Intramedullary Fixation for Displaced Clavicle Fractures in the Adolescent Athlete.

The role of intramedullary (IM) fixation of displaced mid-shaft clavicle fractures in adolescents has not been described. This study analyzes characteristics and outcomes of IM fixation in adolescent clavicle fractures. Patients < 18 years with acute, mid-shaft clavicle fractures treated with IM clavicle pins between March 2007 and August 2013 were reviewed. Outcomes of interest were activity level, fracture pattern, time to union, return to sports and complications. Twenty-nine patients (14.8 years (range 11.4-17.9)) underwent IM pin fixation for a displaced, mid-shaft clavicle fracture, including 7 (24.1%) that were multi-fragmentary (length unstable). Complete displacement (> 100%) occurred in 27/29 (93.1%), with average preoperative shortening length of 18 mm. Union occurred in 100% of patients, at a mean duration of 8 weeks. Among student-athletes (25/29, 86.2%), average return to sport was at 18 weeks post-injury. IM pinning offers stable fixation of clavicle fractures in the active adolescent population.(Journal of Surgical Orthopaedic Advances 29(2):81-87, 2020).

Increased Cost of Negative Pressure Dressings Is Not Justified for Split-Thickness Skin Grafting of Low-Risk Wounds.

OBJECTIVES: (1) To determine whether negative pressure dressings (NPDs) are superior to conventional compressive dressings (CDs) for split-thickness skin grafts (STSGs) placed on healthy, low-risk wounds, (2) To determine the cost difference of NPDs versus that of CDs. DESIGN: Retrospective. SETTING: Level I Trauma Center. PATIENTS/PARTICIPANTS: One hundred ninety-five traumatic wounds treated with STSG. MAIN OUTCOME MEASUREMENTS: Patients were assigned outcomes based on postoperative documentation: completely healed, incompletely healed (small areas of graft necrosis), failed, or lost to follow-up. The costs associated with each dressing type were documented. RESULTS: Thirty five of 195 STSGs were lost to follow-up, leaving n = 120 STSG-NPD, n = 40 STSG-CD. Of the remaining 120 STSGs treated with NPD, 91 completely healed, 23 incompletely healed, and 6 failed. Of the 40 STSGs treated with a CD, 37 completely healed, 1 incompletely healed, and 2 failed. Patients treated with CDs had a higher likelihood of healing relative to those treated with the NPD (P = 0.018). Analyzing the outcomes as failed versus "not failed" revealed no significant difference between the groups (P = 1.00). There were more smokers in the CD group (P = 0.022). In this series, the mean cost associated with NPD compared with that of CD was $2370 more per patient. CONCLUSIONS: There is a high rate of successful healing of STSGs for traumatic extremity wounds regardless of the dressing used. The increased cost of NPDs is not justified in wounds that are at a low risk of developing STSG failure. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Reduction and association of the scaphoid and lunate procedure: short-term clinical and radiographic outcomes.

PURPOSE: To evaluate the success of reduction and association of the scaphoid and lunate with a fibrous union in an effort to evaluate the technique's validity and reproducibility. METHODS: A retrospective review was performed on 7 patients (8 wrists) with an average follow-up of 38 months. Static and grip radiographs were examined in the preoperative, immediate postoperative, and final follow-up settings to evaluate scapholunate (SL) diastasis, SL angle, hardware position, and complications. At final follow-up, grip strength and wrist range of motion were recorded, and patients completed the Disabilities of the Arm, Shoulder, and Hand and the Patient-Rated Wrist Evaluation outcome questionnaires. RESULTS: Radiographic success, defined by maintenance of corrected SL diastasis, absence of dorsal intercalated segmental instability, and no progression of SL advanced collapse was achieved in 3 of the 8 wrists. One wrist developed radioscaphoid arthritis. No patients required a salvage procedure. Despite the loss of reduction that occurred in all patients, the patients' disability remained minimal as detected by the scores on the outcome measures. CONCLUSIONS: The procedure was ineffective in providing stability about the SL interval. With a majority of patients experiencing early radiographic failure of the procedure in the short term, our experience suggests that the reduction and association of the scaphoid and lunate procedure should be abandoned despite the relatively low outcomes measures scores, which may be reflective of the short follow-up duration for this series. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.