Unique distal clavicular fracture in an active-duty military population.

We present a series of distal clavicle fractures in which the coracoclavicular ligaments remain intact to the proximal segment, but the distal aspect of the clavicle is displaced superiorly. The fractures sustained in this series are not described in any of the multiple classification systems currently in use for clavicular fractures. We present a series of 2 active-duty patients who sustained nearly identical distal clavicle fractures during Army combatives training. A 23-year-old male was treated successfully with nonoperative therapy and returned to deployment within 2 months. A 23-year-old female failed nonoperative treatment and was successfully treated with an operative open distal clavicle resection. This rare fracture attributed to a specific mechanism of injury has a potential to be commonly encountered in active-duty patients taking part in mandatory combatives programs.

Shortening osteotomy and compression plating for atrophic humeral nonunions: surgical technique.

The incidence of nonunion after humeral shaft fractures is low with both operative and nonoperative interventions. However, when a delayed union or nonunion occurs, it can be a very debilitating, leading to limited function and pain. Several methods have been described for the management of humeral diaphyseal nonunions. We present 11 cases managed with a transverse, shortening osteotomy and compression plating with or without bone grafting. Of the 11 cases, 10 had prior surgical treatment of open reduction and internal fixation. Union was achieved in all 11 humeri.

Role of the triradiate cartilage in predicting curve progression in adolescent idiopathic scoliosis.

Braces are commonly used to treat progressive adolescent idiopathic scoliosis. Several previous studies have reported a correlation between the success of brace treatment and skeletal maturity markers. These studies have not focused on the status of the triradiate cartilage (TRC) as it relates to successful brace treatment for adolescent idiopathic scoliosis. The authors retrospectively evaluated all patients at their institution from 1990 to 1997 with a diagnosis of adolescent idiopathic scoliosis who were treated in a Boston brace. Sixty-two patients met inclusion criteria. At presentation, the average age was 12.87 years, the average Risser sign was 0.56, and 45% of patients had an open TRC. The average follow-up was 2.92 years. Greater than 5 degrees of progression at discontinuation of bracing was considered a failure. Curves with a closed TRC failed bracing 21% of the time, whereas those with an open TRC failed 54% of the time (P = 0.0069). Those curves with a closed TRC progressed 3.12 degrees on average, whereas curves with an open TRC progressed 6.86 degrees. Curves associated with a closed TRC at initiation of bracing progressed less frequently and to a lesser degree than those associated with an open TRC (P = 0.027). Although the TRC is not an independent predictor of curve stability, it is an additional indicator of skeletal maturity and may prove most useful in patients with otherwise borderline indications for brace treatment.

Avulsion of the extensor carpi radialis brevis insertion: a case report and review of the literature.

Injuries to the bases of the index finger and long finger metacarpals are unusual because of the stability of the carpometacarpal joints. Such stability is provided by the strong capsuloligamentous attachments and the unique bony architecture. Given the rare nature of these injuries, there is no consensus regarding the optimal management of avulsion fractures of the bases of the index finger and long finger metacarpals. Open reduction and internal fixation of the fracture, with anatomic repair of the extensor carpi radialis brevis or extensor carpi radialis longus, offers several advantages over closed treatment. A case report and a review of the literature are presented.