Portal de Periódicos da CAPES

Commentary

2018; Lippincott Williams & Wilkins; Volume: 38; Issue: Supplement 1 Linguagem: Inglês

10.1097/bpo.0000000000001160

1539-2570

James H. Beaty,

Shoulder Injury and Treatment

The role of arthroscopy in the management of fractures, particularly periarticular fracture, in adults is fairly well-defined. Whether a part of the primary fracture management or an adjunct to percutaneous or open fixation, arthroscopy is especially useful for fixation of tibial plateau fractures and for removal of osteochondral loose bodies after fracture. In their discussion of the arthroscopic treatment of pediatric fractures, Drs Accadbled and N’Dele have demonstrated reasons for considering the use of arthroscopy in children, particularly for tibial eminence fractures and removal of osteochondral loose bodies after periarticular fractures around the knee. The 2 situations are by far the most common indications for the use of arthroscopy in the management of pediatric fractures. As noted in the article, arthroscopy may be helpful in percutaneous fracture reduction and fixation in the ankle, particularly distal tibial physeal and articular injuries. Salter-Harris types III and IV medial malleolar fractures are examples of fractures in which arthroscopy may be used as an adjunct to assist in percutaneous fixation. Future applications of arthroscopy in children and adolescents include use in the upper extremity. Treatment of triangular fibrocartilage complex tears and distal radio ulnar joint instability have been described, as have arthroscopic debridement for osteochondritis dissecans and impingement in the elbow. Arthroscopic assistance with fixation of lateral humeral condylar fractures. As Drs Accadbled and N’Dele emphasize, arthroscopy is not a “one-size-fits-all” solution for traumatic conditions in children and adolescents, and it is technically demanding; however, it may be used safely and successfully in a variety of situations, and for many it is the preferred technique for fixation of tibial eminence fractures and removal of loose osteochondral bodies around the knee. James H. Beaty, MDLe Bonheur Children’s Hospital University of Tennessee-Campbell Clinic Memphis, TN