Frequency and complications after operative fixation of clavicular fractures.

BACKGROUND: The purpose of this study was to analyze whether a recent trend in evidence supporting operative treatment of clavicular fractures is matched with an increase in operative fixation and complication rates in the United States. METHODS: The American Board of Orthopaedic Surgery database was reviewed for cases with Current Procedural Terminology (American Medical Association, Chicago, IL, USA) code 23515 (clavicle open reduction internal fixation [ORIF]) from 1999 to 2010. The procedure rate for each year and the number of procedures for each candidate performing clavicle ORIF were calculated to determine if a change had occurred in the frequency of ORIF for clavicular fractures. Complication and outcome data were also reviewed. RESULTS: In 2010 vs, 1999, there were statistically significant increases in the mean number of clavicle ORIF performed among all candidates (0.89 vs. 0.13; P < .0001) and in the mean number of clavicle ORIF per candidate performing clavicle ORIF (2.47 vs. 1.20, P < .0473). The difference in the percentage of part II candidates performing clavicle ORIF from the start to the end of the study (11% vs. 36%) was significant (P < .0001). There was a significant increase in the clavicle ORIF percentage of total cases (0.11% vs. 0.74%, P < .0001). The most common complication was hardware failure (4%). CONCLUSION: The rate of ORIF of clavicular fractures has increased in candidates taking part II of the American Board of Orthopaedic Surgery, with a low complication rate. The increase in operative fixation during this interval may have been influenced by literature suggesting improved outcomes in patients treated with operative stabilization of their clavicular fracture.

Body mass index and Blount disease.

As the increasing prevalence of overweight and obese children is approaching epidemic proportions in North America, this study was designed to investigate whether Body Mass Index (BMI) and age- and gender-specific percentile Body Mass Index (BMI %) are associated with the likelihood of being listed for surgery for Blount disease after initial presentation to a tertiary referral centre. In a restrospective consecutive sample of 102 children with an average age of 5.9 +/- 4.3 years, it was determined that there was a significant association between BMI and BMI% and being listed for surgery, after adjusting for the effects of the child's age and gender, with mean odds ratios of 1.30 (95% confidence interval 1.02-1.60) and 1.05 (95% confidence interval 1.01-1.09) respectively. When the sample was subgrouped into infantile (less than 3 years of age) and late-onset (greater than 3 years of age), BMI and BMI% were still significantly associated with the children being listed for surgery in the late-onset group with mean odds ratios 2.75 (95% confidence interval 1.03-7.33) and 1.09 (95% confidence interval 1.01-1.18) respectively. However, of the two measures only the BMI was significant in the infantile group with an odds ratio of 1.27 (95% confidence interval 1.01-1.60). Should these associations be real then measures aimed at decreasing weight in children may have some effect on the number of children undergoing surgery for the treatment of Blount disease.

The impact of the garden classification on proposed operative treatment.

The current study evaluates the interobserver reliability and intraobserver reproducibility of the Garden classification of femoral neck fractures, assesses the influence of a lateral radiograph on a fracture's classification, and determines the classification's impact on the surgeon's choice of operative treatment. Forty radiographs of femoral neck fractures were evaluated independently by five orthopaedic surgeons. Kappa values were calculated for interobserver reliability and intraobserver variability with respect to the readers' ability to assess the fractures using the Garden classification and to determine fracture displacement with and without access to a lateral radiograph. In 69% of the instances in which a reader changed the classification of a fracture, the proposed treatment of the fracture did not change. The Garden classification has poor interobserver reliability but good intraobserver reproducibility. The addition of a lateral radiograph does not seem to improve the reliability of the current Garden classification system but may improve the reader's ability to determine fracture displacement. To improve the reliability and usefulness of the Garden classification, the authors suggest that the classification should be modified to have only two stages (Garden A-nondisplaced or valgus impacted and Garden B-displaced) and to include the use of a lateral radiograph.