Ultrasound guided Joystick technique combined with Kirschner wire and external stent fixation for the treatment of refractory Salter-Harris Ⅱ proximal humeral fractures in children
Objective To explore the clinical efficacy of ultrasound-guided Joystick technique combined with Kirschner wire and external stent fixation in the treatment of refractory Salter-Harris Ⅱ proximal humeral fractures in children.Methods From January 2018 to March 2022,9 children with Salter-Harris Ⅱproximal humeral fractures were treated in our hospital with failed manual closed reduction.All cases were treated with ultrasound guided Joystick technique for closed reduction combined with Kirschner wire and external fixation.Ultrasound was used throughout the entire process for monitoring,and the fracture situation was confirmed before surgery.An external stent screw was inserted into the distal humerus as the operating rod,combined with a 3.0 mm diameter Kirschner wire.Ultrasound guidance was used during the surgery to pry and maintain the position.After Kirschner wire fixation,a combined external fixation frame was installed.After fixation,ultrasound was performed again to check the quality of fracture reduction,and the reduction status was verified through C-arm fluoroscopy.Results The surgery was successfully completed,with a 100％success rate in closed reduction.There were no complications such as nerve and blood vessel injury,fracture malunion,nonunion,and proximal humeral epiphyseal bridge formation after surgery.Two cases of children had redness and swelling in the proximal external stent screw path,which improved after dressing change.All patients were follow-up for 6 to 18 months,with an average of 10.6 months.The fracture healing time was 6 to 8 weeks,with an average of 6.3 weeks.The Neer score of the shoulder joint in the last follow-up was 90 to 100 points,with an average score of 96.3 points.Conclusion Ultrasound guided Joystick technique can improve the success rate of closed reduction and reduce intraoperative radiation in the treatment of refractory Salter-Harris Ⅱ proximal humeral fractures in children.The combination of Kirschner wire and external stent fixation can provide good stability,facilitate early rehabilitation and exercise of children,conform to the fracture ERAS concept,and is worthy of clinical promotion.
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