Mid-America Orthopaedic Association Physician in Training Award: Surgical technique: Pediatric supracondylar humerus fractures: a technique to aid closed reduction.

BACKGROUND: Anatomic reduction of some displaced pediatric supracondylar humerus fractures is not attainable via closed manipulation, thus necessitating open reduction. Open reduction has been associated with increased complications, including elbow stiffness, scarring, iatrogenic neurovascular injury, and longer hospital stays. Using a Schanz pin to aid in closed reduction may decrease the need for conversion to an open procedure, possibly reducing morbidity. DESCRIPTION OF TECHNIQUE: A percutaneously placed 2.5-mm Schanz pin was drilled into the posterior humeral diaphysis and used as a joystick to reduce anterior and posterior, varus and valgus, and rotational deformity. The fracture then was stabilized with 0.62-mm K-wires placed under fluoroscopy and the Schanz pin then was removed. METHODS: We retrospectively reviewed all displaced pediatric supracondylar humerus fractures treated by one surgeon from March 2002 through December 2010, with 143 fractures meeting criteria for inclusion. These fractures then were divided into two groups. Group 1 (90 fractures) included fractures treated before implantation of the Schanz pin. In this group, if successful reduction could not be achieved via closed manipulations, a formal open reduction was performed. In Group 2, (53 fractures) the Schanz pin technique was used to assist with reduction of fractures that were not reduced successfully by closed manipulations. All fractures were stabilized with the 0.62-mm K-wires after the reductions. To equalize group size, the 37 most remote fractures in Group 1 were removed, leaving a final 53 fractures in each group for analysis. Demographics, injury data, operative technique, complications, and radiographic reduction were analyzed. The minimum followup for both groups was 3.3 weeks (average, 13 weeks; range, 3.3-130 weeks). RESULTS: Fewer fractures in Group 2 (one of 53, 1.9%) compared with Group 1 (seven of 53, 13%) underwent open reduction. Ten fractures in Group 2 underwent the Schanz pin technique, and none of these had open reductions. We found no difference between the groups concerning fracture alignment at final followup or postoperative complications. CONCLUSIONS: A posteriorly placed Schanz pin aids in anatomic reduction and decreases the need for open treatment of displaced pediatric supracondylar humerus fractures, without compromising the complication rate or final radiographic outcome.

Results of anterior-inferior 2.7-mm dynamic compression plate fixation of midshaft clavicular fractures.

OBJECTIVES: To evaluate the outcome of operatively treated unstable displaced diaphyseal clavicle fractures with anterior-inferior 2.7-mm dynamic compression plate (DCP) fixation. DESIGN: Retrospective review of clavicle fractures. SETTING: Level-1 trauma teaching center. PATIENTS/PARTICIPANTS: One hundred twenty-nine clavicle fractures. INTERVENTION: An anterior-inferior approach to clavicle fractures was used with the application of a 2.7-mm DCPs. MAIN OUTCOME MEASUREMENT: Radiographic assessment of healing and complication rates. RESULTS: One hundred twenty-five fractures healed (97%). Postoperative complications included 1 superficial wound problem, 3 deep wound problems, 5 nonunions, and 4 prominent implants requiring removal in 3. CONCLUSIONS: Anterior-inferior placement of 2.7-mm DCPs seems safe and is associated with minimal complications. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Modified Judet approach and minifragment fixation of scapular body and glenoid neck fractures.

OBJECTIVES: To describe the technique and to determine the outcome of operatively treated displaced scapular body or glenoid neck fractures using minifragment fixation through a modified Judet approach. DESIGN: Retrospective review of scapular or glenoid fractures. SETTING: Level 1 teaching trauma center. PATIENTS: All treated scapular or glenoid fractures over 7 years (1999-2005) were determined. Of a total of 227 scapular or glenoid fractures, 37 were treated with open reduction internal fixation and formed the basis of study. All patients were followed for a minimum of 1 year until healing or discharge from care. INTERVENTIONS: All operatively treated scapular fractures were performed in the lateral position on a radiolucent table. A modified Judet approach was used in all patients. The posterior deltoid was incised off the scapular spine cephalad reaching the lateral scapular border. The interval between the teres minor and infraspinatus was paramount for fracture reduction and implant insertion. The 2.7-mm minifragment plates were applied along the lateral border of the scapula. MAIN OUTCOME MEASUREMENT: Radiographic assessment of fracture healing and clinical assessment of shoulder function. RESULTS: The majority of patients were males (31 males, 6 females) who sustained blunt trauma. All scapular fractures maintained fixation and reduction. No wound or muscle dehiscence problems were noted. Average range of motion was 158 degrees (range 90-180 degrees). There were no fixation failures or instances of implant loosening. CONCLUSIONS: The modified Judet approach allows for excellent scapular and glenoid fracture visualization and reduction while preserving rotator cuff function. Minifragment fixation along the lateral scapular border provides excellent plate position, screw length, and fracture stability.