Percutaneous Reduction Technique Research Articles

A Percutaneous Technique for Reduction and Internal Fixation of Displaced Intra-Articular Calcaneal Fractures.

A retrospective cohort study demonstrated that, in comparison with open reduction and internal fixation through an extensile lateral approach, our percutaneous technique for reduction and internal fixation of displaced intra-articular calcaneal fractures decreases the rate of complications and achieves and maintains extra-articular fracture reductions just as well. Position the patient correctly to obtain excellent fluoroscopic views, which are key to the procedure. The techniques for reducing and fixing joint depression and tongue-type calcaneal fractures differ and will be described separately. Identify screw entry points and paths using fluoroscopic images, and confirm the final positions with c-arm imaging. Apply a splint; then obtain postoperative images to confirm fracture reduction and screw placement. The results of percutaneous reduction of displaced intra-articular calcaneal fractures in seventy-nine patients with a total of eighty-three fractures were compared with those obtained by another surgeon using the extensile lateral approach. IndicationsContraindicationsPitfalls & Challenges.

Technique and Early Results of Percutaneous Reduction of Sagittally Unstable Intertrochateric Fractures

BackgroundThis paper introduces a percutaneous reduction technique using one or two Steinman pin(s) to reduce sagittally unstable intertrochanteric fractures.MethodsA fracture was defined as a sagittally unstable intertrochanteric fracture when posterior sagging of a distal fragment and flexion of the proximal fragment worsens after usual maneuvers for a closed reduction. Of 119 intertrochanteric fractures treated from June 2007 to December 2008, twenty-one hips showed sagittal instability. The sagittal displacement was reduced using a Steinmann pin as a joystick, and stabilized with a nail device. Nineteen hips were followed up for more than one year. The clinical and radiological results were reviewed in 19 hips and compared with those of the remaining cases.ResultsThe demographics were similar in both groups. The mean anesthetic time did not differ. Although the pre-injury and final activity levels were significantly lower in the study group, the degree of recovery was the same. No clinical complications related to this technique were encountered. Radiologically, the reduction was good in all hips in both groups. Union was obtained in all cases without any time differences.ConclusionsThis less invasive reduction technique is simple and safe to use for this type of difficult fracture.

Dislocation of the Interphalangeal Joint of the Great Toe: Is Percutaneous Reduction of an Incarcerated Sesamoid an Option?

Dorsal dislocation of the interphalangeal joint of the great toe is rare. It results from a hyperextension injury to the joint. Closed reduction is often attempted in the emergency setting, but this measure is seldom successful owing to invagination of the sesamoid-plantar plate complex into the interphalangeal space. The classic treatment, open reduction, is indicated when closed reduction fails1-12. In this report, attempts at closed reduction were unsuccessful in two patients. A novel technique of percutaneous reduction of the incarcerated sesamoid was then performed, leading to a successful reduction. Both patients and their families were informed that data concerning the case would be submitted for publication, and they consented. ### Surgical Technique With the patient under local, regional, or general anesthesia, a small stab incision is made over the extensor hallucis longus tendon. Under fluoroscopic guidance, a 1.0-mm Kirschner wire is introduced through the extensor tendon head and the dorsal capsule toward the invaginated sesamoid while traction is applied to the distal phalanx. The Kirschner wire is then used as a joystick to lever the sesamoid away from the head of the proximal phalanx and into the joint and then to push it plantarward (for Miki type-II injuries) (Fig. 1-A)1. To avoid fracturing the sesamoid, the Kirschner wire is not drilled into it but is manipulated by hand. Adequate reduction is then confirmed by noting that the distal phalanx is clinically unstable, and the sesamoid is restored with use of fluoroscopy to its original location plantar to the interphalangeal joint. Obstructed interphalangeal joint flexion and extension suggest reduction of the sesamoid into the joint space and conversion of a type-II to a type-I dislocation (Fig. 1-B)1. The procedure should then be repeated until the sesamoid is reduced to the plantar surface (Fig. 1-C …

Surgical technique for minimally invasive fibula fracture fixation

This paper describes a minimally invasive percutaneous technique for reduction and fixation of distal fibula fractures using plate osteosynthesis. We believe this technique benefits patients with poor quality soft tissue envelopes. So far a total of 25 patients have undergone percutaneous fixation, 22 females and 3 males. At no stage yet has a minimally invasive procedure been abandoned intra-operatively in favour of conversion to an open procedure. The mean age was 61.6 years (range 25-80 years). The mean time to surgery was 2.00 days (range 0-5) and mean time to discharge was 4.20 days (range 1-9). At a minimum of over 1 year's follow-up all fractures have healed, with no delayed unions or complications so far experienced.

A specific closed percutaneous technique for reduction of Jeffery type II lesion

Open reduction is commonly recommended in Jeffery type II fractures. Attempts to reduce these fractures percutaneously were reported as unsafe and unreliable. We revisited this technique and used a specific percutaneous reduction that turned out to be successful in two cases. Instead of lifting the radial head as described in leverage maneuver, we use a pushing-back procedure to reduce the fracture. The maneuver aims at suppressing the capitellum interposition between the head fragment and the metaphysis by reproducing the reversed trajectory of trauma. This reduction is made possible because of the posterior periosteal attachment of the radial head. A few weeks after the procedure, the two patients remained painless, recovered a complete range of motion in prono-supination and returned to sports. In these two cases, the procedure used led to a prompt recovery and provided a much better outcome than described with the classic open approach.

Arthroscopic Treatment of Acute Traumatic Posterior Glenohumeral Dislocation and Anatomic Neck Fracture

Abstract We describe a simple method of arthroscopic-assisted reduction of a posterior fracture dislocation of the proximal humerus, the principle of which could be used as a method of reduction for all fracture dislocations of the proximal humerus for which percutaneous reduction is beneficial. With the patient in the beach-chair position and using a posterior portal 2 cm medial and 2 cm inferior to the posterolateral corner of the acromion on the medial edge of the displaced head, a 4.5-mm blunt trocar is introduced, directed medial to the head fragment toward the posterior lateral scapular neck, translating the distal tip laterally to enter the shoulder joint. The trocar is then redirected medially onto the articular surface of the glenoid and the head is levered into the joint atraumatically. The standard technique of percutaneous reduction of the proximal humerus follows. Arthroscopic evaluation of the shoulder with gravity-assisted flow is performed to improve the articular reduction and document any associated capsular, ligamentous, labral, or tendon damage. Similarly, anterior fracture dislocations can be reduced atraumatically using lateral and anterior portals, after which percutaneous reduction could be effective when indicated.

Vertical Axis Patellar Dislocation With Ipsilateral Femoral Fracture: Use of a Closed Percutaneous Technique for Reduction of the Dislocation

Intra-articular vertical axis dislocations are rare injuries, which mostly occur after blunt trauma. In this type of dislocation, the patella rotates along its vertical axis, bringing the articular surface to face medially or laterally. A 13-year-old boy sustained an intra-articular lateral patellar dislocation with a 90 degrees vertical axis medial rotation, which resulted in the articular surface facing laterally, the medial edge of the patella pointing posteriorly, and the lateral edge of the patella pointing anteriorly. As a result, the patella was wedged between the medial and lateral femoral condyles. He also sustained an ipsilateral closed distal femoral shaft fracture. Closed reduction of the dislocation was not successful. Subsequently an A-O reduction clamp was used percutaneously to reduce the patellar dislocation. The femoral fracture was then stabilized by internal fixation using a dynamic compression plate. Isolated vertical and horizontal dislocations have been previously described, but the presence of an ipsilateral femoral shaft fracture makes this a unique case. The percutaneous method used for reduction of the patella has not been previously described. A focused review of the literature, pathoanatomy, and methods of treatment of this condition are presented.

Percutaneous technique for reduction of complex metacarpophalangeal dislocations.

Historically, complex metacarpophalangeal (MCP) joint dislocations have necessitated open surgical management by either a volar or dorsal approach. The authors describe a relatively simple and reliable percutaneous technique to treat these complex MCP dislocations, with results comparable with open surgical reduction. This minimally invasive technique can be performed in the emergency room setting, thereby avoiding the cost and morbidity associated with an open procedure in the operating room. From 1996 to 2003, the percutaneous technique was performed on 4 patients with complex MCP joint dislocations. Three patients underwent percutaneous reduction in an operating room whereas the fourth patient was reduced in the emergency room. Successful reduction was attained on the first attempt in all 4 patients without complications. All dislocations were stable after reduction. Near full, painless range of motion was achieved in all 4 patients and there were no cases of recurrent instability. All patients were satisfied with their results.

Technique of percutaneous reduction and cancellous bone plasty in humeral head fractures

Technique of percutaneous reduction and cancellous bone plasty in humeral head fractures