Analysis of Contoured Anatomic Plate Fixation versus Intramedullary Rod Fixation for Acute Midshaft Clavicle Fractures

The recent trend has been toward surgical fixation of displaced clavicle fractures. Several fixation techniques have been reported yet it is unclear which is preferable. We retrospectively reviewed one hundred one consecutive patients with acute midshaft clavicle fractures treated operatively at a level-1 trauma center. Thirty-four patients underwent intramedullary pin fixation and 67 had anatomic plate fixation. The outcomes we assessed were operative time, complications, infection, implant failure, fracture union, range of motion, and reoperation rate. There were 92 males and 9 females with an average age of 30 years (range: 14–68 years). All patients were followed to healing with an average followup of 20 months (range: 15–32 months). While fracture union by six months (P=0.8729) and range of motion at three months (P=0.6139) were similar, the overall healing time for pin fixation was shorter (P=0.0380). The pin group had more infections (P=0.0335) and implant failures (P=0.0245) than the plate group. Intramedullary pin fixation may have improved early results, but there was no long term difference in overall rate of union and achievement of full shoulder motion. The higher rate of implant failure with pin fixation may indicate that not all fracture patterns are amenable to fixation using this device

A High Rate of Bacteriologic Culture-Positive Findings Is Seen After Revision Rotator Cuff Surgery

Purpose: To determine the incidence of subclinical infections in patients undergoing revision arthroscopic rotator cuff repair and identify any risk factors for developing these infections. Methods: Patients who underwent revision surgery by the senior author between January 2012 and December 2022 after a previous rotator cuff surgery were identified. All patients undergoing an open or arthroscopic revision of their previous rotator cuff surgery were included. Patients who had noted previous shoulder infections or had incomplete chart documentation were excluded. For each patient, demographic information, surgical information, and culture results were recorded. Results: A total of 115 patients were identified. Thirty-nine were excluded due to incomplete chart documentation (35) or a history of infection (4); therefore, 22 patients (28.9%) had positive cultures (31 cultures in total). Seventeen patients had only Cutibacterium acnes identified. C acnes cultures turned positive on average 13.52 days after culture collection. There was no difference in infection incidence rates between isolated rotator cuff repair and rotator cuff repair plus additional surgeries (P = .88) or between initial arthroscopic versus open procedures (P = .83). None of the 12 identified risk factors, including age, sex, race, smoking history, previous corticosteroid injections, malnutrition, renal failure, liver failure, diabetes mellitus, immunocompromised status, intravenous drug use, and number of revisions, were correlated with the presence of a subclinical infection. Finally, 6 patients had control cultures taken. One culture (16.6%) was positive for C acnes, while this patient did not have a positive shoulder culture. Conclusions: Subclinical shoulder infections can be present in more than one-quarter of patients undergoing revision after rotator cuff repair. Level of Evidence: Level IV, diagnostic case series

Luggage Tag Technique of Anatomic Fixation of Displaced Acromioclavicular Joint Separations

Acromioclavicular joint dislocations are common injuries in active individuals. Most of these injuries may be treated nonoperatively. However, many techniques have been described when surgical management is warranted. A recent biomechanical study favors anatomic reconstruction of the conoid and trapezoid ligaments and the acromioclavicular joint capsule, as opposed to the traditional technique of excision of the lateral end of clavicle and transfer of the coracoacromial ligament to the intramedullary canal of the distal clavicle. We present a modification of the anatomic fixation technique using a luggage tag method, which places a graft under the base of the coracoid. This procedure has been associated with few redisplacements of the distal clavicle, reliable pain relief, and minimal postoperative morbidity. We found the luggage tag technique provides anatomic fixation of the distal clavicle and restoration of coronal and sagittal plane stability to the injured acromioclavicular joint. This procedure should reduce the possibility of coracoid fracture and decreases the risk of hardware complications associated with reconstruction techniques that violate the base of the coracoid process

Scapula fractures: interobserver reliability of classification and treatment

OBJECTIVES:There is substantial variation in the classification and the management of scapula fractures. The first purpose of this study was to analyze the interobserver reliability of the OTA/AO and the New International Classification of scapula fractures. The second purpose was to assess the proportion of agreement among orthopaedic surgeons on operative or nonoperative treatment. DESIGN:: Web-based reliability study SETTING:: Independent orthopaedic surgeons from several countries were invited to classify scapular fractures in an online survey. PARTICIPANTS:One-hundred and three orthopaedic surgeons evaluated 35 movies of 3DCT-reconstruction of selected scapular fractures, representing a full spectrum of fracture patterns. MAIN OUTCOME MEASUREMENTS:Fleiss' kappa (κ) was used to assess the reliability of agreement between the surgeons. RESULTS:: The overall agreement on the OTA/AO Classification was moderate for the types (A, B, and C, κ = 0.54) with a 71% proportion of rater agreement (PA) as well as for the nine groups (A1 to C3, κ = 0.47) with a 57% PA. For the New International Classification, the agreement about the intra-articular extension of the fracture (Fossa (F), κ = 0.79) was substantial, the agreement about a fractured body (Body (B), κ = 0.57) or process was moderate (Process (P), κ = 0.53), however PAs were more than 81%. The agreement on the treatment recommendation was moderate (κ = 0.57) with a 73% PA. CONCLUSIONS:The New International Classification was more reliable. Body and process fractures generated more disagreement than intra-articular fractures and need further clear definitions