Impact of Transverse Ultrasound Images on the Classification and Treatment of Pediatric Lateral Humeral Condyle Fractures

Abstract

Background: Pediatric lateral humeral condyle fractures (LHCFs) are sometimes misdiagnosed and inappropriately treated on the basis of x-ray radiographs because cartilage cannot be seen on radiographs. However, as a useful technique, transverse ultrasonography can accurately and readily determine the integrity of the cartilage hinge in pediatric LHCFs. The purpose of this study was to assess the reliability of the Jakob classification, the treatment plan, and the necessity for further examination of pediatric LHCFs with the use of x-ray with and without transverse ultrasound images. Methods: Five pediatric orthopaedic surgeons with different levels of experience evaluated 62 cases on the basis of the use of x-ray alone and x-ray combined with transverse ultrasound images. These 2 types of evaluations were repeated after an interval of 4 to 6 weeks. At the time of each evaluation, all observers were asked to classify the fractures according to the Jakob classification, to formulate treatment plans, and to determine whether further examinations were required. Results: After the training of transverse ultrasound image interpretation, the interobserver reliability of the Jakob classification significantly improved from fair (a kappa of 0.54) to moderate (a kappa of 0.71) with the addition of transverse ultrasound images. The treatment plan was changed from conservative treatment to surgical treatment in 7% of the ratings but from surgical treatment to conservative treatment in 15% of the ratings after reviewing the ultrasound images, and the difference was statistically significant (P=0.003). Conclusions: The use of the Jakob classification and a treatment plan for pediatric LHCFs can be optimized by the addition of transverse ultrasound images, especially after training for transverse ultrasound image interpretation. Level of Evidence: Level III—diagnostic study.

Comparison of ultrasound-guided closed reduction and percutaneous pinning fixation for unstable humeral lateral condylar fractures

“…This three-center study with a medium sample size included all severely displaced HLCFs and an uncommon type of dislocation with more comprehensive fracture characteristics. It clearly reported the treatment outcomes of severely displaced HLCFs compared to previous studies (16)(17)(18). The surgical time was not increased, and the incidence of complications was comparable to that of previous reports (8,(19)(20)(21).…”

Criteria of ultrasound-guided closed reduction with percutaneous pinning in unstable humeral lateral condylar fractures: a three-center retrospective cohort study

“…According to Song's criteria, unstable HLCFs are traditionally treated by open reduction with k-wires fixation to ensure anatomical reduction of the cartilage hinge. In recent years, UG-CRPP has became popular and achieved good results in children (24)(25)(26). Ultrasonography can reveal the displacement, shape, rotation, alignment, and condylar shaft angle of the cartilage hinge.…”

“…Ultrasonography can reveal the displacement, shape, rotation, alignment, and condylar shaft angle of the cartilage hinge. During the HLCFs reduction process, the alignment of two fragments can be clearly observed, and the live first intracartilage k-wires fixation process reduces the pinning penetration time (13,18,(24)(25)(26)(27).…”

A comparative study: Ultrasound-guided leverage reduction with internal fixation using Kirschner wires or elastic stable intramedullary nailing for severely displaced radial neck fractures in children

“…Our team has been dedicated to the minimally invasive treatment of pediatric fractures under ultrasound guidance for more than 9 years, and has achieved promising initial success, demonstrating the potential of this approach in improving clinical outcomes for young patients . [27][28][29][30][31][32] Given ultrasound's superior penetration through the epiphysis and the distinct grayscale difference between bone, cartilage, and soft tissue, it effectively displays the radial head, the proximal cortex of the radius, and the relationship between the radial head and the distal articular surface of the humerus. Normally, the epiphysis appears as a hypoechoic area (dark area), with the ossification center and bone cortex exhibiting hyperechoic areas (bright areas).…”