The first 100 patients treated with a new anatomical pre-contoured locking plate for clavicular midshaft fractures.

BACKGROUND: Pre-contoured locking plates were recently introduced in the management of clavicular midshaft fractures. These plates may offer advantages such as no necessity for intraoperative bending and reduced plate irritation. The purpose of this study was to review the clinical and radiographical outcome of the first 100 patients treated with a new anatomical pre-contoured locking plate. METHODS: In a retrospective single-center study, 100 consecutive patients (16 female, 84 male) with a median age of 40 years (range 15-82) who underwent surgery for clavicular midshaft fractures with a VariAx locking plate (Stryker Corporation Kalmazoo, MI, USA) between March 2012 and January 2016 were included. Postoperative follow-up was performed until union was clinically and radiographically achieved. Fracture type, surgical time, intraoperative need for contouring the plate, further surgery such as revision or hardware removal and complications were recorded. RESULTS: One-hundred patients with a dislocated midshaft clavicular fracture with a mean follow-up of 21.9 months (standard deviation 13.2) were included. Ninety-three patients reported normal shoulder function at latest follow-up. Median surgical time was 75.5 min (range, 35-179). In three patients, intraoperative bending of the plate was necessary. In two patients, plates designed for the other side were implanted. Five patients needed revision surgery: One patient with wound healing problems, one patient with a re-fracture after early (13 months) hardware removal and minor trauma, one patient with postoperative shoulder stiffness and two patients with failed osteosynthesis because of surgical implantation fault. One asymptomatic nonunion without further treatment was observed. In 30 patients, the plate was removed after a mean of 17.5 months (SD 4.2) because of subjective plate discomfort. CONCLUSIONS: With this new pre-contoured locking plate, good to excellent intraoperative fit to the anatomical shape of the clavicle can be achieved. The implant seems to be reliable regarding handling and complications. Clinical and radiological results are comparable to results reported in the literature. Hardware removal rate is comparable to other studies with a pre-contoured plate and lower compared to non-pre-contoured.

Acute Motor Failure of the N. Peroneus Profundus Caused by a Cystic Tibiofibular Joint. / Isolierter motorischer Ausfall des N. peroneus profundus durch ein zystisches Tibiofibulargelenkganglion.

A ganglion cyst is rarely the cause of peripheral nerve compression. In the lower extremity, it is important to distinguish clinically the symptoms from a radiculopathy. In the literature, neural damage of the peroneal nerve due to a ganglion cyst has been described. An acute, isolated plegia of the foot/toe dorsiflexors with completely unaffected sensory function - as in our case - has not yet been described. After clinical examination and imaging, the ganglion cyst was surgically removed and the nerve decompressed, which was followed by complete recovery of the motoric function. Peripheral nerve compression due to a ganglion cyst is an important differential diagnosis in peripheral nerve deficit. The therapy of choice is the fastest possible surgical decompression. Recovery is expected within a few weeks.