Ultrasound-guided vs. arthrogram-guided techniques in percutaneous leverage reduction of radial neck fractures in early childhood: A comparative study.

OBJECTIVE

This study aims to compare the safety and efficacy of ultrasound-guided and arthrogram-guided techniques in the treatment of radial neck fractures in early childhood using the percutaneous leverage technique.

METHODS

This retrospective case series study included children under 7 years of age with closed radial neck fractures who underwent surgery between November 2015 and July 2021. Patients were divided into two groups based on the guidance techniques employed: the ultrasound guidance group (19 cases) and the arthrogram guidance group (14 cases). The primary outcomes included operative time, radiation exposure, and postoperative functional outcomes assessed using the Métaizeau criteria and the Mayo Elbow Performance Score (MEPS).

RESULTS

No statistically significant differences were observed between the two groups concerning age, gender, injured side, or type of fractures. The ultrasound guidance group had a significantly shorter operative time (23.7 ± 5.9 min) compared to the arthrogram guidance group (33.1 ± 10.0 min) (P < 0.05). The ultrasound guidance group did not require radiation exposure (mean 0), in contrast to the arthrogram guidance group (mean 60.55±46.46 mGy) (P = 0.000). According to the Métaizeau criteria, there were no significant differences in the postoperative anatomical reduction between the two groups. Similarly, no significant differences were observed in the functional outcomes based on MEPS, with excellent results in 94.7 % of the ultrasound guidance group and 85.7 % of the arthrogram guidance group (P = 0.380). Complications were comparable between the groups, with no cases of secondary displacement, pin tract infection, or nerve injury.

CONCLUSION

Ultrasound-guided reduction offers several distinct advantages, including enhanced real-time visualization, the absence of radiation exposure, and reduced operative times. Although outcomes are comparable, ultrasound may be considered a viable alternative to arthrogram for guiding percutaneous leverage reduction in the early childhood population.

LEVEL OF EVIDENCE: Therapeutic Level III.