Anteroinferior 2.7-mm versus 3.5-mm plating for AO/OTA type B clavicle fractures: a comparative cohort clinical outcomes study.

OBJECTIVES: To compare the Disability of the Arm, Shoulder, and Hand (DASH) and Constant scores, time to union, rate of union, patient cosmetic satisfaction rate, and the need for secondary procedures between 2.7- and 3.5-mm anteroinferior plating for Arbeitsgemeinschaft für Osteosynthesefragen (AO)/Orthopaedic Trauma Association (OTA) type B clavicle fractures. DESIGN: Retrospective, comparative cohort clinical outcomes study. SETTING: Level I university trauma center. PATIENTS/PARTICIPATION: Thirty-seven patients with an AO/OTA type B clavicle fracture who underwent open reduction internal fixation with either a 2.7- or 3.5-mm reconstruction plate placed in the anterior-inferior position. The main outcome comparisons included DASH score, Constant score, time to union, rate of union, rate of hardware failure, cosmetic satisfaction, and secondary procedure. MAIN OUTCOME MEASUREMENT: DASH score, constant score, time to union, rate of union, cosmetic satisfaction, secondary procedure. RESULTS: At 1-year follow-up, analysis yielded no significant differences in DASH scores (P = 0.26) and Constant Shoulder scores (P = 0.79) between the 2 cohorts. There were no statistically significant differences in the time to union (P = 0.86) and the rate of union (P = 0.49). Although the 2.7-mm cohort had a lower reoperation rate, it was not statistically significant (P = 0.11). However, the 2.7-mm cohort did demonstrate a significantly higher rate of cosmetically acceptable reconstruction (P = 0.003). CONCLUSIONS: Compared with 3.5-mm anterior-inferior plating, 2.7-mm anteroinferior plating for AO/OTA type B clavicle fractures leads to significantly higher rates of cosmetic acceptability while reducing the need for a secondary procedure and achieving excellent clinical outcomes as measured by the DASH and Constant scores. There were no differences between the 2.7 and 3.5 cohorts in time to union or in union rate. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Identification of the radial nerve during the posterior approach to the humerus: a cadaveric study.

OBJECTIVE: Identification of the radial nerve is necessary during the posterior approach to the humerus in an effort to maintain its integrity. Other than anatomic descriptions of the radial nerve with respect to osseous structures, there are few superficial intraoperative landmarks along the course of the traditional triceps-splitting approach to provide facile nerve identification. The objective of this study was to determine the reliability of using the anatomic intersection of the long and lateral heads of the triceps and the triceps aponeurosis as a superficial reference point for radial nerve identification during the posterior approach to the humerus. METHODS: Thirty adult human cadaver upper extremities as 15 matched pairs were used. Systematic identification and measurement from the point of intersection between the long and lateral heads of the triceps and the triceps aponeurosis to the distal most aspect of the radial nerve as it coursed the posterior humerus at its midaxial point was performed and recorded. RESULTS: Mean distance was found to measure 39.0 ± 2.1 mm (range, 36-44 mm), approximating a fixed distance, two finger breadths proximal to our identified point of intersection. Statistical analysis between the two matched pair groups yielded no significant difference in measured distances (P = 0.88). CONCLUSIONS: Our group has identified the point of intersection among three landmarks forming a point of intersection. This point is the confluence of the long and lateral heads of the triceps and the triceps aponeurosis. This serves as a visualized anatomic reference point during the posterior surgical exposure to the humerus and can be used to identify the radial nerve as it courses the posterior humerus.

Use of an "antibiotic plate" for infected periprosthetic fracture in total hip arthroplasty.

Periprosthetic fracture and infection are dreaded complications after total hip arthroplasty. We present the case of a 50-year-old man who suffered an early postoperative Vancouver B1 periprosthetic fracture, which was further complicated by concurrent infection after open reduction and internal fixation. We report the novel use of an antibiotic-impregnated cement coated locking plate during the staged treatment of concomitant periprosthetic fracture and chronic total hip arthroplasty infection. At 1-year follow-up, the patient is pain free and ambulating independently with full range of motion.

Forward progression of the helical blade into the pelvis after repair with the Trochanter Fixation Nail (TFN).

Unstable intertrochanteric and subtrochanteric fractures historically have been prone to inferior displacement of the femoral head as well as varus collapse. Efforts to mitigate these untoward outcomes have led to the evolution of the Trochanteric Fixation Nail (TFN) with its helical spiral blade. The TFN has many proposed advantages such as simplified insertion, less hardware, and improved resistance to "cutout" of cephallomedullary fixation. Previous case reports have shown spiral blade perforation through the femoral head and, in some cases, into the hip. However, to our knowledge, there have not been any reports describing the advancement of the helical spiral blade into the pelvic cavity. We present a case of forward advancement of the helical spiral blade through the femoral head and acetabulum into the pelvic cavity.

Foreign-body reaction to the Artelon CMC joint spacer: case report.

The Artelon CMC spacer (Small Bone Innovations, Inc., Morrisville, PA) is a relatively new device that was developed for the treatment of basal joint arthritis. It is composed of a biodegradable polycaprolactone-based polyurethane urea that acts to resurface the distal part of the trapezium and stabilize the trapeziometacarpal joint by augmenting the joint capsule. This is a case report of a foreign-body tissue reaction to the Artelon CMC spacer.

Slipped capital femoral epiphysis in an obese teenager.

Adolescents are especially prone to develop slipped capital femoral epiphysis (SCFE). Hormonal changes in puberty, obesity, and hypogonadism suggest that endocrine dysfunction is a contributing factor. SCFE may be one of the most common disorders affecting the hip, yet the diagnosis is often missed or delayed as a result of inappropriate initial evaluation, as occurred in this report of a 13-year-old boy. Timely recognition and, typically, surgical intervention are critical to forestall progression and to prevent further complications.