The use of ultrasound for monitoring reduction and ulnar nerve subluxation in pediatric humeral supracondylar fractures

• Published in: European journal of radiology 2024-01, Vol.170, p.111201-111201, Article 111201
• Main Authors: Shih, Chien-An, Huang, Ming-Tung, Chern, Tai-Chang, Shao, Chung-Jung, Wu, Kuo-Chen, Lin, Chii-Jeng, Jou, I-Ming, Wu, Po-Ting
• Format: Article
• Language: English
• Subjects: Fracture reduction; Humeral supracondylar fracture; Iatrogenic ulnar nerve injury; Ulnar nerve subluxation; Ultrasound
• ISSN: 0720-048X; 1872-7727
• DOI: 10.1016/j.ejrad.2023.111201

•Intraoperative ultrasound is a reliable, safe alternative to fluoroscopy for pediatric supracondylar fractures.•Ultrasound use improves reduction accuracy, radiographic outcomes, and reduces malunions compared to traditional methods.•Real-time ultrasound prevents ulnar nerve injury during medial pinning by precise position tracking. Traditional treatment for displaced humeral supracondylar fractures (SCFs) in children involves closed reduction (CR) under fluoroscopic guidance, percutaneous pinning, and immobilization with a long-arm cast. This study aims to explore the viability of using radiation-free ultrasound (US) for guiding CR and tracking ulnar nerve dynamics during medial pinning, contrasting the US method with the conventional cross pinning technique. We assessed 70 children with acute displaced SCFs. The US group (n = 30) underwent US-guided reduction, whereas the traditional group (n = 40) underwent fluoroscopy-guided reduction. Both groups received percutaneous cross pinning and subsequent cast immobilization. Postoperative outcomes were compared between the two methods after a 6-month follow-up. In the US group, ultrasonography assessed fracture displacement distances before and after CR. The angle at which the ulnar nerve relocated to the cubital tunnel during elbow extension was documented using real-time US monitoring during medial pinning. The US group demonstrated improved reduction accuracy, increased range of motion, superior restoration of both Baumann and Humeroulnar angles, and a decreased incidence of malunions compared to the traditional group (all p  0.90). In the US group, no ulnar nerve injury was noted, compared to 2.5 % in the traditional group, and real-time US observations revealed ulnar nerve hypermobility, with 53.3 % of patients exhibiting anterior ulnar nerve subluxation at 120° elbow flexion, 40 % at 90°, 16.7 % at 60°, and none at 30° flexion. Ultrasound is as reliable as fluoroscopy for evaluating fracture reductions. The use of intra-operative ultrasound significantly improves reduction accuracy and radiographic outcomes while reducing the risk of ulnar nerve injury.