Pan Bowen,Zhao Guoqiang,Zhu Ming,et al.Treatment of radial neck fracture in children by percutaneous K-wire pry plus intramedullary needle internal fixation under ultrasonic guidance[J].Journal of Clinical Pediatric Surgery,,21():174-178.[doi:10.3760/cma.j.cn.101785-202104073-014]
Treatment of radial neck fracture in children by percutaneous K-wire pry plus intramedullary needle internal fixation under ultrasonic guidance
- Keywords:
- Radius Fractures/SU; Fracture Fixation; Internal; Closed Fracture Reduction; Ultrasonography; Treatment Outcome
- Abstract:
- Objective To explore the significance of ultrasonography and intramedullary needle in the treatment of radial neck fractures and provide a mini-invasive and radiation-free treatment for radial neck fractures in children. Methods From August 2018 to December 2019, clinical data were reviewed for 16 children hospitalized with Juedet Ⅲ/Ⅳ radial neck fractures.There were 6 boys and 10 girls with an average age of 98(45-135) months.And the involved side was left (n=11) and right (n=5).Emergency manual reduction failed.There were Juedet Ⅲ (n=12) and Ⅳ (n=4).The former included ulna fracture (n=3).The average time between injury and operation was 2.1(0.5-5) days.After admission, needle under ultrasonography-guided reduction by percutaneous K-wire pry was followed by intramedullary needle internal fixation.Operative duration, intraoperative volume of blood loss, intraoperative fluoroscopic frequency and postoperative fracture healing time were recorded.Before removing internal fixation, Metaizeau technique was employed for evaluating elbow function.Such postoperative complications as presence of nerve damage and early epiphyseal closure were evaluated.Results The postoperative follow-up period was (6-18) months.Operative duration was (13±3.7) min, intraoperative volume of blood loss (2±1.5) ml, intraoperative fluoroscopy frequency (2-6), postoperative fracture healing time (1.8±0.5) months and internal fixation removed within an average of 5.5(3-8) months.All cases achieved postoperative osseous healing.Based upon the Metaizeau criteria, the outcome was excellent (n=14) and decent (n=2) with an excellent/decent rate of 100%; Functional recovery was excellent (n=15) and decent (n=1) with an excellent/decent rate of 100%.There was no postoperative occurrence of nerve injury or early epiphyseal closure.One case of incision infection occurred after removing internal fixation and healing was excellent during outpatient follow-ups.Conclusion Ultrasonography guided treatment of radial neck fracture is both safe and reliable in children.Through accurately prying fracture end during operation, it reduces iatrogenic injury caused by blind operation and minimize the radiation exposure of operator and patients.Using an elastic intramedullary needle may prevent metaphyseal injury of proximal radius.
References:
[1] Prathapkumar KR,Garg NK,Bruce CE.Elastic stable intramedullary nail fixation for severely displaced fractures of the neck of the radius in children[J].J Bone Joint Surg Br,2006,88(3):358-361.DOI:10.1302/0301-620X.88B3.17099.
[2] Gagliardi Ida C,Mouraria GG,Funayama B,et al.Evaluation of chuildren with radial neck fractures treated with flexible intramedullary nail[J].Acta Ortop Bras,2016,24(2):81-84.DOI:10.1590/1413-785220162402154788.
[3] Metaizeau JP,Lascombes P,Lemelle JL,et al.Reduction and fixation of displaced radial neck fractures by closed intramedullary pinning[J].J Pediatr Orthop,1993,13(3):355-360.DOI:10.1097/01241398-199305000-00015.
[4] Jiang H,Wu Y,Dang Y,et al.Closed reduction using the percutaneous leverage technique and internal fixation with K-wires to treat angulated radial neck fractures in children-case report[J].Medicine,2017,96(1):e5806.DOI:10.1097/MD.0000000000005806.
[5] Cha SM,Shin HD,Kim KC,et al.Percutaneous reduction and leverage fixation using K-wires in paediatric angulated radial neck fractures[J].Int Orthop,2012,36(4):803-809.DOI:10.1007/s00264-011-1387-3.
[6] Choi WS,Han KJ,Lee DH,et al.Stepwise percutaneous leverage technique to avoid posterior interosseous nerve injury in pediatric radial neck fracture[J].Orthop Trauma,2017,31(5):e151-e157.DOI:10.1097/BOT.0000000000000790.
[7] Eberl R,Singer G,Fruhmann J,et al.Intramedullary nailing for the treatment of dislocated pediatric radial neck fractures[J].Eur Pediatr Surg,2010,20(4):250-252.DOI:10.1055/s-0030-1249104.
[8] Song KS,Kim BS,Lee SW.Percutaneous leverage reduction for severely displaced radial neck fractures in children[J].Pediatr Orthop,2015,35(4):e26-e30.DOI:10.1097/BPO.0000000000000305.
[9] Nazan ?G,Cansa B,Yavuz A,et al.Functional and radiological results of percutaneous K-wire aided Métaizeau technique in the treatment of displaced radial neck fractures in children[J].Acta Orthop Traumatol Turc,2018,52(6):428-434.DOI:10.1016/j.aott.2018.07.007.
[10] 沈先涛,陈小亮,李雄涛,等.B型超声引导经皮克氏针撬拨治疗儿童桡骨颈骨折[J].中华小儿外科杂志,2015,36(5):363-367.DOI:10.3760/cma.j.issn.0253-3006.2015.05.011. Shen XT,Chen XL,Li XT,et al.Treatment of radial neck fracture in children with B-type ultrasound guided by pickles needle pry[J].Chinese Journal of Pediatric Surgery,2015,36(5):363-367.DOI:10.3760/cma.j.issn.0253-3006.2015.05.011.
[11] 杨大兴,单延具,张琰,等.弹性髓内钉与克氏针固定治疗儿童桡骨颈骨折的临床对比[J].实用骨科杂志,2019,25(11):961-964. Yang DX,Shan YJ,Zhang Y,et al.Comparison of elastic intramedullary nail versus Kirschner wire fixation for the treatment of radial neck fractures in children[J].Journal of Applied Orthopaedics,2019,25(11):961-964.
[12] Ho-Fung VM,Zapala MA,Lee EY.Musculoskeletal traumatic injuries in children:characteristic imaging findings and mimickers[J].Radiol Clin N Am,2017,55(4):785-802.DOI:10.1016/j.rcl.2017.02.011.
[13] Eckert K,Janssen N,Ackermann O,et al.Ultrasound diagnosis of supracondylar fractures in children.European journal of trauma and emergency surgery[J].Official Publication of the European Trauma Society,2014,40(2):159-168.DOI:10.1007/s00068-013-0306-2.
[14] Rowlands R,Rippey J,Tie S,et al.Bedside ultrasound vs X-ray for the diagnosis of forearm fractures in children[J].Journal of Emergency Medicine,2017,52(2):208-215.DOI:10.1016/j.jemermed.2016.10.013.
[15] Kodama N,Takemura Y,Ueba H,et al.Ultrasound-assisted closed reduction of distal radius fractures[J].J Hand Surg Am,2014,39(7):1287-94.DOI:10.1016/j.jhsa.2014.02.031.
[16] 杨晓东,唐学阳,蒋欣,等.超声技术在儿童前臂骨折闭合复位弹性髓内针内固定术中的应用[J].临床小儿外科杂志,2015,14(4):287-289,294.DOI:10.3969/j.issn.1671-6353.2015.04.010. Yang XD,Tang XY,Jiang X,et al.Ultrasonography for closed reduction of forearm fracture with elastic intramedullary pin in children[J].J Clin Ped Sur,2015,14(4):287-289,294.DOI:10.3969/j.issn.1671-6353.2015.04.010
[17] Lee JE,Kim JB,Choi ES.Ultrasonography-guided reduction of pediatric radial neck fractures[J].BMC Musculoskelet Disord,2017,18(1):516.DOI:10.1186/s12891-017-1891-8.
Memo
收稿日期:2021-04-23。
基金项目:浙江省卫生厅医药科技项目（2017KY444）
通讯作者:赵国强,Email:hello868@zju.edu.cn