Elastic Stable Intramedullary Nailing for Pediatric Humeral Shaft Fractures Under Ultrasonographic Guidance: A Retrospective Study

Abstract

ObjectiveFixation with an elastic stable intramedullary nail (ESIN) is a widely used technique for the treatment of humeral shaft fractures. Ultrasonography (US) is used as an auxiliary tool and alternative to radiography during surgery to reduce radiation damage, but whether it is effective in pediatric patients is not known. In this study we evaluated the utility of US in the treatment of pediatric humeral shaft fractures by closed reduction and fixation with an ESIN.MethodsChildren who were admitted to our hospital with humeral shaft fractures were retrospectively examined from January 2016 to March 2019. The patients were divided into 2 groups, US (treated by US-guided closed reduction and ESIN fixation) and non-US (treated with the same technique but with intraoperative radiography instead of US). The postoperative functional recovery of the 2 groups was compared.ResultsThe study population comprised 28 boys and 17 girls (age range: 4–16 years) with humeral shaft fractures. US significantly reduced radiation exposure during the operation (P = 0.008), and intraoperative US facilitated the detection of nerve and vascular injury and aided surgical planning. There was no difference between the 2 groups in postoperative recovery based on the Constant–Murley shoulder score (CMS).ConclusionsThese results demonstrate that US-guided closed reduction and ESIN fixation for humeral shaft fractures can limit radiation exposure and help doctors to determine the optimal surgical strategy to avoid radial nerve injury.

Color Doppler ultrasound for assessing the efficacy of conservative treatment of pediatric femoral shaft fractures at different sites

“…Ultrasound also plays a key role in surgical treatment. Ultrasound-guided surgery for pediatric fractures gradually used [14].…”

“…Ultrasonography has relatively good imaging of soft tissue injuries [9,10] and can assist in clarifying whether there is concomitant nerve damage [11][12][13], and the information can assist in diagnosis of bone fractures. Nowadays, ultrasonography is gradually used in children with fractures to assist in localization during surgical treatment [14][15][16][17]. During the healing process of fracture, the distribution of blood supply at the fracture site is extremely important [18].…”

The emerging application of ultrasound technology in pediatric bone fractures: Clinical application, related issues and development prospect

“…The ultrasound‐guided fixation has better results compared to traditional C‐arm fluoroscopic‐assisted fixation. In a study of 45 children who underwent the same procedure with X‐ray assistance and ultrasound assistance, we found that the use of ultrasound‐assisted surgery not only significantly reduced radiation exposure, but also showed no significant difference in postoperative recovery between the two based on the Constant–Murley shoulder score 32 . In another recent study, 56 children with forearm fractures were treated with ultrasound guidance and fluoroscopy guidance, and the results showed statistical differences in operative time, fluoroscopy time, and radiation dose between the two groups, with the ultrasound group performing better and with no differences in elbow function between the two groups at final follow‐up 33 .…”

“…In a study of 45 children who underwent the same procedure with X-ray assistance and ultrasound assistance, we found that the use of ultrasound-assisted surgery not only significantly reduced radiation exposure, but also showed no significant difference in postoperative recovery between the two based on the Constant-Murley shoulder score. 32 In another recent study, 56 children with forearm fractures were treated with ultrasound guidance and fluoroscopy guidance, and the results showed statistical differences in operative time, fluoroscopy time, and radiation dose between the two groups, with the ultrasound group performing better and with no differences in elbow function between the two groups at final follow-up. 33 This suggests that ultrasound technology also plays an important role in the surgical treatment in pediatric fractures and holds promise as an alternative to conventional X-ray to reduce radiation exposure to patients and health care workers during surgery.…”