Abstract
OBJECTIVE: This study aimed to compare the effectiveness of ultrasound-guided closed reduction and fixation versus traditional techniques in managing pediatric phalangeal and metatarsal fractures. METHODS: This retrospective study included 112 pediatric patients with phalangeal or metatarsal fractures treated between January 2020 and December 2023. The participants were categorized into two groups: the ultrasound-guided group (US-guided; n = 50, including 37 with phalangeal and 13 with metatarsal fractures) and the conventional fluoroscopy-guided group (C-group; n = 62, including 32 with phalangeal and 30 with metatarsal fractures). The collected data included surgical time, frequency of X-ray examinations, radiation exposure, closed reduction rate, complication rate, and postoperative function. Postoperative functional outcomes were assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system. RESULTS: Surgical time was significantly shorter in the US-guided group (average 44.36 ± 15.23 min) than in the C-group (average 59.15 ± 18.85 min; p < 0.001). Additionally, the US-guided group required approximately four fewer X-ray examinations (2.98 ± 0.94 vs. 7.31 ± 1.47, p < 0.001). Radiation exposure was significantly lower in the US-guided group (1.73 ± 0.54 mGy) than in the C-group (4.24 ± 0.85 mGy, p < 0.001). In the US-guided group, the surgical time for phalangeal fractures was shorter than that for metatarsal fractures (41.08 ± 14.17 min vs. 53.69 ± 14.74 min, p = 0.009). However, there were no significant differences in the closed reduction rate (US-guided group vs. C-group; 92% vs. 80.6%, p = 0.08), AOFAS score (93.6 ± 7.81 vs. 94.16 ± 5.27, p = 0.65), or complication rate (2% vs. 3.2%, p = 0.69). CONCLUSION: Ultrasound-guided closed reduction and fixation significantly shortened surgical time, reduced X-ray frequency and radiation exposure versus fluoroscopy-guided treatment. With additional advantages in efficiency, simplicity and reproducibility, this approach appears to be a safe and effective option for pediatric phalangeal and metatarsal fractures.