Operative management of an extra-lateral distal clavicle fracture pattern: a study of 48 patients and a proposed update to the modified Neer classification.

BACKGROUND: The purpose of this study was to determine the efficacy of operative management for the treatment of patients with an extra-lateral distal clavicle fracture pattern. This fracture pattern is not currently included in the modified Neer classification. METHODS: We retrospectively reviewed 48 patients who underwent open reduction and internal fixation of an acute extra-lateral distal clavicle fracture pattern between August 2005 and March 2019. The postoperative clinical outcomes were time to union; active shoulder range of motion; scar size; patient sensation of a "normal" shoulder; and Disabilities of the Arm, Shoulder and Hand score. RESULTS: Postoperatively, all patients achieved union at an average of 7.9 weeks (range, 4-20 weeks). All patients regained full active shoulder range of motion at an average of 10.1 weeks (range, 5-44 weeks) and had a scar size of 3-4 cm; 93.8% of patients reported that their shoulder felt normal again after union. The mean Disabilities of the Arm, Shoulder and Hand score was 1.7 (range, 0-28) at 12 months postoperatively. CONCLUSION: The patients had very good clinical outcomes following operative management of an extra-lateral distal clavicle fracture pattern. We recommend that this fracture pattern be added to the current modified Neer classification as a type IIC fracture.

Efficacy of a platelet-rich plasma injection for the treatment of proximal hamstring tendinopathy: A pilot study.

OBJECTIVES: To determine the efficacy of an ultrasound-guided platelet-rich plasma (PRP) injection in the treatment of patients with proximal hamstring tendinopathy (PHT). DESIGN: Pilot prospective cohort study METHODS: Administration of a single PRP injection under ultrasound guidance to 29 patients with PHT confirmed on magnetic resonance imaging (MRI). Pain, function and sporting activity were measured via the Victorian Institute of Sport Assessment-Proximal Hamstring Tendons (VISA-H) questionnaire, administered before injection and at 8-weeks follow-up. RESULTS: The study sample consisted of 22 females and 7 males with a mean age of 45.2 years (95% CI 40.8-49.5). When comparing pre-injection VISA-H scores (mean: 43.90; 95% CI 37.77-50.03) with 8-week post-injection VISA-H scores (mean: 51.14; 95% CI 43.39-58.88) in the total sample of patients, no statistically significant difference was found (p=0.14). When performing separate analyses for patients with mild (n=9), moderate (n=16) or marked (n=4) PHT, no statistically significant difference was found in pre-and post-injection VISA-H scores for any of the groups (p=0.86, p=0.13, p=0.28 respectively). 69% of patients reported no change in their ability to undertake sport or other physical activity at 8-weeks follow-up. CONCLUSIONS: Patients with PHT receiving a PRP injection did not improve on clinical outcomes at 8-weeks follow-up.

Does sedentary behavior increase the risk of low back pain? A population-based co-twin study of Spanish twins.

BACKGROUND: The relationship between sedentary lifestyle and low back pain (LBP) remains unclear and previous research has not accounted for genetic and early environmental factors. PURPOSE: Our aim was to investigate if sedentary behavior is associated with the lifetime prevalence of persistent LBP and the risk of developing persistent LBP, care-seeking due to LBP, and activity limiting LBP when genetics and early environmental factors are accounted for. STUDY DESIGN: Both cross-sectional and longitudinal designs with a within-pair twin case-control were implemented. PATIENT SAMPLE: There were 2,148 twins included in the cross-sectional analysis whereas 1,098 twins free of persistent LBP at baseline were included in the longitudinal analysis. OUTCOME MEASURES: Sedentary behavior was the explanatory variable. Lifetime prevalence of LBP was the outcome variable in the cross-sectional analysis. The incidence of persistent LBP, care-seeking due to LBP, and activity limiting LBP were the outcome variables for the longitudinal analysis. METHODS: This observational study was supported by a grant in 2012. No competing interests were declared. RESULTS: In the cross-sectional analysis, sedentary behavior was slightly associated with an increased prevalence of persistent LBP in females but not in males. This association was not apparent when genetics and early environmental factors were accounted for. We acknowledge that the small sample included in the co-twin analyses have yielded wide confidence intervals, and that caution should be exercised when interpreting and an association may not be ruled out. In the longitudinal analysis, sedentary behavior did not significantly increase the risk of persistent LBP, care-seeking due to LBP, or activity limiting LBP. CONCLUSIONS: Sedentary behavior is associated with concurrent LBP. However, this association is weak; it only appears in females and decreases when accounting for genetics. Future studies using a twin design with larger samples should be conducted to further test these findings.