Ultrasonic diagnosis of distal humeral fracture in infants and toddlers and its clinical significance of ancillary treatment

Abstract

Objective To explore the diagnostic value of ultrasound and its clinical significance of ancillary treatment in infants and toddlers of distal humeral fracture. Methods Among a total of 158 cases of distal humeral fracture, there were supracondylar fracture of humerus (n=102) (Gartland Ⅱ 34; Ⅲ 68), fracture-separation of distal humeral epiphysis (n=8), humeral lateral condyle fracture (n=44) (JacobⅡ23; Ⅲ 11) and humeral medial epicondyle fracture (n=4). The mean age was 20 months (3 days to 35 months). Detections were made from 6 orientations of lateral humeroradial joint, front and rear of humeroradial joint, interior humeroulnar joint, front and rear of humeroulnar joint. Results Under normal conditions, bone cortex and epiphysis of distal humerus are continuous with a straight line or arc and there is no staircase. It was thus possible to judge the position and direction of fracture. The appearances of humeroradial joint from three directions were similar and resembled a double-breast sign. Anteroposteriorly, coronoid and olecranon epiphyses and coronoid fossa appeared anteriorly while olecranon and trochlear epiphyses and olecranon fossa posteriorly, resembling a check-mark sign. Medial epicondyle, cubital tunnel and distal humerus appeared collectively as a saddle sign. In humeral lateral condyle fracture, humeroulnar joint remains normal. But three directions of humeroradial joint had unusual staircase signs. In supracondylar humerus and distal humerus epiphysis fractures, six directions had unusual staircase signs. In humeral media epicondyle fracture, only inner side of humeroulnar joint had abnormal ultrasound. Conclusions As a noninvasive examination modality, ultrasound can judge the types of distal humeral fracture accurately and avoid a misdiagnosis, especially epiphyseal fracture. It also guides closed reductions and percutaneous pinning for distal humeral fracture. Key words: Ultrasonogaphy; Humeral fractures; Infant