Pre-contoured superior locking plates offer poor bone fit for midshaft clavicle fracture fixation: cadaveric analysis of 4 commercially available systems.

OBJECTIVE: The goal of this study is to verify how commercially available pre-contoured superior plates fit on clavicle midshaft fractures. METHODS: 100 cadaveric clavicles were evaluated by three distinct observers applying the clavicle congruence score and comparing four different 6 to 8-hole pre-contoured anatomic locking-plate systems. RESULTS: the inter-observer agreement was considered moderate by the percentage agreement and fair by the Fleiss' Kappa, with no significant differences between evaluations. Only 1 of the 8 plates presented an anatomic fit greater than 70%. Long plates (8 holes) presented a poor fit compared to short plates (6 or 7 holes). CONCLUSIONS: the overall evaluation showed that currently-available pre-contoured superior plate systems provide a poor fit on clavicles for midshaft fracture fixations. Long plates present a worse fit compared to short ones.

Pre-contoured superior locking plates offer poor bone fit for midshaft clavicle fracture fixation: cadaveric analysis of 4 commercially available systems / Placas pré-moldadas superiores possuem adaptação ruim para fixação de fraturas do terço médio da clavícula: análise cadavérica de quatro sistemas disponíveis comercialmente

ABSTRACT Objective: The goal of this study is to verify how commercially available pre-contoured superior plates fit on clavicle midshaft fractures. Methods: 100 cadaveric clavicles were evaluated by three distinct observers applying the clavicle congruence score and comparing four different 6 to 8-hole pre-contoured anatomic locking-plate systems. Results: the inter-observer agreement was considered moderate by the percentage agreement and fair by the Fleiss' Kappa, with no significant differences between evaluations. Only 1 of the 8 plates presented an anatomic fit greater than 70%. Long plates (8 holes) presented a poor fit compared to short plates (6 or 7 holes). Conclusions: the overall evaluation showed that currently-available pre-contoured superior plate systems provide a poor fit on clavicles for midshaft fracture fixations. Long plates present a worse fit compared to short ones.

RESUMO Objetivo: verificar como as placas superiores pré-moldadas disponíveis no mercado se adaptam às fraturas do terço médio da clavícula. Método: 100 clavículas de cadáveres foram avaliadas por três observadores distintos, aplicando-se o escore de congruência da clavícula e comparando quatro sistemas diferentes de placas bloqueadas anatômicas pré-moldadas de seis a oito furos. Resultados: a concordância interobservador foi considerada moderada pelo percentual de concordância e regular pelo índice Kappa de Fleiss, sem diferenças significativas entre as avaliações. Apenas uma das oito placas apresentou encaixe anatômico maior que 70%. As placas longas (oito furos) apresentaram um encaixe ruim em comparação com as placas curtas (seis ou sete furos). Conclusões: os sistemas de placa superior pré-moldadas disponíveis atualmente fornecem um encaixe inadequado às clavículas para fixações de fraturas do terço médio. Placas longas apresentam um encaixe pior que as curtas.

Septic Arthritis of the Pubic Symphysis in Adult: A Case Report.

Septic arthritis of the pubic symphysis is a rare condition. Risk factors include trauma, low-grade infection, urological or gynecological procedures, malignant tumors of the pelvis, sports, and intravenous drug abuse. This report describes a case of septic arthritis of the pubic symphysis in a 23-year-old male patient with no history of pelvic surgery, previous infections, or intense physical activity. Arthritis was diagnosed by blood culture positive for Enterococcus spp. and yeasts, and the patient was treated with antibiotics. This case emphasizes the importance of complementary exams to aid the treatment of septic arthritis of the pubic symphysis and shows that an invasive procedure, such as pubic symphysis puncture biopsy, may not be required.

Septic Arthritis of the Pubic Symphysis in Adult: A Case Report / Artrite séptica da sínfise pubiana em adultos: Relato de caso

Abstract Septic arthritis of the pubic symphysis is a rare condition. Risk factors include trauma, low-grade infection, urological or gynecological procedures, malignant tumors of the pelvis, sports, and intravenous drug abuse. This report describes a case of septic arthritis of the pubic symphysis in a 23-year-old male patient with no history of pelvic surgery, previous infections, or intense physical activity. Arthritis was diagnosed by blood culture positive for Enterococcus spp. and yeasts, and the patient was treated with antibiotics. This case emphasizes the importance of complementary exams to aid the treatment of septic arthritis of the pubic symphysis and shows that an invasive procedure, such as pubic symphysis puncture biopsy, may not be required.

Resumo A artrite séptica da sínfise púbica é uma condição rara. Os fatores de risco são trauma, infecção de baixo grau, procedimentos urológicos ou ginecológicos, tumores malignos da pelve, prática de esportes e uso de drogas intravenosas. O presente relato descreve um caso de artrite séptica da sínfise púbica em um paciente do sexo masculino, de 23 anos, sem história de cirurgias pélvicas, infecções prévias ou atividade física intensa. A artrite foi diagnosticada pela hemocultura que revelou crescimento de Enterococcus sp + leveduras, e o paciente foi tratado com antibioticoterapia. Este caso enfatiza a importância de exames complementares no auxílio do tratamento da artrite séptica da sínfise púbica, e demonstra que procedimentos invasivos, tais como a punção da sínfise púbica, podem não ser necessários.

Does the position of the scapula in relation to the glenopolar angle change the preferred treatment of extra-articular fractures?

OBJECTIVE: To analyse the glenopolar angle (GPA) at different inclinations of the scapula using 3D CT, to test the hypothesis that the result could change the indication from conservative treatment to surgery. MATERIALS AND METHODS: Analysis of 30 3D CT images of patients' scapulae, measuring the GPA. The GPA was measured with scapulae at 0° and at 20° and 30° of internal and external rotation. Angles were compared by age, sex and examiner for the different angles of rotation of the scapulae. RESULTS: The GPA of scapulae in rotation tended to be smaller than the GPA without rotation, and the larger the degree of rotation, the more the angle was underestimated. Additionally, for the same degree of rotation, internal rotation was associated with greater underestimation of the GPA than external rotation. Two different examiners achieved an excellent level of agreement between angle measurements. The GPA with the scapula at 0° was significantly higher among elderly patients. The variation in GPA with the scapula in rotation (20° and 30°) in relation to the GPA without rotation was significantly greater for female patients. CONCLUSIONS: As the rotation of the scapula was displaced from the scapula in the coronal position (GPA 0°), both in internal rotation and in external rotation, the GPA reduced. Therefore, rotational displacement may lead to an error in GPA measurement, resulting in incorrect indication of treatment. It is recommended that whenever possible, GPA measurements should be taken in neutral rotation, with the scapula in a neutral position at 0°.