Ultrasonography-guided closed reduction in the treatment of displaced transphyseal fracture of the distal humerus

J Orthop Surg Res. 2020 Dec 1;15(1):575. doi: 10.1186/s13018-020-02118-2.

Abstract

Background: To evaluate the clinical and radiographic outcomes of ultrasonography-guided closed reduction in the treatment of displaced transphyseal fracture of the distal humerus (TFDH).

Methods: Twenty-seven patients with displaced TFDH were successfully treated by the ultrasonography-guided closed reduction during January 2012 to December 2016 and were retrospectively reviewed. After the mean follow-up of 34.88 months, the clinical and radiographic outcomes of patients were evaluated. The cubitus varus of the affected elbows was also assessed at the latest follow-up.

Results: The successful rate of ultrasonography-guided closed reduction in the treatment of displaced TFDH was 84% (27/32). The twenty-seven patients with successful reduction were included for the following analysis. There were 20 males and 7 females included in the study, and the mean age at treatment was 15.39 ± 3.10 months; seventeen fractures occurred in the right side elbow and ten in the left side. At the last follow-up, there were significant decreases in the elbow flexion (3°, P = 0.027) and range of motion (5°, P = 0.003) between the injured and uninjured elbow, respectively, whereas no difference in elbow extension was detected (P = 0.110). Flynn's criteria assessment showed that all the patients achieved excellent or good outcomes both in the functional and cosmetic categories. The clinical and radiographic carrying angles at the last follow-up were 11.67 ± 3.11° and 10.46 ± 3.88°, respectively. And the incidence of cubitus varus after treatment was 7.4% at the last follow-up.

Conclusion: The ultrasonography-guided closed reduction in the treatment of displaced TFDH is an effective procedure; the adequate fracture reduction can be acquired with the advantages of real-time, non-radioactive, and simple utilization. With the percutaneous pining fixation, satisfactory clinical and radiographic outcomes can be achieved with a low incidence of postoperative cubitus varus.

Keywords: Closed reduction; Displaced transphyseal fracture of the distal humerus; Ultrasonography.

MeSH terms

  • Closed Fracture Reduction / methods*
  • Elbow / diagnostic imaging
  • Elbow / physiopathology
  • Elbow / surgery
  • Elbow Injuries
  • Female
  • Follow-Up Studies
  • Fractures, Bone / diagnostic imaging
  • Fractures, Bone / physiopathology
  • Fractures, Bone / surgery*
  • Humans
  • Humerus / diagnostic imaging
  • Humerus / injuries*
  • Humerus / physiopathology
  • Humerus / surgery*
  • Infant
  • Male
  • Radiography
  • Range of Motion, Articular
  • Retrospective Studies
  • Surgery, Computer-Assisted / methods*
  • Treatment Outcome
  • Ultrasonography / methods*