Posterior C1-C2 Fixation Using Absorbable Suture for Type II Odontoid Fracture in 2-Year-Old Child: Description of a New Technique and Literature Review.

Odontoid synchondrosis fractures are rare in children, even though they are the more common cervical fracture in children less than 7 years old. Nonoperative treatment with external orthosis immobilization is the treatment of choice for stable undisplaced or minimally displaced injuries. In unstable fractures, when reduction cannot be achieved or maintained, surgical fixation is recommended. We report a 2-year-old boy with an unstable fracture of the odontoid treated surgically using an absorbable monofilament suture for C1-C2 interlaminar fixation without bone grafting. This suture was strong enough to provide the stability necessary to allow healing of the synchondrosis and the delayed resorption of the suture was followed by complete restoration of the mobility between C1 and C2. This case illustrates that surgical stabilization using an absorbable suture in young children with an unstable odontoid fracture is a safe and effective alternative to other surgical techniques. LEVEL OF EVIDENCE: Level III.

Is intramedullary pinning for isolated ulnar shaft fractures a surgical alternative to plate fixation?

INTRODUCTION: Unstable isolated ulnar shaft fractures are rare injuries that need to be surgically treated. The purpose of this study was to compare the functional and radiographic outcomes of two types of surgeries: closed reduction and intramedullary fixation (IMF) by pinning and open reduction and internal fixation (ORIF). HYPOTHESIS: Our hypothesis was that IMF obtained similar outcomes to ORIF. MATERIALS AND METHODS: All patients treated for an isolated distal or middle third ulnar shaft fracture between 2016 and 2019 were enrolled into two groups: ORIF and IMF. The technique performed depended on the surgeon's preference and not the type of fracture or patient. Demographic and clinical data (QuickDASH) and complications were retrospectively collected. X-rays were also examined to classify the fracture, assess postoperative reduction quality, and determine the amount of shortening and angulation. RESULTS: A total of 81 patients with a mean age of 34 years were divided into two groups: 34 in ORIF and 47 in IMF. The two groups had similar demographics, mechanisms of injury, and preoperative fracture characteristics. The only difference was smoking (p<0.001). Despite a greater mean ulnar shortening of 0.4 mm in the IMF group (p=0.048), there were no significant differences regarding the functional score (QuickDASH) and rate of pseudarthrosis. However, the operative time (p<0.001) was shorter in the IMF group. DISCUSSION: In the treatment of unstable isolated ulnar shaft fractures, IMF and ORIF had similar clinical and radiographic outcomes in terms of bone healing. The mean ulnar shortening reported in the IMF group was small and was not at risk of developing posttraumatic osteoarthritis. CONCLUSION: IMF is a feasible therapeutic alternative to ORIF for isolated fractures of the distal two-thirds of the ulnar shaft. Further studies with a higher level of evidence need to be conducted to confirm the equivalence of these two fixation techniques. LEVEL OF EVIDENCE: IV, retrospective study.

Interspinalis-longissimus mid-line approach for thoracic and thoracolumbar minimally invasive fixation: Technical note.

The authors present a new minimally invasive posterior thoracic and upper lumbar spinal approach, using midline-staged incision with bilateral dissection via the natural muscular cleavage plane between the spinalis and longissimus muscles for pedicle fixation. The aim was to clarify anatomy and compare results between this technique and the conventional paraspinal approach. An anatomic MRI study determined the position of the superficial aponeurosis of the spinalis-longissimus intermuscular cleavage plane with respect to the midline. The surgical procedure is described. A radiological and clinical study evaluated 24 patients divided into two comparative groups, operated on via the medial intermuscular or the paraspinal approach, for isolated A3 and B2 Magerl fracture between T2 and L2, without neurologic involvement. Pain, postoperative complications, reduction quality and esthetic satisfaction were assessed. MRI located the cleavage plane, which was consistently 11.01±0.9mm (range, 9.4-12.3mm) from the midline. In the "medial approach" group, hospital stay was significantly shorter, by 3 days, at 4±1.9 (range, 2-8 days) (p: 0.005); pain on VAS was 2 points lower at postoperative day 1 (2.1±1.4; range,≤1-4; p:0.032), and lower at discharge (0.3±0.6; range, 0-1; p: 0.001). The scar was considered esthetically very satisfactory. This easily performed and reproducible medial intermuscular approach showed low iatrogenesis, significantly improving postoperative course.