A 65-Year-Old Female with Missed Open Clavicle Fracture and Subsequent Fracture-Related Infection, Treated with Distal Clavicle Resection.

Introduction: Open clavicle fractures are rare, and there are no current reported cases in the literature of a missed open clavicle with resultant fracture-related infection and osteomyelitis. Case Report: We present a 65-year-old female with no reported medical history, who presented to our institution with left clavicular pain and wound drainage 8 days after she was struck by a motor vehicle in her home country of Guyana. She was found to have a missed open clavicle fracture with an associated severe infection. She was subsequently treated with irrigation, debridement, and distal clavicle excision. Conclusion: We present this unique case with a potential procedure which could prove beneficial in cases of infection, trauma, or oncologic lesions in which the distal clavicle is deemed unsalvageable.

Screw Configuration Does Not Significantly Alter Neck Shortening After Valgus-Impacted Femoral Neck Fracture (OTA Type 31B1.1).

OBJECTIVES: To compare 3 different cancellous screw configurations used for Garden 1 femoral neck fractures (FNFs). DESIGN: Retrospective review. SETTING: A large urban academic medical center. PATIENT SELECTION CRITERIA: All patients with Orthopaedic Trauma Association 31B1.1 FNF who underwent in situ fixation with cancellous screws between 2012 and 2021 were included. Patients were divided into 3 groups: 2 screws placed in a parallel fashion, 3 screws placed in an inverted triangle configuration, and 3-screw fixation with placement of 1 "out-of-plane" screw perpendicular to the long axis of the femur. OUTCOME MEASURES AND COMPARISONS: Postoperative femoral neck shortening (mm) was the primary outcome, which was compared among the 3 groups of different screw configurations. RESULTS: Sixty-one patients with a median follow-up of 1 year (interquartile range 0.6-1.8 years) and an average age of 72 years (interquartile range 65.0-83.0 years) were included. All fractures demonstrated bony healing. Overall, 68.9% of the cohort had ≤2 mm of femoral neck shortening. There was no difference between groups in the proportion of patients who experienced greater than 2 mm of shortening (P = 0.839) or in the amount (mm) of femoral neck shortening (Kruskal-Wallis χ2 = 0.517, P = 0.772). CONCLUSIONS: Although most patients with valgus-impacted FNF treated with screw fixation do not experience further femoral neck shortening, some patients demonstrated continued radiographic shortening during the healing process. The development of further femoral neck shortening and the amount of shortening that occurs do not differ based on implant configuration. Multiple different screw configurations seem to be acceptable for achieving healing and minimizing further femoral neck impaction. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Classification of open tibia fractures: the rationale for a new classification system.

Open tibial shaft fractures are one of the most common long bone injuries encountered. Current existing classifications are designed to characterize the nature of the injury and guide clinical decision making. However, despite these advancements, there are areas in our current classification system that can be improved to not only make reliability more producible but also create prognostic factors that can help guide treatment.

Socioeconomic Status Impacts Access to Orthopaedic Specialty Care.

¼: Financial, personal, and structural barriers affect access to all aspects of orthopaedic specialty care. ¼: Disparities in access to care are present across all subspecialties of orthopaedic surgery in the United States. ¼: Improving timely access to care in orthopaedic surgery is crucial for both health equity and optimizing patient outcomes. ¼: Options for improving orthopaedic access include increasing Medicaid/Medicare payments to physicians, providing secondary resources to assist patients with limited finances, and reducing language barriers in both clinical care and patient education.