What’s New in Orthopaedic Trauma

Abstract

This update presents a synopsis of the most clinically relevant high-quality studies related to orthopaedic trauma from the past twelve months. Key methods (♦), results (➢), and take-home points (✶) for these studies are presented. A number of comparative and cohort studies presented data on alternative methods of clavicular and proximal humeral fracture fixation. Comparative functional outcome data from these studies are presented in Table I. View this table: TABLE I Data from Studies on Clavicular and Proximal Humeral Fracture Fixation ### Clavicular Fractures #### Open Reduction and Internal Fixation Versus Nonoperative Treatment ♦ Sixty patients with displaced midshaft clavicular fractures were randomized to either nonoperative treatment (n = 32) or open reduction and internal fixation (ORIF) (n = 28)1. ➢ The rate of nonunion was 24% in the nonoperative group and 0% in the ORIF group. However, there were no differences in the Constant score, Disabilities of the Arm, Shoulder and Hand (DASH) score, or pain at one year (Table I). ✶ Nonoperative treatment of displaced clavicular shaft fractures is associated with a higher nonunion rate than ORIF, but the outcomes in terms of function and pain are similar. #### Outcomes After Hook Plating of Lateral Fractures ♦ Thirty-six patients who were managed with hook plates for the treatment of lateral clavicular fractures were evaluated after a median duration of follow-up of twenty-eight months2. ➢ Ninety-five percent of the fractures healed, and ninety-two percent of the patients required reoperation for plate removal. The Oxford and Constant shoulder scores improved after plate removal, and improvement was greater if plate removal was performed prior to six months (Table I). ✶ Lateral clavicular fractures that are treated with a hook plate have high union rates, and plate removal prior to six months is recommended. ### Proximal Humeral Fractures #### Hemiarthroplasty Versus Nonoperative Treatment ♦ A prospective randomized trial in the Netherlands compared hemiarthroplasty with nonoperative treatment for patients with four-part proximal humeral fractures3. Twenty-five patients were included …