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Duplex ultrasound for assessing vascular impairment after supracondylar humerus fractures
BACKGROUND: Supracondylar humerus fractures (SHF) are the second most common fracture in children and the most common fracture in children under seven years. Subtle neurovascular lesions in displaced SHF may be underdiagnosed clinically, but their sequelae can mean life-long symptoms. Here we show t...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9276126/ https://www.ncbi.nlm.nih.gov/pubmed/35583535 http://dx.doi.org/10.1097/MD.0000000000029258 |
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author | Storch, Katja Schultz, Jurek Fitze, Guido |
author_facet | Storch, Katja Schultz, Jurek Fitze, Guido |
author_sort | Storch, Katja |
collection | PubMed |
description | BACKGROUND: Supracondylar humerus fractures (SHF) are the second most common fracture in children and the most common fracture in children under seven years. Subtle neurovascular lesions in displaced SHF may be underdiagnosed clinically, but their sequelae can mean life-long symptoms. Here we show that color-coded duplex ultrasound (DUS) could help to identify these patients. METHODS: We reviewed records of 229 children who had recovered from SHF. Ninety patients were available for detailed questionnaires, in-depth neurovascular examinations, and DUS. RESULTS: In 90 examined patients, only two had been known to have suffered from vascular complications before our study. Only one still complained spontaneously about perfusion-induced symptoms. Qualitative changes in blood flow in duplex-sonography were detectable in both. Another two patients showed similar changes in blood flow at the fracture site. Both reported load-induced pain and paresthesia on detailed inquisition when no vascular impairments had been known before. Thus, duplex-sonography identified two patients with vascular affections that had not been noticed before in routine clinical examinations. CONCLUSION: DUS can be a sensitive tool in diagnosing vascular impairments in patients with SHF. It could reduce diagnostic insecurity, especially in anesthetized or otherwise hard to examine children, and thus help avoid the therapeutic delay that otherwise might foster life-long sequelae for the patients. More studies are needed to establish age-adjusted reference values for duplex-sonography of children's arms. Level of Evidence: Level III, Study of nonconsecutive patients (without consistently applied reference). |
format | Online Article Text |
id | pubmed-9276126 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-92761262022-07-13 Duplex ultrasound for assessing vascular impairment after supracondylar humerus fractures Storch, Katja Schultz, Jurek Fitze, Guido Medicine (Baltimore) 7100 BACKGROUND: Supracondylar humerus fractures (SHF) are the second most common fracture in children and the most common fracture in children under seven years. Subtle neurovascular lesions in displaced SHF may be underdiagnosed clinically, but their sequelae can mean life-long symptoms. Here we show that color-coded duplex ultrasound (DUS) could help to identify these patients. METHODS: We reviewed records of 229 children who had recovered from SHF. Ninety patients were available for detailed questionnaires, in-depth neurovascular examinations, and DUS. RESULTS: In 90 examined patients, only two had been known to have suffered from vascular complications before our study. Only one still complained spontaneously about perfusion-induced symptoms. Qualitative changes in blood flow in duplex-sonography were detectable in both. Another two patients showed similar changes in blood flow at the fracture site. Both reported load-induced pain and paresthesia on detailed inquisition when no vascular impairments had been known before. Thus, duplex-sonography identified two patients with vascular affections that had not been noticed before in routine clinical examinations. CONCLUSION: DUS can be a sensitive tool in diagnosing vascular impairments in patients with SHF. It could reduce diagnostic insecurity, especially in anesthetized or otherwise hard to examine children, and thus help avoid the therapeutic delay that otherwise might foster life-long sequelae for the patients. More studies are needed to establish age-adjusted reference values for duplex-sonography of children's arms. Level of Evidence: Level III, Study of nonconsecutive patients (without consistently applied reference). Lippincott Williams & Wilkins 2022-05-20 /pmc/articles/PMC9276126/ /pubmed/35583535 http://dx.doi.org/10.1097/MD.0000000000029258 Text en Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0 (https://creativecommons.org/licenses/by-nc/4.0/) |
spellingShingle | 7100 Storch, Katja Schultz, Jurek Fitze, Guido Duplex ultrasound for assessing vascular impairment after supracondylar humerus fractures |
title | Duplex ultrasound for assessing vascular impairment after supracondylar humerus fractures |
title_full | Duplex ultrasound for assessing vascular impairment after supracondylar humerus fractures |
title_fullStr | Duplex ultrasound for assessing vascular impairment after supracondylar humerus fractures |
title_full_unstemmed | Duplex ultrasound for assessing vascular impairment after supracondylar humerus fractures |
title_short | Duplex ultrasound for assessing vascular impairment after supracondylar humerus fractures |
title_sort | duplex ultrasound for assessing vascular impairment after supracondylar humerus fractures |
topic | 7100 |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9276126/ https://www.ncbi.nlm.nih.gov/pubmed/35583535 http://dx.doi.org/10.1097/MD.0000000000029258 |
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