Department of Orthopedics, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu, 214062, China.
Department of Ultrasound, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu, 214062, China.
Injury. 2024 Nov;55(11):111780. doi: 10.1016/j.injury.2024.111780. Epub 2024 Aug 15.
This study aims to evaluate the clinical application efficacy of the ultrasound-guided Joystick technique for percutaneous leverage reduction in conjunction with Kirschner wires and external fixator in the treatment of difficult-to-reduce pediatric Salter-Harris II type proximal humerus fractures.
A retrospective analysis was conducted on children with Salter-Harris II type proximal humerus fractures, who failed manual closed reduction from January 2018 to March 2022. The group consisted of 7 males and 2 females, aged between 10 and 14 years. The surgical method involved percutaneous leverage reduction using the ultrasound-guided Joystick technique, combined with Kirschner wires and external fixation. Throughout the procedure, ultrasound is used for monitoring, with the fracture condition being determined before surgery. An external support screw is inserted into the distal end of the humerus as an operating lever, along with 3.5 mm Kirschner wire for ultrasound-guided reduction and maintenance of position during the operation. Following fixation with Kirschner wire, a combination external fixator is applied. After fixation is completed, ultrasound is used once more to assess the quality of fracture reduction, followed by verification of the reduction status using a C-arm X-ray machine.
All surgeries were successfully completed with a 100 % success rate in resetting. Notably, there were no postoperative complications like nerve or vascular injury, malunion, nonunion, or bone bridge formation in the proximal humeral physis. Three cases experienced minor complications (redness and swelling at the screw sites), which improved with conservative management. The follow-up period ranged from 6 to 18 months, averaging 10.6 months, with fracture clinical healing occurring within 6 to 8 weeks (average 6.3 weeks). The final follow-up revealed excellent functional outcomes, with Neer scores ranging from 90 to 100 (average 96.3 points).
The ultrasound-guided Joystick technique for percutaneous leverage reduction in conjunction with Kirschner wires and external fixator can effectively treat difficult-to-reduce Salter-Harris II proximal humeral fractures in children, avoiding open reduction and minimizing intraoperative radiation exposure. This approach offers good stability and facilitates early rehabilitation, aligning with the ERAS (Enhanced Recovery After Surgery) concept in fracture management, thus warranting clinical promotion.
本研究旨在评估超声引导下 Joystick 技术经皮撬拨复位联合克氏针和外固定器治疗儿童难复性Ⅱ型 Salter-Harris 肱骨近端骨折的临床应用效果。
回顾性分析 2018 年 1 月至 2022 年 3 月间手法闭合复位失败的儿童Ⅱ型 Salter-Harris 肱骨近端骨折患儿，男 7 例，女 2 例；年龄 10~14 岁。手术方法采用超声引导下 Joystick 技术经皮撬拨复位，联合克氏针和外固定。手术全程均在超声监视下进行，术前根据骨折情况确定手术方案。在肱骨远端插入一枚作为操作杠杆的外支持螺钉，并用 3.5mm 克氏针进行超声引导下复位并维持术中位置。克氏针固定后，再应用组合式外固定架。固定完成后，再次行超声检查评估骨折复位质量，然后用 C 臂 X 线机验证复位情况。
复位成功率为 100%，所有手术均顺利完成。术后无神经血管损伤、畸形愈合、不愈合或肱骨近端骨骺骨桥形成等并发症。3 例出现轻微并发症（螺钉部位红肿和肿胀），经保守治疗后好转。随访时间 618 个月，平均 10.6 个月，骨折临床愈合时间为 68 周（平均 6.3 周）。末次随访时，Neer 评分 90~100 分，平均 96.3 分，功能结果优良。
超声引导下 Joystick 技术经皮撬拨复位联合克氏针和外固定器可有效治疗儿童难复性Ⅱ型 Salter-Harris 肱骨近端骨折，避免了切开复位，减少了术中辐射暴露。该方法稳定性好，便于早期康复，符合骨折管理中 ERAS（加速康复外科）理念，值得临床推广。
