Developmental dysplasia of the hip in infants with congenital muscular torticollis.

Infants with congenital muscular torticollis (CMT) are at increased risk for developmental dysplasia of the hip (DDH), which has led to increased use of diagnostic procedures. Our goal in this study was to establish indications for imaging the hips of infants presenting with CMT. We reviewed the cases of 292 patients with the diagnosis of CMT, 16 of whom were found to have DDH. Each patient with DDH had an abnormal clinical hip examination. Our study results demonstrate that, despite the association of these disorders, an infant presenting with CMT does not require routine hip imaging in light of a normal clinical hip examination. The coexistence rate for CMT and DDH requiring treatment is 4.5%, which is lower than the commonly accepted 20%.

Scapulothoracic dissociation with acromioclavicular separation: a case report of a novel fixation method.

We present a case of 39-year-old female with a scapulothoracic dissociation and acromioclavicular (AC) separation and who had fixation of the AC joint with a locking plate, coracoclavicular screw, and transarticular AC screw. The coracoclavicular and AC relationships were maintained during postoperative rehabilitation and after hardware removal. Use of a locking plate can lead to good functional outcome without the complications associated with the use of pin and wire constructs or without violating the subacromial space.

The outcome of intra-articular distal radius fractures treated with fragment-specific fixation.

PURPOSE: To assess the clinical, radiographic, and functional outcome of treating intra-articular distal radius fractures with fragment-specific fixation. METHODS: A retrospective review of 81 patients with 85 intra-articular distal radius fractures who were treated with fragment-specific fixation was performed. Minimum time to follow-up evaluation was 1 year, with a mean time of 32 months. The immediate postoperative films were compared with those taken at the final follow-up evaluation. Radiographs of the uninjured wrist were also obtained at the final follow-up evaluation for comparison. Patients were examined for wrist and finger range of motion, deformity, and grip strength, and they completed a standard Disabilities of the Arm, Shoulder, and Hand outcome survey. RESULTS: According to Gartland and Werley scoring there were 61 excellent and 24 good results. Flexion and extension of the surgically treated wrist at the final follow-up evaluation averaged 85% and 91%, respectively, of the uninjured wrist; grip strength averaged 92% compared with the uninjured side. The average Disabilities of the Arm, Shoulder, and Hand outcome score for the injured wrist was 9. Sixty-two percent of patients achieved a 100 degrees arc of flexion and extension and normal forearm rotation by postoperative week 6. Radiographic alignment was maintained between immediate postoperative and final follow-up films, and there were no cases of symptomatic arthritis at the final follow-up evaluation. CONCLUSIONS: Fragment-specific fixation is a reasonable alternative for treating intra-articular fractures of the distal radius. At final follow-up evaluations, patients had good to excellent results with respect to range of motion, grip strength, radiographic alignment, and satisfaction scores. Stable fixation allowed starting active and passive motion of the wrist without compromising postoperative alignment. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Comparison of lateral locking plate and antiglide plate for fixation of distal fibular fractures in osteoporotic bone: a biomechanical study.

OBJECTIVES: The purpose of this study was to compare the biomechanical properties of posterolateral antiglide plating and lateral locked plating for fixation of displaced short oblique fractures of the fibula in osteoporotic bone. METHODS: Short oblique fractures of the distal fibula at the level of the syndesmosis were simulated with a fibular osteotomy and ligamentous sectioning in 18 paired fresh frozen ankles. The fractures were fixed with either a lateral locking plate with an independent lag screw or a posterolateral antiglide plate with a lag screw through the plate. The specimens were tested under a torsional load to failure. The torque to failure, angular rotation at failure, and construct stiffness of the two groups were compared. RESULTS: The torque to failure and construct stiffness were significantly greater on the side with the posterolateral antiglide plate than on the side with the the lateral locking plate (P = 0.01 and 0.005, respectively). CONCLUSIONS: The posterolateral antiglide plate demonstrated improved biomechanical stability as compared to the lateral locking plate in osteoporotic bone. In situations where fixation needs to be optimized, use of an antiglide plate may be favored over a lateral locking plate construct.

Effect of hip hemiarthroplasty on articular cartilage and bone in a canine model.

The purpose of this study was to determine if acetabular articular cartilage damage occurs in the presence or absence of changes in subchondral plate thickness or porosity and trabecular bone architecture after hip hemiarthroplasty. Eight canines were sacrificed 6 months after receiving unilateral hemiarthroplasties in which a cobalt chrome alloy femoral head was used. The acetabular cartilage, subchondral plate, and trabecular bone were quantitatively evaluated. Although the articular cartilage in the treated hip showed gross and histologic degenerative changes, there were no differences in the treated and contralateral hips in any of the trabecular bone parameters or subchondral plate thickness. However, the subchondral plate porosity was increased 2.6-fold in the treated hip. Therefore, degradation of cartilage can occur in the absence of thickening of the subchondral plate or alterations in the supporting trabecular bone architecture. These observations provide a better understanding of the role that periarticular bone has in the degenerative process after hemiarthoplasty.