Treatment of Acetabular Fractures in Adolescents.

Although the treatment of acetabular fractures in adults has evolved substantially, treatment of these injuries in adolescents remains primarily nonoperative. We performed a retrospective review to evaluate outcomes of treatment of adolescent acetabular fractures. We identified 38 adolescent acetabular fractures (patient ages, 11-18 years), all treated by an experienced trauma surgeon. Open reduction and internal fixation (ORIF) was performed in 37 cases, and 1 case was treated nonoperatively. Mean follow-up was 38.2 months. All fractures healed. Reduction was anatomical in 30 cases, imperfect in 7. One patient had surgical secondary congruence, 1 had preoperative deep vein thrombosis, 1 developed a deep infection, and 2 had femoral head avascular necrosis and developed posttraumatic arthritis (both had hip dislocations). Of the 38 patients, 34 returned to full activity. At latest follow-up, 29 had no pain, and 6 had mild intermittent pain not limiting activity. ORIF was found to be safe and to result in predictable union. We therefore advocate a more aggressive strategy. Given our low complication rate, we recommend nonoperative management only for stable, minimally displaced fractures (<1 mm). Unstable fractures, fractures with any hip subluxation, and fractures displaced more than 1 mm should be managed with ORIF. As reported in adults, articular injury often is associated with secondary degenerative arthritis. This association is expected in adolescents as well. Given adolescents' life expectancy subsequent to injury and surgery, any late posttraumatic arthritis will have a significant impact on quality of life over the long term, with increased duration compared with adults.

Superior versus anteroinferior plating of the clavicle revisited: a mechanical study.

OBJECTIVES: This study was designed to compare bone-implant stiffness of two fixation techniques on a sawbone model of a clavicle fracture. METHODS: Twenty-four preosteotomized synthetic left clavicles (Sawbones Worldwide, Vashon, WA) were divided into four groups based on type of fixation: standard 3.5-mm pelvic reconstruction plate in the superior position; standard 3.5-mm pelvic reconstruction plate in an anteroinferior position; 3.5-mm locking pelvic reconstruction plate in a superior position; and a 3.5-mm locking pelvic reconstruction plate in an anteroinferior position. Three nondestructive cyclic mechanical tests were performed in random order: axial, torsion, and four-point bend. RESULTS: No significant difference was found in axial (P = 0.61) or torsional stiffness (internal rotation, P = 0.46 or external rotation, P = 0.49) among all groups. No significant difference occurred in bending rigidity (four-point bending test) with type of plate (P = 0.41), but when the plate was placed anteroinferiorly, bending rigidity was significantly higher (P < 0.001) than in the superior position. CONCLUSION: Placing the plate anteroinferiorly on the clavicle provides a more stable construct in terms of bending rigidity with no detriment in axial and torsional stiffness compared with placing the plate superiorly. We believe that anteroinferior plating is preferred as a result of the increase in bending rigidity together with other advantages, including avoidance of neurovascular compromise, the use of longer screws, and decreased hardware prominence.