Outcomes of operative versus nonoperative treatment of displaced pediatric clavicle fractures.

Current literature proposes relative and absolute indications for surgical treatment of clavicle fractures in adults. However, few studies have evaluated these fractures in children. The current study examined short- and long-term outcomes of pediatric patients with displaced clavicle fractures. Outcomes assessed included radiographic healing, full active range of motion, and return to activity. The authors' hypothesis was that open reduction and internal fixation of displaced clavicle fractures would lead to better outcomes than nonoperative treatment. The authors retrospectively reviewed the charts of pediatric patients treated for clavicle fractures between January 2001 and October 2011. The nonoperative group included 32 patients, and the operative group included 46 patients. Mean time to return to activity was 12.24 weeks in the nonoperative group and 12.70 weeks in the operative group (P=.67). Mean time to full active range of motion was 7.85 weeks in the nonoperative group and 8.74 weeks in the operative group (P=.24). Mean time to radiographic evidence of healing was 12.02 weeks in the nonoperative group and 11.90 weeks in the operative group (P=.90). Average Disabilities of the Arm, Shoulder and Hand (DASH) score was 0.04 in the nonoperative group (range, 0-0.08) and 1.17 in the operative group (range, 0-8.3), with no significant difference between groups. No significant difference between operative treatment and nonoperative treatment was found in any of the authors' outcome measures. Thus, the authors propose that unless the patient's injury is an absolute indication for surgery, conservative management provides equivalent immediate and long-term clinical results.

A prospective study of the association between bone contusion and intra-articular injuries associated with acute anterior cruciate ligament tear.

BACKGROUND: Bone bruising, commonly found on magnetic resonance imaging (MRI) after anterior cruciate ligament (ACL) injury, may be associated with intra-articular injuries, but little is known about this association. PURPOSE: To examine demographic factors and intra-articular injuries associated with bone bruising in patients undergoing ACL reconstruction. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Patients with ACL injury who had an MRI within 6 weeks and arthroscopy within 3 months of injury were included in this prospective study (N = 171). Presence and severity of bone bruising were determined from preoperative MRIs for each anatomic site: lateral femoral condyle (LFC), lateral tibial plateau (LTP), medial femoral condyle (MFC), and medial tibial plateau (MTP). Multiple logistic regression was used to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI) for predictors of bruising and associations between bruising and intra-articular injuries found during arthroscopy. Outcomes included the presence of bruising and severity of lateral bruising (mild, moderate, severe vs none/minimal bruising). RESULTS: Frequencies of bone bruising were as follows: 85% LTP, 77% LFC, 26% MTP, and 6% MFC. Patient age between 18 and 28 years (OR, 0.27; 95% CI, 0.09-0.82) and 29 years and older (OR, 0.18; 95% CI, 0.05-0.61) predicted less LFC bruising compared with patients aged 17 years and younger. Age (18-28 years: OR, 0.15; 95% CI, 0.03-0.66; ≥29 years: OR, 0.10; 95% CI, 0.02-0.68) and contact injuries (OR, 0.17; 95% CI, 0.04-0.78) predicted less moderate LFC bruising. Male sex predicted mild (OR, 6.16; 95% CI, 1.44-26.43), moderate (OR, 8.98; 95% CI, 1.96-41.19), and severe (OR, 15.66; 95% CI, 3.19-76.92) LFC bruising. Male sex also predicted mild LTP bruising (OR, 0.19; 95% CI, 0.05-0.83), and contact injuries predicted severe LTP bruising (OR, 5.01; 95% CI, 1.21-20.67). LFC bruising (OR, 2.57; 95% CI, 1.04-6.32) and LTP bruising (OR, 3.13; 95% CI, 1.06-9.23) were associated with lateral meniscal tears. Moderate (OR, 8.14; 95% CI, 1.93-34.27) and severe (OR, 15.30; 95% CI, 2.34-100.10) LTP bruising was associated with medial meniscal tears. MFC bruising and MTP bruising were not associated with any predictors or intra-articular injuries. CONCLUSION: Bone bruising is more common and severe in young men, and lateral bone bruising is associated with lateral meniscal tears. Medial meniscal tears are associated with increased severity of LTP bruising.

Simple versus horizontal suture anchor repair of Bankart lesions: which better restores labral anatomy?

PURPOSE: The goal of this study was to determine which suture repair technique better restores glenoid labrum height: horizontal sutures or simple sutures. METHODS: Sixteen cadaveric glenoids, 8 per repair technique, were used to measure native labral height at the 3:00 to 6:00 positions in half-hour increments. A Bankart lesion was then created from 3:00 to 6:30. Height measurements at each time point were again taken after creation of the Bankart lesion. Repair with a 3-mm knotted suture anchor was then performed at 3:30, 4:30, and 5:30 with either a simple or horizontal suture technique, and postrepair heights were measured across all time points. RESULTS: Significant decreases in height, as compared with native height, were observed at 3:30, 4:30, and 5:30 in the simple repair group. Decreases in height of 1.4 mm (P = .044), 2.1 mm (P = .030), and 1.1 (P = .034) were observed at 3:30, 4:30, and 5:30. There was no significant decrease in height at these respective time points in the horizontal repair group. CONCLUSIONS: The in vitro horizontal mattress suture technique better restores labral height and anatomy when compared with a simple suture technique in the repair of acute Bankart lesions. CLINICAL RELEVANCE: Compared with the simple suture technique, horizontal suture repair may provide increased stability to the glenohumeral construct.