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The Use of the Semi-Sterile Technique for Closed Reduction and Percutaneous Pinning (CRPP) of Upper Extremity Fractures in Pediatric Patients
Charles Joseph Blevins, BS; Karan Dua, MD; Joshua M. Abzug, MD
University of Maryland School of Medicine, Baltimore, MD

Introduction: The vast majority of operative upper extremity pediatric fractures can be treated utilizing closed reduction and percutaneous pinning techniques (CRPP). While the norm is to perform a full surgical prep and drape during these procedures, this can be inefficient and wasteful of materials. The semi-sterile technique has been utilized in the treatment of pediatric supracondylar humerus fractures and was shown to have no difference in infection or complication rates. This technique utilizes only sterile towels and sterile gloves following prep of the limb with chlorhexidine paint. No scrub of the limb is performed, no drapes are utilized and no gowns are worn. The purpose of this study was to assess the use of the semi-sterile technique during CRPP of all pediatric upper extremity fractures.
Materials and Methods: A retrospective review was performed of all pediatric patients that underwent CRPP of an upper extremity fracture over a four-year period. During the study period, there was a transition from utilizing a full prep and drape to utilizing the semi sterile technique. Demographic data, the fracture location, and time period of pin fixation were recorded. Additionally, any infections or other complications were noted.
Results: 60 patients were reviewed including 44 in the semi sterile group and 16 in the full prep group. The average time to pin removal was 26 days (range 19-35 days). There was one pin tract infection in the full prep group in a four-year old female with a supracondylar fracture. Three patients had a nerve palsy following supracondylar fracture.

Fracture Types  (n = 60)
Semi Sterile Prep Full Sterile Prep Totals
Humerus 16 Humerus 10 26
Radius 15 Radius 4 19
Ulna 0 Ulna 0 0
Carpal 0 Carpal 0 0
Metacarpal 3 Metacarpal 1 4
Phalange 10 Phalange 1 11
Total 44 Total 16 60

Conclusion: The semi-sterile technique is a safe, efficient, cost-saving technique that can be utilized when performing CRPP of pediatric upper extremity fractures. Continuing to utilize full prep and drapes during these procedures adds medical waste while increasing costs and therefore should be abandoned. It is likely that this technique is also safe to perform in adult upper extremity CRPP procedures.

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