Concurrent Ipsilateral Tibial Shaft and Distal Tibial Fractures in Pediatric Patients: Risk Factors, Frequency, and Risk of Missed Diagnosis.

BACKGROUND: The purpose of this study was to determine the frequency of concurrent ipsilateral distal tibial fractures with tibial shaft fractures in the pediatric population; to identify patient and fracture characteristics that increase the likelihood of a concurrent fracture; and determine if any of these concurrent distal tibial fractures were missed on initial radiographic examination. METHODS: Retrospective chart review was done to identify patients 5 to 17 years old who were treated for a tibial shaft fracture at a large, Level 1 free-standing children's hospital and an outpatient orthopaedic practice between 2008 and 2016. Patient and fracture characteristics were recorded. RESULTS: Of 517 fractures (515 patients), 22 (4.3%) had concurrent ipsilateral distal tibial fractures: 11 triplane, 5 medial malleolar, 3 bimalleolar, and 2 Tillaux (Salter-Harris III) ankle fractures, and 1 Salter-Harris II distal tibial fracture. Age was the only patient characteristic significantly associated with a second, more distal fracture: patients with both fractures were older (12.7 y) than those with an isolated tibial shaft fracture (11 y). There was no difference in the rate of distal tibial fractures between high-energy and low-energy mechanisms of injury and no differences in the rate of open injuries or the presence of a fibular fracture. Patients with a tibial shaft fracture at the junction of the middle and distal thirds were significantly more likely to have a concurrent distal tibial fracture; oblique and spiral fracture patterns were more frequent in the group with concurrent distal tibial fractures than in the isolated tibial shaft fracture group. CONCLUSIONS: In our series, 36% of the concurrent distal tibial fractures were not diagnosed until chart review for this study, which suggests the need for ankle-specific imaging in certain patients. We recommend ankle-specific imaging when an oblique or spiral tibial shaft fracture is located at the junction of the middle and distal thirds of the tibia or in patients in whom a distal tibial fracture is suspected because of pain, swelling, or bruising. LEVEL OF EVIDENCE: Level III-retrospective comparative study.

The Relationship Between All-Suture and Solid Medial-Row Anchors and Patient-Reported Outcomes for Double-Row Suture Bridge Rotator Cuff Repair.

Background: The use of all-suture anchors for rotator cuff repair is increasing. Potential benefits include decreased bone loss and decreased damage to the chondral surface. Minimal evidence exists comparing outcomes among medial-row anchor fixation methods in double-row suture bridge rotator cuff repair. Purpose: To compare the clinical outcomes between all-suture and solid medial-row anchors in double-row suture bridge rotator cuff repair. Study Design: Case series; Level of evidence, 4. Methods: A total of 352 patients (mean age at surgery, 60.3 years) underwent double-row suture bridge rotator cuff repair at our institution. Patients were separated into 2 groups based on whether they underwent all-suture (n = 280) or solid (n = 72) anchor fixation for the medial row. Outcomes data were collected via an ongoing longitudinal data repository or through telephone calls (minimum follow-up time, 2.0 years; mean follow-up time, 3.0 years). Outcomes were evaluated using the American Shoulder and Elbow Surgeons (ASES) standardized shoulder assessment form and the visual analog scale (VAS). The same rehabilitation protocol was administered to all patients. The proportions of patients meeting previously published Patient Acceptable Symptom State (PASS) thresholds were calculated for the outcome measures, and outcome scores and the proportions of patients meeting PASS thresholds between groups were compared using linear and logistic regression, respectively. Results: The groups did not differ in terms of age at surgery, sex distribution, rotator cuff tear size, or number of medial-row anchors used. The solid anchor group had a longer follow-up time compared with the all-suture anchor group (3.6 ± 0.7 vs 2.8 ± 0.8 years, respectively; P < .01). After controlling for follow-up time, the solid and all-suture anchor groups did not differ in ASES scores (89.6 ± 17.8 vs 88.8 ± 16.7, respectively; P = .44) or VAS scores (1.1 ± 2.1 vs 1.2 ± 2.1, respectively; P = .37). Similarly, after controlling for follow-up time, the solid and all-suture anchor groups did not differ in the proportions of patients meeting PASS cutoffs for the ASES (84.7% vs 80.7%, respectively; P = .44) or the VAS (80.6% vs 75.0%, respectively; P = .83). Conclusion: Double-row suture bridge rotator cuff repair using all-suture anchors for medial-row fixation demonstrated similar excellent clinical outcomes to rotator cuff repair using solid medial-row anchors.

Ulnar Collateral Ligament Reconstruction.

Ulnar collateral ligament (UCL) injuries can significantly impair the overhead athlete. Reconstruction of the anterior bundle of the UCL (UCL-R) has allowed a high proportion of these individuals to return to their previous level of play. Several techniques for UCL-R are described that produce acceptable results with an overall low complication rate. Transient ulnar neuritis is the most common complication following UCL-R. The rate of UCL injury in young athletes is rising with increased youth involvement and year-round participation in overhead sports. The sports medicine community must broaden its focus to not only treat UCL injuries but also prevent them.