Morrey BF (1986) Results of delayed excision of the radial head after fracture. J Bone Joint Surg Am 68:669–674

    Article  CAS  PubMed  Google Scholar 

  27. Tokarski J, Avner JR, Rabiner JE (2018) Reduction of radiography with point-of-care elbow ultrasonography for elbow trauma in children. J Pediatr. 198:214–9.e2

    Article  PubMed  Google Scholar 

  28. Wu Y, Lu R, Liao S, Ding X, Su W, Wei Q (2021) Application of ultrasound in the closed reduction and percutaneous pinning in supracondylar humeral fractures. J Orthop Surg Res. 16(1):588

    Article  PubMed  PubMed Central  Google Scholar 

  29. Li XT, Shen XT, Wu X, Chen XL (2019) A novel transverse ultrasonography technique for minimally displaced lateral humeral condyle fractures in children. Orthop Traumatol Surg Res. 105:557–562

    Article  PubMed  Google Scholar 

  30. Connolly B, Racadio J, Towbin R (2006) Practice of ALARA in the pediatric interventional suite. Pediatr Radiol. 36(Suppl 2):163–167

    Article  PubMed  PubMed Central  Google Scholar 

  31. Wellsh BM, Kuzma JM (2016) Ultrasound-guided pediatric forearm fracture reductions in a resource-limited ED. Am J Emerg Med. 34:40–44

    Article  PubMed  Google Scholar 

  32. Okoroafor UC, Cannada LK, McGinty JL (2017) Obesity and failure of nonsurgical management of pediatric both-bone forearm fractures. J Hand Surg Am. 42(9):711–716

    Article  PubMed  Google Scholar 

  33. Korhonen L, Lutz N, Sinikumpu JJ (2020) The association of metal frame construct of ESIN and radiographic bone healing of pediatric forearm fractures. Injury. 51(4):856–862

    Article  PubMed  Google Scholar 

  34. Brooker B, Harris PC, Donnan LT, Graham HK (2014) Rupture of the extensor pollicis longus tendon following dorsal entry flexible nailing of radial shaft fractures in children. J Child Orthop. 8(4):353–357

    Article  PubMed  PubMed Central  Google Scholar 

  35. Di Gennaro GL, Stilli S, Trisolino G (2017) Post-traumatic forearm nonunion in healthy skeletally immature children: a report on 15 cases. Injury. 48(3):724–730

    Article  PubMed  Google Scholar 

  36. Blackman AJ, Wall LB, Keeler KA et al (2014) Acute compartment syndrome after intramedullary nailing of isolated radius and ulna fractures in children. J Pediatr Orthop. 34(1):50–54

    Article  PubMed  Google Scholar 

Download references

Data availability

All the original clinical data can be achieved if asking for the corresponding author.

Author information

Authors and Affiliations

  1. Pediatric Surgery, The Second Affiliated Hospital of Shandong First Medical University, Changcheng Road 619#, Taian City, Shandong Province, China

    Song Jia, Cheng Xu & Kuang Li

  2. Ultrasound Department, The Second Affiliated Hospital of Shandong First Medical University, Taian, Shandong, China

    Jing Wang

  3. Pediatric Orthopedics, Affiliated Hospital of Jining Medical University, Jining, Shandong, China

    Baohua Yu

Authors
  1. Song Jia
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jing Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Baohua Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cheng Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kuang Li
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

KL and SJ participated in the study and drafted the manuscript. JW, BY, and CX collected the clinical data and helped draft the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Kuang Li.

Ethics declarations

Ethics approval

The ethics committee of The Second Affiliated Hospital of Shandong First Medical University approved this study.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent for publication

Informed consent for the publication of photographs was obtained from all subjects.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Level of evidence: III

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jia, S., Wang, J., Yu, B. et al. Ultrasound assistance in treatment with elastic stable intramedullary nail fixation in radial and ulnar fractures in children. International Orthopaedics (SICOT) 47, 773–779 (2023). https://doi.org/10.1007/s00264-022-05683-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-022-05683-9

Keywords

Search

Navigation