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Friday, March 2, 2001

'Parachute technique' speeds union, reduces pain

The 'parachute technique" provides a solution for the surgeon faced with a displaced surgical neck fracture in an osteopenic patient, say researchers in scientific exhibit 1.

They reviewed the charts of 14 patients (average age 68) who underwent valgus impaction osteotomy with Dacron tape fixation for displaced surgical neck fractures. Follow-up averaged 18.5 months with a range of 1.5 to 61.5 months. At each follow-up patients were evaluated both radiographically for union and clinically for functional return.

In this method, a stable fracture pattern is created by narrowing the diameter of the humeral shaft through an osteotomy and impacting it into the humeral head fragment. Tension Band sutures (Dacron tape) stabilize the fragments. Two tapes are placed over the greater tuberosity to counter the pull of the surpaspinatus muscle and two tapes are placed over the lesser tuberosity to counter the anterior and medial deforming forces of the pectoralis major and deltoid muscles.

Union was achieved in 13 cases at 45 days. One patient was lost to follow-up until the 31st week at which time union was confirmed. There was a mean loss of forward flexion, external rotation and internal rotation of 17.5 degrees, 7.86 degrees and 2.08 spinal levels, respectively. However, all patients were able to perform activities of daily living without difficulty.

The researchers said the "parachute technique" produces dramatic decrease in time-to-union and postoperative pain because of the solid intraoperative reduction through the impaction osteotomy. Subsequently, both morbidity and hospital stay are decreased.

The researchers are John M. Felin, MD, the Rothman Institute, Philadelphia, Pa.; Stephen P. Banco, MD, department of orthopaedic surgery, Thomas Jefferson University, Philadelphia, Pa.; Barbara G. Frieman, MD, the Rothman Institute, Philadelphia, Pa.; and Matthew Ramsey, MD, department of orthopaedic surgery, University of Pennsylvania, Philadelphia, Pa.

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2001 Academy News March 2 Index C

Last modified 15/February/2001 by IS