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Technique for Arthroscopic-Assisted Reduction and Cannulated Screw Fixation for Coronal Shear Fractures of the Distal Humerus.

ABSTRACT: Several articles have described arthroscopic fixation of coronal shear fractures of the distal humerus. However, not all of them have used purely arthroscopic techniques. In this Technical Note we describe another technique for intra-articular distal humeral fracture fixation using arthroscopy alone. Standard proximal anteromedial, proximal anterolateral, and posterolateral viewing portals are established with soft spot portal for reduction. During intra-articular examination, the fragment involving the capitellum and the trochlea as 1 piece is detected. Closed manipulative reduction under anesthesia is conducted with distraction, varus force, and gradual elbow extension. After closed reduction, reduction of the fragment more precisely under arthroscopic visualization using probe and elevator is performed. The fragment is temporarily fixed using 2 Kirschner wires from posterior direction. Anatomic reduction is confirmed with an image intensifier. Screw guide pin is inserted posteroanteriorly under image intensification, and a headless compression screw is placed over each wire. We describe a safe, reproducible, and minimal invasive technique for the arthroscopic treatment of coronal shear fractures of the distal humerus.

SUBMITTER: Van Nguyen T

PROVIDER: S-EPMC8084756 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:ObjectiveTo compare the effects between computer-assisted and traditional cannulated screw internal fixation on treating femoral neck fracture.MethodsThe search was conducted in Embase, Pubmed, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI) and Wanfang Database from the beginning to August 2020. RevMan5.4 software, which was provided by the International Cochrane Group, was used for the meta-analysis comparing the differences in operation time, intraoperative bleeding volume, fluoroscopy frequency, fracture healing time, total drilling times, Harris score, fracture healing rate, and femoral head necrosis rate between computer-assisted and traditional methods groups.ResultsA total of 1028 patients were included in 16 studies. Primary outcome indicators: Compared with the traditional method group, the computer-assisted group had less operative time (2RCTs, P < 0.00001; 8 non-RCTs, P = 0.009; Overall, P < 0.00001), intraoperative bleeding (1 RCTs, P < 0.00001; 9non-RCTs, P < 0.00001; Overall, P < 0.00001), femoral head necrosis rate (1 RCT, P = 0.11;7 non-RCTs, P = 0.09; Overall, P = 0.02) and higher Harris scores (1 RCT, P < 0.0001; 9 non-RCTs, P = 0.0002; Overall, P < 0.0001), and there were no significant differences in fracture healing rate between the two groups (5 non-RCTs, P = 0.17). Secondary outcomes indicators: The computer-assisted group had a lower frequency of intraoperative fluoroscopy and total number of drills compared with the traditional method group, while there was no significant difference in fracture healing time.ConclusionCompared with the traditional hollow screw internal fixation on the treatment of femoral neck fracture, computer-assisted percutaneous cannulated screw fixation can shorten the operation time and improve the operation efficiency and reduce the X-ray injury of medical staff and help patients obtain a better prognosis. Therefore, computer-assisted percutaneous cannulated screw fixation is a better choice for the treatment of femoral neck fracture. Study registration PROSPERO registration number CRD42020214493.

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Technique for Arthroscopic-Assisted Reduction and Cannulated Screw Fixation for Coronal Shear Fractures of the Distal Humerus.

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