Comparable results of superior vs antero-inferior plating for the treatment of displaced midshaft clavicle fractures. A comparative study.

BACKGROUND: Clavicle fractures represent up to 10 % of all fractures, affecting mainly a young population. Open reduction and internal plate fixation provide good results, but evidence on the best plate positioning is still unclear. Aim of this retrospective study was to compare superior and antero-inferior plating positioning in the surgical treatment of displaced midshaft clavicle fractures. MATERIALS AND METHODS: 104 patients aged > 18 years, treated surgically with plate fixation (51 superior, 53 antero-inferior) for a midshaft clavicle fracture from January 2010 to April 2021 were included. At the time of the visit, mean follow-up time was 6.6 ± 2.6 years. Shoulder function was evaluated with the use of Constant-Murley Score (CMS) and Disabilities of the Arm, Shoulder, and Hand (DASH) score. Return to sport, aesthetic satisfaction, operative time, radiological outcomes, rate of implant removal, and overall patient satisfaction were documented as well. RESULTS: Mean CMS was 94.1 ± 10.0 points in the superior plating group and 93.4 ± 11.6 points in the antero-inferior plating group. DASH score: 4.6 ± 11.0 superior, 5.1 ± 10.5 antero-inferior. Return to sport: 8.2 ± 2.9 superior, 8.2 ± 3.0 antero-inferior. Aesthetic satisfaction: 8.9 ± 1.6 superior, 8.8 ± 2.1 antero-inferior. Overall satisfaction: 9.1 ± 1.5 superior, 8.9 ± 1.7 antero-inferior. The comparison between groups showed no statistically significant differences (p = n.s.) for all outcome measures. Operative time: 101.6 ± 27.3 min superior, 113.0 ± 31.6 min antero-inferior (p = 0.05). Radiological follow-up documented one non-union and one mal-union in the antero-inferior plating group. Overall, 63 patients underwent plate removal: 58.8 % in the superior plating group and 62.3 % in the antero-inferior plating group (p = n.s.). Main reason for plate removal was pain/discomfort. CONCLUSIONS: Both superior and antero-inferior plating provided excellent clinical, functional, and radiological results for the treatment of displaced midshaft clavicle fractures, without significant differences between groups. The superior plating group showed a statistically shorter operative time. High rate of re-interventions with implant removal was documented in both groups. LEVEL OF EVIDENCE: III.

Recurrent Patellar Dislocations Without Untreated Predisposing Factors: Medial Patellofemoral Ligament Reconstruction Versus Other Medial Soft-Tissue Surgical Techniques-A Meta-analysis.

PURPOSE: To provide a direct comparison between medial patellofemoral ligament (MPFL) reconstruction and the other medial patellofemoral soft-tissue surgeries in the restoration of the medial patellar restraint after lateral patellar dislocations in the absence of untreated predisposing factors such as high grade trochlear dysplasia, knee malalignment, patella alta or high tibial tubercle-trochlear groove distance. METHODS: PubMed, Cochrane-library, Web of Science, and gray literature databases were searched to find all the relevant records. Study selection, data extraction, and risk of bias assessment were performed following the Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Different techniques to treat lateral patellar dislocation in the absence of untreated predisposing factors were compared in terms of redislocation and complication rates, Kujala, Lysholm, International Knee Documentation Committee, and Tegner scores at the short-term (3 years) and long-term (>3 years) follow-up through meta-analyses. RESULTS: Six studies involving 319 knees were included in the meta-analysis. The analyses of redislocation (0.7% vs 2.9%) and minor complication rates (12% vs 9%) showed no significant differences between MPFL reconstruction and other medial soft-tissue surgeries. Significant differences favoring MPFL reconstruction were documented in Kujala and Lysholm scores at short-term (8.6, P< .001; 10.9, P < .001) and long-term follow-ups (6.3, P = .02; 13.5, P < .001). No significant differences were found in the analyses of International Knee Documentation Committee (P = .10) and Tegner scores (P = .19). Level of evidence was low or very low. CONCLUSIONS: MPFL reconstruction and medial patellofemoral soft-tissue surgery procedures were both effective in restoring the medial restraining forces preventing redislocation, but MPFL reconstruction provided better functional outcomes both at short-term and long-term follow-up. Thus, besides the treatment of predisposing factors, MPFL reconstruction seems to be, based on the results of this meta-analysis, a suitable strategy to restore the medial restraining function in the treatment of recurrent LPD. LEVEL OF EVIDENCE: Level III (meta-analysis of randomized and nonrandomized comparative trials).