Clinical and radiographic outcomes of a transosseous suture technique for displaced lateral clavicle fractures.

BACKGROUND: The purpose of this study was to evaluate the clinical and radiographic outcomes of a transosseous suture fixation technique for the treatment of unstable lateral clavicle fractures. The appropriate treatment for lateral clavicle fractures is controversial. Many authors have argued for nonsurgical treatment of these injuries; however, recent literature has shown a role for the surgical treatment of unstable fractures. The paucity of lateral clavicular bone and the unique anatomy of this area of the shoulder makes surgical treatment of these injuries challenging. This article reports a single-surgeon experience with a transosseous suture fixation technique for the treatment of unstable lateral clavicle fractures. MATERIALS AND METHODS: A retrospective review of all patients with unstable lateral clavicle fractures treated with a transosseous suture technique from 2015-2018 was performed. The indication for surgery was significant displacement between the main medial and lateral clavicle fragments. The surgical technique used was a modification of the technique as described by Levy. Patients were followed postoperatively with active and passive range of motion (ROM) measurements, strength testing, and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score, visual analog scale score, and standard radiographs. Patients were followed to radiographic union. RESULTS: Twelve patients underwent surgical fixation of unstable lateral clavicle fractures from 2015-2018. All patients had excellent function, full ROM, minimal pain, and improved functional scores at final follow-up. Eleven patients achieved complete union of the fracture. One patient healed with a fibrous union; however, the fracture had maintained alignment and the patient was asymptomatic and satisfied with the result. No patient required a second surgery. CONCLUSION: We found that the transosseous suture technique for fixation is an effective treatment for unstable lateral clavicle fracture. This technique is reproducible, cost effective, and limits the need for revision surgery often encountered with other techniques.

Variability of Elbow Radiography in the Injured Child: A Potential Diagnostic Dilemma.

BACKGROUND: Radiographic imaging is essential in assessing the severity and treatment of injuries. However, when a radiographic series is of poor quality, its diagnostic utility is limited, especially in cases involving pediatric elbow injuries. OBJECTIVES: This study aims to investigate the variability of elbow radiographs in the injured child, review parameters used to assess diagnostic quality, and introduce the lateral distal humeral metaphyseal-diaphyseal (LDHMD) ratio as a potential measurement of the quality of a lateral elbow radiograph. METHODS: A retrospective review was performed of elbow radiographs of children who presented to our hospital. Demographic data, injury, location where the radiograph was obtained, and presence of immobilization were collected. Radiographs were subjectively classified as optimal, adequate, or suboptimal based on several radiographic parameters, one of which was the LDHMD ratio. RESULTS: There were 286 radiographic series reviewed. Per our assessment of the anteroposterior images, 81% were found to be optimal, 18% adequate, and 1% suboptimal. In contrast, only 24% of the lateral images were deemed optimal, 63% adequate, and 13% suboptimal, therefore making the lateral radiographs the focus of our investigation. The LDHMD ratios of the optimal (n = 21) and suboptimal (n = 11) lateral radiographs without definite fracture were 0.96 and 0.84, respectively (p < 0.001). CONCLUSIONS: An LDHMD ratio that is approximately 1 and an hourglass sign appearing in the anterior third of the humerus are criteria for determining true pediatric lateral radiograph, and with increased awareness, will lead to improved diagnostic utility of radiographs when assessing the injured child's elbow and determining management.