Titanium elastic stable intramedullary nailing of displaced midshaft clavicle fractures: A review of 38 cases.

INTRODUCTION: Clavicle fractures accounting for 3 to 5% of all adult fractures are usually treated non-operatively. There is an increasing trend toward their surgical fixation. The aim of our study was to investigate the outcome following titanium elastic stable intramedullary nailing (ESIN) for midshaft non-comminuted clavicle fractures with >20 mm shortening/displacement. MATERIALS AND METHODS: A total of 38 patients, which met inclusion criteria, were reviewed retrospectively. There were 32 males and six females. The mean age was 27.6 years. The patients were assessed for clinical/radiological union and by Oxford Shoulder and QuickDASH scores. 71% patients required open reduction. RESULTS: 100% union was achieved at average of 11.3 weeks. The average follow-up was 12 months. The average Oxford Shoulder and QuickDASH scores were 45.6 and 6.7, respectively. 47% patients had nail removal. One patient had lateral nail protrusion while other required its medial trimming. CONCLUSION: In our hands, ESIN is safe and minimally invasive with good patient satisfaction, cosmetic appearance, and overall outcome.

Double semi-tubular plating of clavicle using a piggyback technique--an alternative way of treating clavicle mid-shaft fractures in young patients.

The majority of clavicle fractures unite uneventfully. Indications for operative surgery are limited, with high rates of complications. We describe our results with an alternative cost effective method of treating these injuries in young patients. It is a retrospective series of 20 patients treated between January 2005 and January 2009 with a "piggy back" technique using double plating with two 3.5 mm drill hole semitubular plates. All patients were assessed with DASH (Disability of Arm, Shoulder and Hand) score at last review. Average time to union was 12.5 weeks. The average DASH score was 834 (0-34.2). There was one case each of non-union, implant removal and symptomatic numbness around the scar. The overall complication rate was 15% with 5% incidence of non-union. The results compare favourably with previously published series. We propose that this technique allows a cost effective way of treating these fractures in young patients, with a high patient satisfaction rate.

Tuberculous infection in a total knee replacement performed for medial tibial plateau fracture: a case report.

There has been increasing interest in performing acute total knee replacement for periarticular knee fractures in elderly osteoporotic patients. This is comparable to treating femoral neck fractures with arthroplasty. We present a case of tuberculous infection in a primary total knee replacement performed for a medial tibial condyle fracture, in an 85-year-old Caucasian female with a previously asymptomatic knee. The incidence of tuberculosis is gradually increasing. We highlight the problem with musculoskeletal tuberculosis in relation to the delay in diagnosis and subsequent initiation of treatment.

Osteochondritis dissecans of the talus involving the subtalar joint: a case report.

Osteochondritis dissecans can affect any joint, although the ankle is the third most common location after the knee and elbow. When the ankle is involved, the lesion usually affects the talar dome. The authors report a case of osteochondritis of the subtalar joint affecting the talus in a 14-year-old girl without any history of trauma. Plain radiographs did not show any bony pathology, and the diagnosis was made with computerized tomography. The patient was treated initially in a non-weight bearing plaster cast with antiinflammatory medication and subsequent physiotherapy. The conservative treatment failed to relieve her symptoms, and she underwent subtalar arthroscopy followed by surgical excision, curettage, and drilling through a mini-arthrotomy. Postoperatively, the patient was managed with protected weight bearing and physiotherapy. A year after surgery, she had returned to her routine activities, including sports, with no further complaints related to the affected foot.

Occult Monteggia fracture in an adult: a case report.

Injuries with the Monteggia fracture-dislocation pattern necessitate operative fixation of the ulna fracture in an adult. It is important to identify this by taking radiographs of the elbow and wrist joints in all cases of ulna fracture. We present a case of an occult Monteggia fracture-dislocation in an adult, which was not apparent on the initial radiographs. A thorough clinical examination along with an examination under anaesthesia in view of the high index of suspicion helped us to achieve the diagnosis.