Ultrasonography-guided closed reduction in the treatment of displaced transphyseal fracture of the distal humerus

Abstract

Background: To evaluate the clinical and radiographic outcomes of ultrasonography-guided closed reduction in the treatment of displaced transphyseal fracture of the distal humerus (TFDH).

Methods: Twenty-seven patients with displaced TFDH were successfully treated by the ultrasonography-guided closed reduction during January 2012 to December 2016 and were retrospectively reviewed. After the mean follow-up of 34.88 months, the clinical and radiographic outcomes of patients were evaluated. The cubitus varus of the affected elbows was also assessed at the latest follow-up.

Results: The successful rate of ultrasonography-guided closed reduction in the treatment of displaced TFDH was 84% (27/32). The twenty-seven patients with successful reduction were included for the following analysis. There were 20 males and 7 females included in the study, and the mean age at treatment was 15.39 ± 3.10 months; seventeen fractures occurred in the right side elbow and ten in the left side. At the last follow-up, there were significant decreases in the elbow flexion (3°, P = 0.027) and range of motion (5°, P = 0.003) between the injured and uninjured elbow, respectively, whereas no difference in elbow extension was detected (P = 0.110). Flynn's criteria assessment showed that all the patients achieved excellent or good outcomes both in the functional and cosmetic categories. The clinical and radiographic carrying angles at the last follow-up were 11.67 ± 3.11° and 10.46 ± 3.88°, respectively. And the incidence of cubitus varus after treatment was 7.4% at the last follow-up.

Conclusion: The ultrasonography-guided closed reduction in the treatment of displaced TFDH is an effective procedure; the adequate fracture reduction can be acquired with the advantages of real-time, non-radioactive, and simple utilization. With the percutaneous pining fixation, satisfactory clinical and radiographic outcomes can be achieved with a low incidence of postoperative cubitus varus.

Keywords: Closed reduction; Displaced transphyseal fracture of the distal humerus; Ultrasonography.

Fig. 1

An 9-month-old boy with TFDH secondary to falling down from a bed. The typical medial displacement of the proximal forearm related to the distal humerus on the anteroposterior radiography (1A). The ultrasonic transducer was placed to the radial side of the elbow to assess the lateral displacement of the fracture (1B). The medial displacement of the humeral capitellum (*) and the radial head (R) compared with the humerus (H) (1C). After the closed reduction, the relationship between humeral capitellum (*) and humerus (H) has been corrected (1D). The anteroposterior radiography after treatment (1E). The typical posterior displacement of the proximal forearm related to the distal humerus on the lateral radiography (2A). The transducer was placed to the posterior side of the distal humerus to assess the posterior displacement of the distal humerus (2B). The posterior displacement of the humeral capitellum (*) compared with humerus (H) (2C). After the closed reduction, the posterior displacement of the humeral capitellum (*) has been corrected (2D). The lateral radiography after treatment (2E)