Determining the stability of minimally displaced lateral humeral condyle fractures in children: ultrasound is better than arthrography

Abstract

Background Evaluating of the articular cartilage status of the distal humeral epiphysis is difficult. Ultrasound imaging of the elbow is increasingly being used to confirm the integrity of the articular cartilage of minimally displaced lateral humeral condyle fractures in children with minimally displaced fractures. The aims of this study were to assess the correlations between ultrasound and arthrography findings for predicting the integrity of the cartilage hinge and to describe the utility of ultrasound in determining the need for pre-treatment. Methods Thirty-nine patients with minimally displaced lateral humeral condyle fractures who underwent ultrasound and arthrography examinations before surgery from May 2018 to December 2019 were included in this study. Ultrasound and arthrography predictors of the cartilage hinge status were independently measured. The ultrasound and arthrography results were compared. Results The mean displacement of the fractures was 3.1 mm (range, 2.0~5.0 mm). Arthrography showed incomplete fractures in 24 patients (61.5%) and complete fractures in 15 patients (38.5%). Ultrasound showed incomplete fractures in 25 patients (64.1%) and complete fractures in 14 patients (35.9%). The ultrasound and arthrography results of the integrity of the articular surface were consistent in 92.3% of the cases, including 23 that were predicted to have an intact articular surface and 13 that were predicted to have an incongruity articular surface. There was no correlation between the displacement and the fracture appearing complete on the ultrasound scan. The Pearson coefficient between ultrasound and arthrography for assessing the integrity of the articular surface was 0.837. Conclusions Ultrasound and arthrography assessments of the integrity of the cartilage hinge status appear to be highly consistent. Ultrasound can be used as a complementary tool with arthrography to predict the integrity of the cartilage hinge status in children with minimally displaced lateral humeral condyle fractures. Level of evidence Prospective study; level II.

A novel approach for the treatment of Jacob II and III fractures of the lateral humeral condyle in children: Percutaneous Kirschner wire fixation with ultrasound localization

“…The lateral condyle fracture of the humerus is the second most frequent elbow fracture in children. Ultrasound technology has become extremely popular clinically, given its convenience, non-invasiveness, and ability to visualize neurovascular and soft tissues ( 4 ). Kirschner wire fixation with ultrasound localization represents a more effective approach consistent with the contemporary concept of minimally invasive surgery.…”

“…However, arthrography requires repeated x-ray fluoroscopy, which increases the risk of iatrogenic radiation damage and is an invasive procedure with hazards such as allergies to contrast agents. In recent years, ultrasound has been widely employed in treating lateral condyle fractures in children due to its ability to visualize cartilage hinges, properly determine re-displacement risk, and avoid iatrogenic harm ( 4 , 5 ). Therefore, the clinical efficacy of percutaneous Kirschner wire fixation for children with Jacob II and III fractures of the lateral humeral condyle under ultrasound localization was assessed in the present study.…”

Clinical value of MRI in evaluating and diagnosing of humeral lateral condyle fracture in children

“…It still a big challenge for orthopedic pediatricians and radiologists. For better diagnosis and treatment in HLCFs, some studies tried to use modified radiograph projection, high-frequency ultrasound or arthrography to improve the accuracy of HLCFs' diagnosis, but each examination had its own limitations, and the results were also inconsistent [ 2 – 4 ]. MRI has the advantages of high resolution of soft tissues, multi-directional, multi-parameter imaging, etc.…”

Determining the stability of minimally displaced lateral humeral condyle fractures in children: ultrasound is better than arthrography

“…We read with interest the recent publication by Wu and colleagues [1]. Weiss et al [2] defined a classification system and treatment for lateral humeral condyle fractures (LHCF) based on fracture displacement and articular congruity: Bernthal et al [3] reported on 141 LCHFs, 76 treated non-operatively, 14 with CRPP and 51 with ORIF.…”

“…Li et al [5,6] being the same authors as Wu et al [1] previously reported that the lateral humeral cartilage hinge and fracture stability can be accurately determined with transverse ultrasound (US), based on US examinations performed on children with LHCFs treated between February 2013 and May 2019, without the need for arthrograms.…”