Objectives:
Dual plate fixation has been proposed as a solution to the high rates of reoperation secondary to operative management of displaced midshaft clavicle fractures. Previous studies have ...recommended dual plating for patients specifically at higher risk of reoperation. Therefore, the purpose of this study was to compare reoperation rates among patients who underwent single superior, single anterior, and dual plating while adjusting for risk factors including age, smoking status, and high-risk fracture morphology. We hypothesized lower rates of reoperation among patients who underwent dual plate fixation.
Methods:
This was a retrospective cohort study of all patients who presented with a midshaft clavicle fracture and underwent ORIF between 2007 and 2021 to our trauma/sports divisions. Patient demographics, fracture pattern, plating technique, postoperative complications, date of surgery, reoperation status, date of last follow up, and date of reoperation were documented. We report hazard ratio (HR) estimates using a multivariate multilevel mixed-effects parametric survival model, which accounted for patients with multiple reoperations and adjusted for covariates.
Results:
A cohort of 395 patients (mean age 38.5±14.4 years, 81.7% male) were identified with average follow-up of 5.5±8.6 months. There were 77 z-type, 157 transverse, and 161 oblique fractures. With regards to plating technique, 152 underwent single superior plating, 149 experienced single anterior plating, and 94 had dual plating. After initial operation, there were 8 total instances of non-union (2.0%), 0 in the dual plating cohort (0%), 4 in the superior plating cohort (2.6%), and 4 in the anterior plating cohort (2.7%) (p=0.35). A total of 28 reoperations took place among 19 patients (4.8%), with 6 patients experiencing multiple reoperations.
Single plating with superior placement revealed the highest reoperation rate of 0.26 per person-years, followed by anterior placement with 0.17 per person-years, and finally dual plating with 0.02 per person-years (Figure 1). Patients who underwent single plating (either anterior or superior placement) revealed a greater rate of reoperation when compared to patients who underwent dual plating (HR: 8.3, p=0.045). Patients who underwent single plating with superior placement had a rate of reoperation ten- times greater than patients who underwent dual plating (HR:10.1, p=0.03). Patients who underwent single plating with anterior placement had a rate of reoperation six-times greater than patients who underwent dual plating (HR: 6.4, p=0.09), although not statistically significant.
Conclusions:
Dual plate fixation of displaced midshaft clavicle fractures has an eight-fold lower risk of reoperation compared to single plate fixation, while accounting for age, smoking, and high-risk fracture morphology. More specifically, dual plating had lower rates of reoperation than both single plating with anterior and superior placement. When operative management is indicated for a midshaft clavicle fracture, dual plating may be an excellent treatment alternative in patients at high risk for reoperation.
Objectives:
To determine if acromial morphology is associated with posterior or anterior shoulder instability as measured on MRI.
Methods:
MRI measurements of posterior acromial coverage (PAC), ...posterior acromial height (PAH), posterior acromial tilt (PAT), and anterior acromial coverage (AAC) were completed for three separate matched groups who underwent surgical intervention: posterior instability, anterior instability, and a comparison group of patients with who underwent arthroscopic surgery for snapping scapula. Inclusion criteria were patients with recurrent instability younger than 40 years of age without multidirectional instability, glenoid bone loss greater than 13.5% or glenoid retroversion greater than 10%.
Results:
Thirty-seven patients were included in each group. PAC was significantly less in the posterior instability group when compared to anterior and the comparison groups (68.3° vs. 88.7° vs. 81.7°, p<.001). PAH was significantly greater in the posterior group than compared to the anterior instability patients (11.0 mm vs -0.1 mm, p<.001) as well as the comparison patients (0.7 mm, p<.001). There was no difference between the posterior and anterior groups in terms of PAT or AAC (p=0.45, p=0.05). PAT was significantly smaller in the posterior instability group than the comparison group (55.2 degrees vs 62.2 degrees, p=0.026). The anterior and comparison groups were not significantly different in PAH or PAT (p=8.74, p=0.067) but were significantly different with AAC (p=0.26).
Conclusions:
The posterior acromion is significantly higher and flatter in patients with posterior shoulder instability who require arthroscopic capsulolabral repair when measured on pre-operative MRI. This information may help clinicians to both diagnose and predict the need for operative intervention for patients with posterior labral tears.
Category:
Hindfoot; Midfoot/Forefoot
Introduction/Purpose:
Lateral column lengthening (LCL) is the cornerstone for flexible, progressive collapsing foot correction. Evans LCL (ELCL) and Hinterman LCL ...(HLCL) are the most used surgical techniques. ELCL is performed between the anterior and medial facets and endangers specific os-calcis subtypes (OSCT). HLCL passes in a safe zone between the posterior and medial facets and should be suitable for all OSCTs. However, both osteotomies are associated with increased subtalar osteoarthritis, indicating iatrogenic damage. Distance mapping (DM) enables visualization of the relative distance between two articular surfaces using color patterns. This study aims to measure the safe zones for LCL using DM.
Methods:
Using the Bruckner et al. classification, two raters categorized 134 patients and 200 feet into the four OSCTs. Four angles were measured. The proximal posterior safe zone (PSZ) and distal PSZ angles defined the safe zone for HLCLO; it was measured for all OSCTs. The proximal anterior safe zone (ASF) angle and the distal ASF defined the safe zone for ELCLO. They were measured only in cases where a discontinuity between the two facets exists or in the absence of anterior facet. A statistical comparison between the groups was made
Results:
The mean proximal PSZ angle was 68+/-7 degrees, the distal PSZ angle was 75+/-5, the Proximal ASZ angle was 89+/-6 degrees, and the distal ASZ angle was 95+/- 5 degrees. There were no statistically significant differences between the OSCTs. In five patients, the PSZ morphology did not allow planning for HLCLO.in 13 cases; the ASZ left insufficient bone stock between the ELCLO and the calcaneal cuboid joint.
Conclusion:
In this study, we used DM to determine the safe zone for LCL. The high OSCT and morphology variability call for patient-specific LCL preoperative planning. DM could be reliably used to tailor the optimal surgical solution.
We focused in this paper on the dependent use of subjunctive in different stages of Romanian language (from the 16th century to the 21st century). We discuss the elements that precede this verbal ...form and the semantic field they belong to (possibility, probability, certainty, knowledge etc.), some differences due to the evolution of Romanian language and the occurrence of subjunctive in some subordinate clauses.
PDF
