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2020 ; 102
(13
): e66
Nephropedia Template TP
gab.com Text
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Doing Our Part to Conserve Resources: Determining Whether All Personal Protective
Equipment Is Mandatory for Closed Reduction and Percutaneous Pinning of
Supracondylar Humeral Fractures
#MMPMID32618914
Wilson JM
; Schwartz AM
; Farley KX
; Devito DP
; Fletcher ND
J Bone Joint Surg Am
2020[Jul]; 102
(13
): e66
PMID32618914
show ga
BACKGROUND: Closed reduction and percutaneous pinning (CRPP) of supracondylar
humeral fractures is one of the most common procedures performed in pediatric
orthopaedics. The use of full, standard preparation and draping with standard
personal protective equipment (PPE) may not be necessary during this procedure.
This is of particular interest in the current climate as we face unprecedented
PPE shortages due to the current COVID-19 pandemic. METHODS: This is a
retrospective chart review of 1,270 patients treated with CRPP of a supracondylar
humeral fracture at 2 metropolitan pediatric centers by 10 fellowship-trained
pediatric orthopaedic surgeons. One surgeon in the group did not wear a mask when
performing CRPP of supracondylar humeral fractures, and multiple surgeons in the
group utilized a semisterile preparation technique (no sterile gown or drapes).
Infectious outcomes were compared between 2 groups: full sterile preparation and
semisterile preparation. We additionally analyzed a subgroup of patients who had
semisterile preparation without surgeon mask use. Hospital cost data were used to
estimate annual cost savings with the adoption of the semisterile technique.
RESULTS: In this study, 1,270 patients who underwent CRPP of a supracondylar
humeral fracture and met inclusion criteria were identified. There were 3 deep
infections (0.24%). These infections all occurred in the group using full sterile
preparation and surgical masks. No clinically relevant pin-track infections were
noted. There were no known surgeon occupational exposures to bodily fluid. It is
estimated that national adoption of this technique in the United States could
save between 18,612 and 22,162 gowns and masks with costs savings of $3.7 million
to $4.4 million annually. CONCLUSIONS: We currently face critical shortages of
PPE due to the COVID-19 pandemic. Data from this large series suggest that a
semisterile technique during CRPP of supracondylar humeral fractures is a safe
practice. We anticipate that this could preserve approximately 20,000 gowns and
masks in the United States over the next year. Physicians are encouraged to
reevaluate their daily practice to identify safe opportunities for resource
preservation. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for
Authors for a complete description of levels of evidence.