Comparison of Real-Time Sonography Assisted Fracture Reduction with Conventional Radiography Control Reduction in Children with Displaced Forearm Fractures

Pavel Kotlarsky 1 Rostislav Novak 1 Oren Feldman 3 Itai Shavit 3 Mark Eidelman 2
1Orthopedic Surgery, Rambam Healthcare Campus, Israel
2Pediatric Orthopedic Surgery, Rambam Healthcare Campus, Israel
3Pediatric Emergency Department, Rambam Healthcare Campus, Israel

Background: Forearm fractures in children and adolescents are very common. Many are displaced and require reduction. Radiography is essential for evaluation of the fracture and the reduction, however, is not usually available bedside, and performed after reduction and casting. This may lead to multiple reduction attempts and unsatisfying final results. Ultrasonography (US) is widely available, allows visualization of cortical disruption and therefore, can provide real-time information regarding the quality of reduction.

The purpose of this study was to compare real-time sonography assisted fracture reduction with conventional radiography control reduction in children with displaced forearm fractures.

Methods: We compared two groups of patients with forearm fractures – one treated with US-guided fracture reduction, and another one treated with the conventional method of reduction without real-time image guidance. In patients treated with US-guided forearm fracture reduction, ultrasonography was performed before casting in two planes and if necessary additional manipulation was immediately performed. All fractures were examined with conventional radiography after cast application.

Results: 83 children with displaced forearm fractures were included; 32 treated under US guidance and 51 treated with the conventional method of reduction. Mean age was 9 years (range 3-13) in the US group and 10 years (range 3-14) in the conventional treatment group. None of the patients in the US group required revision of reduction. In the conventional treatment group 12% (6 out of 51) of patients underwent additional sedation, cast removal and repeated reduction, due to residual fracture malalignment.

Conclusions: US-guided forearm fracture reduction is reliable and accurate method of correction of displaced forearm fractures before final casting and reduces the probability for repeated reduction.