Long-term outcomes of initially conservatively treated midshaft clavicle fractures

Background: Recent studies about completely displaced midshaft clavicle fractures have reported that their nonunion/malunion rates were significantly higher in conservatively treated patients compared to surgically treated patients. The purpose of this study was to evaluate the factors associated with treatment decisions for midshaft clavicle fractures and also the factors that affect patient satisfaction with their treatment choice. Methods: We retrospectively reviewed the records of 75 patients who had been diagnosed with a midshaft clavicle fracture and were treated conservatively at a single institution between March 1, 2013, and December 31, 2014. Their medical records were reviewed to investigate the severity of the initial vertical displacement. A telephone survey was carried out to identify the presence of any patient-perceived deformity and determine if the patient eventually underwent surgery and whether the patient would prefer surgery if the injury recurred. Results: Significantly more patients with vertical displacement ≥100% (9/28) eventually underwent surgery compared to patients with vertical displacement <100% (3/32, p=0.028). Patients with vertical displacement ≥100% (13/28) were significantly more likely to prefer surgery compared to patients with vertical displacement <100% (7/32, p=0.044). Among the conservatively treated patients, nine of 32 participants with a patient-perceived deformity and one of 16 without a patient-perceived deformity responded that they would prefer to receive surgery in same situation in the future (p=0.079). Conclusions: Patients with a midshaft clavicle fracture with vertical displacement of ≥100% may eventually require surgical treatment. When conservative treatment is carried out, the long-term patient results may be unsatisfactory due to perceived residual deformities

Role of inferomedial supporting screws for secondary varus deformity in non?osteoporotic proximal humerus fracture: A biomechanical study

Introduction The purpose of this study was to evaluate the efect of a medial support screw through a proximal humerus fracture. For this purpose, we verifed whether the biomechanics are diferent according to the position of the screw while using the same number of screws. In addition, we tried to verify whether the insertion of additional inferomedial screws would make a diference in stability. Materials and methods Twenty-four proximal humerus bones were included in the study. A two-part fracture was created and fxed using a locking plate. Cyclic loading and load-to-failure test were applied to three groups: group A (proximal 6 screws+calcar screws), group B (proximal 6 screws), and group C (proximal 4 screws+calcar screws). Interfragmentary gaps were measured following cyclic loading and compared. The failure was defned when the bone breakage or medial gap closing was observed during ultimate failure load applied. The load-to-failure, maximum displacement, stifness, and yield load were recorded and compared. Results The interfragmentary gap was diferently reduced by 0.29±0.14 mm, 0.73±0.25 mm, and 0.53±0.09 mm following 1000 cyclic loading for groups A, B, and C, respectively. The load-to-failure was 945.22±101.02 N, 941.40±148.90 N, and 940.58±91.78 N in groups A, B, and C, respectively. The stifness of group A (214.76±34.0 N/mm) was superior when compared to that of group C (171.12±23.0 N/mm; p=0.025). The maximum displacement prior to failure, yield load, showed no signifcant diference between comparative groups. Conclusion Our study did not show any additional biomechanical efects with the use of inferomedial supporting screws in non-osteoporotic proximal humerus fracture, besides making the fracture-plate construct stif. The role of the inferomedial supporting screw was also unclear. However, the groups that used increased screw fxation and inferomedial screw insertion seemed to be more resistant to cyclic loading