Clavicle and humerus.
Clavicular Plates.
METHODS: A retrospective cohort study compared 2.7 mm (n=19) and 3.5 mm (n=18) anterior inferior reconstruction plates for clavicle stem fractures (AO/OTA type B).
RESULTS: There were no differences in outcome scores, healing time, healing rates, or secondary surgery rates. 2.7-mm low-cut plates had a higher rate of aesthetic acceptability.
KEY POINT: The use of an anterior inferior 2.7 mm reconstruction plate for clavicle fractures is a reasonable and effective option. However, caution is still needed when using it for comminuted fractures. There were only three comminuted fractures in the study and the 2.7 mm plate used in a bridging fashion may not have adequate fatigue strength.
Humeral trunk: intramedullary nailing vs. plate METHODS: A retrospective case-comparison study using insurance data from 1993 to 2007 to evaluate the use of intramedullary nailing (279 cases) and plate (172 cases) treatment, reoperation rates, and mortality in patients with humeral trunk fractures.
RESULTS: There were no differences in reoperation rates or mortality within one year. Anesthesia time was reduced by a mean of 27.1 minutes in the intramedullary nailing group (p<0.0001). < span="">
Key point: Intramedullary nailing and plate reoperation rates were similar. The authors noted that the advantage of shorter operative time with intramedullary nailing may be offset by the low-cost advantage of steel plates.
Elbow.
Intramedullary nailing for hawkbone fractures.
METHODS: A retrospective study evaluated the results of 28 unstable hawkbone fractures treated with ulnar interlocking intramedullary nailing.
RESULTS: All fractures healed within 8 weeks. At 12-week follow-up, range of motion was within 10° from the contralateral side, with no significant pain manifestations.
KEY POINT: Intramedullary nailing can be used as an alternative hawk fracture treatment option to plate fixationNon-operative treatment of hawk fractures.
METHODS: A retrospective study of 53 patients, mean age 76 years (50-98 years), all with intra-articular fractures of the ulnar hawkbone with a displacement greater than 2 mm, treated nonoperatively.
RESULTS: All patients had no second-stage treatment due to nonunion of the fracture. In a short period of time (mean 4 months), 72% of patients had a good outcome. With a mean follow-up of 6 years, 91% of patients were satisfied with the results.
Key point: Nonoperative treatment of displaced hawkhead fractures can be indicated in elderly patients with relatively low elbow joint requirements.
Early activity of radial head fractures.
METHODS: One hundred eighty patients, with AO/OTAB2 radial head fractures (comminuted without compression), were randomly assigned to one of three groups: immediate postoperative activity, activity after 2 days of sling fixation, and activity after 7 days of fixation. Assessment was performed using multiple outcome measures.
RESULTS: The two early activity groups had better outcomes than the brake fixation group. The best results were seen in the group of cases that started activity after two days of rest.
KEY POINT: Brief restrictive immobilization followed by early activity reduces pain and improves prognosis compared to prolonged braking or immediate activity.
Heterotopic ossification of the elbow.
METHODS: The incidence of heterotopic ossification was examined in 130 patients with surgically treated elbow fractures with dislocation, and risk factors for heterotopic ossification were analyzed.
RESULTS: Heterotopic ossification was seen in 37% of elbow fractures, with a 20% incidence of limitation of motion and 10% requiring secondary surgical treatment. Heterotopic ossification occurred at the proximal end of the fracture, at the beginning of the torn soft tissue, most commonly at the posterior aspect of the radial neck and ulna. Distal humeral fractures, the triad of terror, and fracture dislocation are all risk factors for heterotopic ossification.
Key points: Surgical treatment of elbow trauma has a high incidence of heterotopic ossification, seen in 20% of patients.