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A novel transverse ultrasonography technique for minimally displaced lateral humeral condyle fractures in children - 31/03/19

Doi : 10.1016/j.otsr.2019.02.005 
Xiong-tao Li, Xian-tao Shen , Xing Wu, Xiao-liang Chen
 Wuhan Children's Hospital, Tongji, Medical College, Huazhong University of Science & Technology, Wuhan City, PR China 

Corresponding author. Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology, Orthopedics, 100 Hong-Kong Road, Jiang’an District, 430016 Wuhan City, PR China.Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology, Orthopedics100 Hong-Kong Road, Jiang’an DistrictWuhan City430016PR China
Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le dimanche 31 mars 2019
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Abstract

Introduction

Management of minimally displaced lateral humeral condyle fractures in pediatric patients is controversial. This is primarily because with current imaging modalities it is difficult to accurately and conveniently determine the stability of the fractures by detecting the integrity of the cartilage hinge. Nevertheless, transverse ultrasonography has not been intensively reported in previous studies.

Hypothesis

Transverse ultrasonography can determine the integrity of the cartilage hinge in minimally displaced lateral condyle fractures.

Materials and methods

We retrospectively reviewed the medical records of 39 pediatric patients with minimally displaced fractures of the lateral humeral condyle who underwent transverse ultrasonography between 2014 and 2017. Conservative treatment was given to pediatric patients with intact cartilage hinges that had been confirmed by transverse ultrasound images. Surgical treatment was recommended for pediatric patients with disrupted cartilage hinges. Data regarding healing of the lateral humeral condyle fractures were recorded and analyzed.

Results

According to transverse ultrasonography, there were 14 children with intact cartilage hinges and 25 children with disrupted cartilage hinges. Fourteen children with intact cartilage hinges of the fracture were treated conservatively, and none of them showed secondary displacement. There were 16 children in whom there was surgical intervention, and 9 other children decided to have conservative treatment among the 25 children with disruption of the cartilage hinge. Five of these 9 children who underwent conservative treatment were found to have further displacement during an average of 12.6 days after the fracture event, and no other patient was found to have further displacement.

Conclusion

Transverse ultrasonography can simply and accurately determine the stability of minimally displaced lateral condyle fractures without sedation, ionizing radiation or invasive techniques. We recommend routine use of transverse ultrasonography to detect stability of the fractures, which can effectively avoid inadequate treatment and unnecessary surgery in pediatric patients with minimally displaced fractures of the lateral humeral condyle.

Level of evidence

IV, retrospective cohort study.

Le texte complet de cet article est disponible en PDF.

Keywords : Ultrasonography, Stability, Lateral humeral condyle fracture, Children


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