Value of Ultrasound-Guided Closed Reduction and Minimally Invasive Fixation in the Treatment of Metacarpal Fractures

POINT-OF-CARE ULTRASOUND FOR GUIDANCE OF CLOSED REDUCTION OF FIFTH METACARPAL NECK (BOXER'S) FRACTURE

BACKGROUND

Ultrasound has been used previously in fracture identification, analgesia delivery, and fracture reduction for patients in the emergency department. It has not been previously described as a tool for the guidance of closed fracture reduction in fifth metacarpal neck fractures ("boxer's fractures").

CASE REPORT

A 28-year-old man presented with hand pain and swelling after punching a wall. Point-of-care ultrasound revealed a significantly angulated fifth metacarpal fracture, which was confirmed with a subsequent hand x-ray study. After an ultrasound-guided ulnar nerve block, closed reduction was performed. Ultrasound was used to assess reduction and ensure improvement in bony angulation during the closed reduction attempts. Post-reduction x-ray study confirmed improved angulation and adequate alignment. Why Should an Emergency Physician Be Aware of This? Point-of-care ultrasound has previously had efficacy in fracture diagnosis and anesthesia delivery for fifth metacarpal fractures. Ultrasound can also be used at the bedside to assist in the determination of adequate fracture reduction when performing closed reduction of a boxer's fracture.

Ultrasound-guided screw fixation for patellar stress fracture in a female basketball player: A case report

INTRODUCTION

Stress fracture of the patella is an overuse disorder that occurs in the lower extremity. Surgery may be considered if conservative treatment does not work or if a quicker and more reliable return to sports is expected. Surgery is usually performed under fluoroscopic guidance based on the premise that the proper placement of the internal fixation material can be determined on radiographic images.

PATIENT CONCERNS

A 16-year-old female basketball player gradually became aware of pain in the anterior aspect of her right knee during basketball, without any particular history of trauma. A computed tomography scan revealed a small bone fragment on the lateral side of the distal end of the patella.

DIAGNOSIS

Stress fracture of the patella.

INTERVENTIONS

Since it was difficult to determine the exact location of the bone fragment on radiographs, the surgery was performed under ultrasound guidance rather than fluoroscopy. While checking the bone fragment with ultrasound images, insertion of the guide pin, drilling, and screw fixation were performed under ultrasound guidance.

OUTCOMES

Postoperative computed tomography showed accurate screw insertion into the bone fragment. Two months after surgery, bony fusion was confirmed, and the patient returned to her preinjury level of basketball.

CONCLUSION

Ultrasound-guided screw fixation was useful in this case in which internal fixation of fractures is difficult under fluoroscopic guidance.

Using Ultrasonography During the Fixation of Distal Radius and Finger Fractures

Ultrasonography (US) is a noninvasive examination modality that is devoid of risk, both for the patient and the surgeon, compared with fluoroscopy. The principle is the same for distal radius and finger fractures: replace the fluoroscopy checks with US checks to reduce the patient's, surgeon's, and surgical team's exposure to radiation. In this article, the authors report their experience of the effectiveness of ultrasound imaging during the fixation of a distal radius and long finger fracture. They also describe equipment needed and surgical procedure.