A Comparative Study Between Plate Fixation and Intramedullary Fixation for Displaced Mid-Shaft Clavicle Fractures in Adults.

Introduction: Clavicle fractures are frequently encountered by orthopaedic surgeons. Though multiple treatment techniques have been described in literature, open reduction and internal fixation with plating and intramedullary nailing are preferred in adults. This study analyses the functional outcome, complications, duration of bony union of mid-shaft clavicle fractures treated with plate fixation versus intramedullary fixation. Materials and methods: A quasi-experimental study was conducted on 38 patients with mid-shaft clavicle fracture aged between 18 to 60 years at a tertiary care centre in South India. Nineteen patients were treated by plate fixation and 19 patients underwent intramedullary nail fixation. Every alternate patient with mid-shaft fracture clavicle was treated with plate osteosyntheses or nailing. Results: The average age of presentation was 42 years in plate fixation and 31 years in nail fixation group. Robinson's classification type 2B1 was the most common type of fracture in both groups. The Visual Analogue Scale (VAS) score reduced significantly from pre-operative to postoperative day 1 in both the groups but there was no significant difference between the two groups. The Disabilities of the Arm, Shoulder and Hand (DASH) score at 6, 12 and 24 weeks reduced significantly in both the groups but showed no statistically significant difference between the two groups. However, intramedullary nail fixation group had a shorter duration of hospital stay and showed an earlier improvement in the DASH score during the first six months after surgery. Complications included implant loosening (three patients) in plating group and implant failures (two cases) in nailing group. Conclusion: There is a role for surgical intervention for certain cases of displaced and comminuted clavicle fracture in order to avoid malunion or non-union and their potential long-term sequelae. Both the surgical modalities of plating, and nailing provide good functional outcome and allow early return to occupational activities.

Isolated Radiopalmar Dislocation of Fifth Carpometacarpal Joint: A Rare Presentation.

Carpometacarpal (CMC) joint dislocations are uncommon injuries that account for less than 1% of hand injuries. Dorsal dislocations of the CMC joints are more frequent than volar dislocations. Palmar dislocations can be either ulnopalmar or radiopalmar. There are very few reports of isolated radiopalmar dislocations of the fifth CMC joint in the English-language literature. In our case of radiopalmar dislocation, diagnosis was delayed, and attempts at closed reduction were unsuccessful. Therefore, it was treated by open reduction and Kirschner-wire fixation. This article reports a rare type of injury and discusses its management.

Biplanar exposure of the radius and ulna through a single incision.

The surgical approaches used to expose fractures of both bones of the forearm vary depending on the site and type of fracture and the degree of comminution; all have limitations. An exposure is described which allows access to most of the radius and ulna through a single skin incision.