Background: Intra-articular distal radius fractures are common injuries that require precise anatomical reduction to achieve optimal functional recovery. Variable-angle locking plates (VA-LCP) have been increasingly used due to their ability to stabilize periarticular fragments through polyaxial screw placement, potentially enhancing both radiological and clinical outcomes. Methods: A prospective observational study was conducted among 85 patients with intra-articular distal radius fractures who underwent open reduction and internal fixation with VA-LCP at a tertiary care centre. Clinical and radiological assessments were performed at discharge, 4 weeks, and 6 months. Data were analysed using SPSS, with quantitative variables expressed as mean±SD and repeated-measures ANOVA applied for change over time. Results: The mean age was 35.8 years, with males forming 72.9% of the cohort. Significant improvement was observed across all wrist movements (p<0.001), with ≥90% of normal range regained by 6 months. Mean Quick DASH score improved to 5.73, and MMWS increased to 92.59, with 76.5% achieving excellent functional outcomes. Radiological parameters were well maintained, and only 8.2% experienced minor complications. Conclusions: VA-LCP provides stable fixation and results in excellent functional and radiological recovery for intra-articular distal radius fractures, with minimal complications.

Background: Metacarpal fractures are among the most common hand injuries encountered in orthopaedic practice and can significantly impair hand function if not managed appropriately. Stable fixation with early mobilization is essential for optimal functional recovery, particularly in unstable fracture patterns. Plate osteosynthesis provides rigid fixation and allows early rehabilitation, but its clinical and functional outcomes require systematic evaluation. Methods: This prospective observational study was conducted in the Department of Orthopaedics at a tertiary care centre over a defined study period. A total of 20 skeletally mature patients with closed metacarpal fractures were included. All patients underwent open reduction and internal fixation using mini-plates and screws. Patients were followed up at regular intervals for a minimum period of three months. Clinical evaluation, radiological assessment of fracture union, postoperative complications, duration of hospital stay, return to work, and functional outcomes were assessed. Functional outcome was evaluated using the Total Active Flexion (TAF) scoring system recommended by the American Society for Surgery of the Hand. Results: The majority of patients were young to middle-aged adults, with a male predominance. Transverse fractures and shaft-level involvement were the most common fracture characteristics. Radiological union was achieved within 6-7 weeks in 75% of patients. Excellent functional outcomes were observed in 75% of digits 2-5 and in all cases involving the thumb. Overall, 85% of patients achieved satisfactory functional outcomes. Most patients (70%) returned to work within 6-8 weeks. Postoperative complications were minimal, with stiffness observed in 15% of patients and infection in 5%. No cases of non-union, malunion, or implant failure were reported. Conclusions: Plate osteosynthesis is a safe and effective method for the management of metacarpal fractures, providing stable fixation, early mobilization, and excellent functional outcomes with a low complication rate. Meticulous surgical technique and structured postoperative rehabilitation play a crucial role in achieving optimal results.

Background/Objectives: The objective was to evaluate whether surgical timing (daytime vs. nighttime) influences intraoperative and postoperative outcomes in pediatric supracondylar humerus fractures. Methods: A retrospective observational cohort study was conducted at a tertiary center. Pediatric patients aged ≤14 years who underwent surgery for supracondylar humerus fractures between January 2010 and December 2022 were included. Fractures were classified according to the Gartland system. Patients with open fractures, associated neurovascular injury, compartment syndrome, or incomplete follow-up were excluded. Primary outcomes included need for open reduction, reoperation, neuropathy, and loss of joint mobility. Patients were grouped according to the time of surgery: daytime (08:00–22:00) or nighttime (22:00–08:00). Stratified analyses were performed based on fracture severity. Results: Eighty-six patients were included: 56 underwent daytime surgery and 30 underwent nighttime surgery. Groups were comparable in age, sex, and fracture severity. Nighttime surgery was associated with a significantly higher rate of open reduction (33.3% vs. 10.7%, p = 0.023; RR = 3.11). Reoperation (16.6% vs. 5.4%, p = 0.121) and postoperative neuropathy (23.3% vs. 8.9%, p = 0.131) were more frequent in the nighttime group, although these differences were not statistically significant. In complex fractures (Gartland III–IV), nighttime surgery was associated with a significantly higher reoperation rate (20.8% vs. 2.6%, p = 0.026). Conclusions: Nighttime surgery was associated with higher rates of open reduction and reoperation, particularly in complex supracondylar humerus fractures. However, given the retrospective design and limited sample size, these findings may be influenced by residual confounding and should be interpreted as exploratory.

Background/Objectives: Proximal phalangeal fractures account for 38% of all phalangeal fractures, with unstable patterns requiring surgical intervention. Various modalities have been explored, including open reduction and internal fixation, percutaneous K-wire fixation, and intramedullary techniques. This study explores the technical nuances, indication, and outcomes of antegrade cannulated compressive screw (CCS) fixation of proximal phalangeal fractures. Methods: This retrospective case series involved 18 closed proximal phalangeal fractures in 16 patients who underwent intramedullary headless screw fixation between January 2018 and December 2023. Records were reviewed for demographics, fracture characteristics, and screw type. With the metacarpophalangeal joint flexed at 60–75°, a 1 cm longitudinal incision was made, the extensor tendon split, and a 0.9 mm guidewire advanced anterogradely along the phalangeal axis under fluoroscopy. A 2.2 mm or 3.0 mm SpeedTip CCS was selected based on phalanx size and advanced until fully buried below the cartilage line. Postoperatively, patients were immobilized in a volar intrinsic-plus splint, transitioned to a gutter splint within five to seven days, and commenced on range of motion (ROM) exercises within one week. Primary outcomes included radiographic union, Total Active Motion (TAM), QuickDASH scores, and postoperative complications. Results: All fractures were healed within acceptable radiological parameters and with no postoperative complications. Mean TAM was measured to be 216.0° (SD 7.7°, range 200–230°) and mean QuickDASH was 10.1 (SD 2.8, range 5–16). Conclusions: Antegrade intramedullary headless screw fixation demonstrates feasibility, short-term safety, and excellent early functional outcomes for carefully selected unstable proximal phalanx fractures, supporting its role as a minimally invasive alternative in appropriately indicated cases.

To compare the clinical efficacy of two internal fixation methods in the treatment of osteoporotic proximal humeral fractures(PHF) in elderly patients:anatomical locking plate combined with intramedullary bone cement augmentation versus plate combined with bone grafting. A retrospective analysis was conducted on 59 elderly patients with osteoporotic PHF who underwent open reduction and anatomical locking plate and screw fixation between January 2019 and January 2022. Of these patients, 23 were treated with intramedullary augmentation using bone cement (bone cement group), including 7 males and 16 females, aged from 60 to 83 years with a mean of(66.52±5.30) years, with a time from injury to surgery of 2 (1, 3) days. Thirty-six patients were treated with bone grafting(bone graft group), including 11 males and 25 females, aged from 61 to 85 years with a mean of (69.22±6.55) years, with a time from injury to surgery of 2 (2, 4) days. The operation time, total incision length, number of intraoperative fluoroscopy times, intraoperative blood loss, and length of hospital stay were observed and recorded in both groups. The upper extremity joint function was evaluated using the Constant-Murley score and the disability of the arm, shoulder and hand(DASH) score. The humeral neck shaft angle and adverse imaging findings were also documented. All patients were followed up for a period of 18 to 54 months, with a mean±standard deviation of (30.8±9.2) months. Operations were successfully performed in all patients of both groups, and no statistically significant differences were observed between the two groups in terms of operation time, total incision length, number of intraoperative fluoroscopies, intraoperative blood loss, or length of hospital stay (all P>0.05). At the final follow-up, the mean Constant-Murley score was(73.00±5.25) points in the bone cement group and (64.25±5.60) points in the bone graft group, while the mean DASH score was (13.91±4.62) points and (18.47±8.14) points in the two groups, respectively. The bone cement group exhibited significantly better upper extremity joint function than the bone graft group, with statistically significant differences (both P<0.05). Regarding imaging findings, the humeral neck-shaft angle in the bone graft group was (134.61±1.75)° on the first day postoperatively and (132.86±1.84)° at the final follow-up, showing a statistically significant decrease (P<0.001). In contrast, the humeral neck-shaft angle in the bone cement group was(135.35±1.47)° on the first day postoperatively and (135.42±1.68)° at the final follow-up, with no statistically significant difference(P=0.128). At the final follow-up, the humeral neck-shaft angle was significantly smaller in the bone graft group than in the bone cement group(P<0.001). No statistically significant difference was noted in postoperative adverse imaging findings between the two groups (P=0.117). Compared with plate fixation combined with bone grafting, the technique of intramedullary augmentation with bone cement combined with plate-screw fixation yields better shoulder joint function and less loss of humeral neck-shaft angle in the treatment of osteoporotic proximal humeral fractures in elderly patients.

Closed reduction and percutaneous pinning (CRPP) is the standard treatment for pediatric supracondylar humerus fractures (SCHF). However, closed reduction can be challenging in a subset of patients and may fail, requiring conversion to open reduction. A practical preoperative tool to predict failed closed reduction remains lacking. This multicenter retrospective cohort study included pediatric patients with SCHF who underwent intended CRPP at Xiangtan Central Hospital and Zhuzhou Central Hospital between 2020 and 2025. The primary outcome was failed closed reduction, defined as intraoperative conversion to open reduction (including mini-open exposure) after attempted standard closed reduction maneuvers and before definitive K-wire fixation. Candidate predictors were selected using least absolute shrinkage and selection operator (LASSO) regression and incorporated into a multivariable logistic regression model. Model performance was assessed by discrimination, calibration, and decision curve analysis (DCA). External validation was performed using an independent cohort. A total of 179 patients were included (development cohort, n = 86; validation cohort, n = 93). Conversion to open reduction occurred in 34.1% of patients. In the final multivariable model, displacement direction, preoperative Baumann angle, and the presence of a medial spike/entrapment sign were retained as predictors. The model demonstrated good discrimination in the development cohort (AUC = 0.842) and acceptable discrimination in the external validation cohort (AUC = 0.727). Calibration showed good agreement between predicted and observed risks, and decision curve analysis suggested potential clinical utility across relevant threshold probabilities. We developed and externally validated a practical decision-support model for predicting failed closed reduction (conversion to open reduction) in pediatric SCHF. This tool may facilitate preoperative planning and timely preparation for open reduction when needed, potentially improving operative efficiency and patient safety. However, given the retrospective design and the limited regional cohort, further prospective validation is required before routine clinical implementation.

To compare the clinical outcomes and complication profiles of open reduction and internal fixation with plate (ORIF-P) versus reduction and internal fixation with threaded Kirschner wire (ORIF-TKW) for midshaft clavicular fractures (MCFs). A retrospective analysis was conducted on patients with MCFs who underwent either ORIF-P or ORIF-TKW between January 2012 and October 2023. Based on the surgical technique, patients were divided into ORIF-P and ORIF-TKW groups. The two groups were compared in terms of intraoperative blood loss, operative duration, radiographic union duration, shoulder function (Constant-Murley score and Disabilities of the Arm, Shoulder, and Hand [DASH] score), complication rates, and implant removal characteristics. Of 128 eligible patients, 85 received ORIF-P and 43 received ORIF-TKW. The ORIF-TKW group demonstrated more favorable peri‑operative metrics: shorter operative time (51.5 ± 6.4 vs. 63.6 ± 5.7min, p < 0.001), less blood loss (38.7 ± 5.6 vs. 56.2 ± 10.1ml, p < 0.001), and smaller incision length (3.9 ± 0.7 vs. 8.8 ± 0.9cm, p < 0.001). Radiographic union occurred earlier in ORIF-TKW (median 5.0 vs. 6.0months, p < 0.001). All 43 patients in the ORIF‑TKW group underwent planned implant removal, with minimal operative time and blood loss, whereas in the ORIF‑P group, only 50 patients (58.8%) underwent removal, exclusively for symptomatic reasons or patient request, with significantly more invasive removal procedures (p < 0.001). Functional outcomes at 6months were equivalent. Complication rates did not differ significantly between groups. Two refractures in the ORIF P cohort were successfully revised using ORIF TKW. In this single-center retrospective study, ORIF-TKW was associated with superior peri-operative outcomes, earlier radiographic union, and a less invasive planned removal procedure compared with ORIF-P, while functional recovery was similar. A post-hoc analysis demonstrated statistical comparability in fracture complexity within the 2B subgroup, partially mitigating concerns regarding selection bias. However, these findings remain hypothesis-generating and subject to residual confounding; prospective randomized trials with stratification based on fracture morphology are required before any change in routine practice can be recommended. The limited revision experience (2 cases) is insufficient to endorse threaded K-wire fixation as a routine salvage strategy.

Neglected volar dislocation of the thumb metacarpophalangeal joint: A case report with review of literature.

Ketorolac is commonly used as part of multimodal analgesia after orthopaedic surgery; however, concerns persist regarding its potential effects on postoperative wound healing and fracture union. While previous studies have evaluated ketorolac use in arthroplasty and long bone fractures, data specific to ankle open reduction and internal fixation (ORIF) remain limited. This study evaluated the association between perioperative ketorolac use and short-term postoperative complications and longer term healing outcomes after ankle ORIF. This retrospective cohort study obtained data from a healthcare database platform from January 1, 2015, to January 1, 2025. Adult patients (≥18 years) who underwent ankle ORIF were identified using standardized Current Procedural Terminology (CPT) codes. Patients were stratified based on perioperative ketorolac exposure on the day of surgery and compared with a control cohort without ketorolac exposure within a defined perioperative washout window. Cohorts were balanced using 1:1 propensity score matching. Outcomes were assessed at 90 days and 2 years postoperatively. After propensity score matching, 29,920 patients remained in each cohort. At 90 days, perioperative ketorolac use was associated with higher rates of deep and superficial surgical site infection, wound dehiscence, and implant-related infection. Ketorolac use was also associated with lower transfusion rates, although transfusion was rare in both cohorts, and a modestly lower rate of opioid prescribing, although this reflects prescription documentation rather than analgesic efficacy. No significant differences were observed in pulmonary embolism, acute renal failure, or inpatient readmissions. At 2 years, there were no significant differences between cohorts in rates of nonunion, malunion, revision surgery, or below-knee amputation. In this retrospective database analysis, perioperative ketorolac use after ankle ORIF was associated with increased early wound-related and infection-related complications but not with adverse long-term fracture healing or limb outcomes. These findings suggest a nuanced risk-benefit profile for ketorolac in ankle fracture fixation and underscore the importance of individualized perioperative analgesic decision making, particularly for patients at higher risk of soft-tissue complications. Level 3, systematic review and meta-analysis.

Introduction: Patellar fractures constitute about 1% of all skeletal injuries and disproportionately affect elderly women because of osteoporosis and low-energy falls. Displaced transverse fractures disrupt the knee extensor mechanism and, if unaddressed, predispose to non-union and permanent disability. In many low- and middle-income settings, initial referral to traditional bone-setters remains common and frequently delays definitive care. Case presentation: A 66-year-old woman presented one month after a simple fall with a displaced transverse fracture of the left patella and Kellgren–Lawrence grade II osteoarthritis of the same knee. Prior care was limited to traditional bone-setting without improvement. On admission, she had a palpable patellar gap and an inability to actively extend the knee. Radiographs confirmed displacement of 10 mm. Single-stage open reduction and internal fixation with a modified tension band wire construct reinforced by circumferential cerclage was performed. Active-assisted flexion began on postoperative day 14; by four weeks, she had 30° of pain-free flexion, full active extension, and primary wound healing, and was discharged for structured outpatient physiotherapy. Conclusion: A combined tension band wire plus circumferential cerclage construct provided reliable fixation and an encouraging early functional result despite a one-month delay and prior bone-setter manipulation. Prompt referral and structured rehabilitation remain pivotal for minimising non-union, hardware failure, and long-term disability in geriatric patellar fractures.

Purely ligamentous Lisfranc injuries are challenging to manage. Traditional open reduction and internal fixation provides rigid stability but risks cartilage damage, hardware failure, and the need for removal. Flexible fixation methods such as the suture-button (SB) and InternalBrace (IB) systems aim to maintain reduction while allowing physiological motion. This study compared clinical and radiographic outcomes of SB and IB fixation for these injuries. A retrospective comparative study included 64 patients (SB, n = 34; IB, n = 30) with acute, purely ligamentous Lisfranc injuries and ≥24-month follow-up. Primary outcomes were American Orthopaedic Foot & Ankle Society (AOFAS) midfoot and visual analog scale (VAS) pain scores; radiographic outcomes included maintenance of the first cuneiform to second metatarsal (C1-M2) interval. Secondary measures were time to full weight bearing, return to sport, and complications. Both groups demonstrated significant improvements in AOFAS and VAS scores from preoperative to final follow-up (P < .001). There was no statistically significant difference between the SB and IB groups in mean final AOFAS scores (92.4 vs 91.5, respectively; P = .58) or VAS scores (1.5 vs 1.2, respectively; P = .21). Both techniques effectively maintained anatomic reduction, with no significant difference in the final C1-M2 diastasis (P = .75) and no clinically significant loss of reduction at final follow-up. SB and IB fixation provide excellent function, stable radiographic results, and low complication rates for purely ligamentous Lisfranc injuries, offering reliable alternatives to rigid fixation.

Peripheral artery disease (PAD) has been associated with an increased risk of wound complications and surgical site infection following open reduction and internal fixation (ORIF) for ankle fractures. However, longer-term outcomes, including fracture healing, remain poorly characterized. This study evaluates the association between PAD and short- and long-term postoperative complications following ankle ORIF. The TriNetX Research Network was queried to identify patients who underwent isolated unimalleolar, bimalleolar, trimalleolar, or syndesmotic ORIF for ankle fractures. Patients were classified as having PAD if they had a documented diagnosis within 6 months before surgery, whereas patients without PAD served as controls. PAD and non-PAD cohorts were 1:1 propensity score matched for demographics and medical comorbidities. Postoperative complications were assessed at 90 days and 2 years. After propensity matching, 2,159 patients were included in each cohort. At 90 days, patients with PAD had markedly higher rates of surgical site infection (5.5% vs 2.0%), wound disruption (10.2% vs 3.9%), lower extremity cellulitis (7.6% vs 2.1%), and acute osteomyelitis of the ankle or foot (3.1% vs 0.6%) (all P < 0.001). At 2 years, PAD was associated with increased risks of nonunion (RR 3.07, 95% CI, 1.69 to 5.60), chronic osteomyelitis (RR 8.42, 95% CI, 4.64 to 15.27), implant infection (RR 3.19, 95% CI, 2.47 to 4.11), implant removal (RR 1.54, 95% CI, 1.32 to 1.81), and below-knee amputation (RR 10.5, 95% CI, 5.50 to 20.03) (all P ≤ 0.0001). PAD is associated with markedly increased short- and long-term complications following ankle ORIF, including a sustained risk of impaired fracture healing. These findings underscore the importance of long-term risk stratification in patients with PAD undergoing ankle fracture fixation.

Distal humerus fractures (DHF) in the elderly pose a challenge due to osteoporotic bone, comminution, and potential for poor functional recovery. Surgical management typically involves open reduction and internal fixation (ORIF) or total elbow arthroplasty (TEA). However, inconsistent findings across studies have led to uncertainty regarding which intervention optimizes outcomes, underscoring the need for a rigorous meta-analysis to guide clinical decision making. A systematic literature search was conducted across PubMed, Scopus, Cochrane Library, and Google Scholar for studies published up to October 28, 2025. Randomized controlled trials and comparative studies evaluating ORIF vs. TEA in patients older than 65 years with DHF were included. Seven studies (1,347 patients aged ≥65 years) met inclusion criteria. Key outcome measures included the DASH score, flexion-extension arc, hospital stay, surgical time, complication rate, infection rate, revision surgery rate, and Mayo Elbow Performance Score. Pooled analysis demonstrated that TEA was associated with a statistically significant improvement in elbow flexion-extension range of motion compared with ORIF (mean difference: -9°, 95% confidence interval, -14.72 to -3.28; P = 0.002). No statistically significant differences were observed between TEA and ORIF about surgical time, hospital length of stay, Mayo Elbow Performance Score, overall complication rates, infection rates, or revision surgery rates (all P > 0.05). In elderly patients with intra-articular DHF, TEA provides a modest but statistically significant improvement in elbow range of motion compared with ORIF, although this difference is below commonly reported thresholds for minimal clinically important difference. These findings support an individualized treatment approach, favoring ORIF when durable fixation is achievable, while reserving TEA for carefully selected low-demand or frail patients with fracture patterns unlikely to permit stable reconstruction. Long-term implications of implant-related failure should be considered in surgical decision making. Meta-analysis, Level II.

Platelet-rich fibrin (PRF) is an autologous biomaterial that promotes tissue regeneration through sustained release of growth factors. Its role in accelerating bone healing in mandibular fractures, however, remains incompletely defined. This study evaluated the effect of PRF on bone regeneration following open reduction and internal fixation (ORIF) of bilateral mandibular fractures. A prospective split-mouth clinical trial was conducted at a single center between December 2023 and September 2025. Twenty patients with bilateral mandibular fractures were enrolled; each patient received PRF on one fracture side and conventional ORIF on the contralateral side. Bone density was quantified using Hounsfield units (HU) from preoperative and postoperative computed tomography scans at 2 weeks, 1 month, and 3 months. Statistical analysis employed a two-way repeated-measures analysis of variance with post hoc comparisons. Eighteen patients completed the 3-month follow-up and were included in the final analysis. Bone density increased significantly over time in both sides (p< 0.001), with a significant side by time interaction (p< 0.001). At 3 months, PRF-treated sites demonstrated higher HU values (700.0± 152.1) than controls (567.8± 135.7), yielding a mean difference of 132.2 HU (p< 0.001, Cohen's d= 0.94). No early intergroup differences or postoperative complications were observed. Adjunctive use of PRF significantly enhanced bone density at 3 months without increasing complications. PRF appears to promote late-stage bone mineralization; however, larger multicenter studies with longer follow-up are required before recommending routine clinical implementation.

Combined hip procedure (CHP) involving open reduction and internal fixation and acute total hip arthroplasty (THA) for elderly acetabular fractures: a comparative analysis to THA for femoral neck fractures and hip osteoarthritis.

Background/Objectives: The subciliary approach offers excellent exposure for orbital and zygomaticomaxillary complex fracture repair but is associated with a relatively high risk of postoperative lower eyelid ectropion. This study evaluated the preventive efficacy of an acellular dermal matrix (ADM; WITHderm®) spacer graft placed during subciliary incision repair. Methods: This prospective observational cohort study included 20 patients who underwent open reduction and internal fixation for orbital wall or zygomaticomaxillary complex fractures using a subciliary approach between June and December 2024. A human-derived ADM (WITHderm®) spacer graft was interposed between the orbital septum and the orbicularis oculi muscle during incision closure. Postoperative outcomes were assessed at three time points: ectropion grading at 1 month and scar outcomes at 3 and 6 months using the Patient and Observer Scar Assessment Scale (POSAS). Results: No patients developed postoperative lower eyelid ectropion at 1-month follow-up (0% incidence). Both patient-reported and observer-reported scar outcomes improved significantly over time. The mean total PSAS score decreased from 21.0 ± 2.85 at 3 months to 11.3 ± 2.13 at 6 months (p < 0.001), while the mean total OSAS score decreased from 21.35 ± 2.25 to 11.4 ± 1.67 (p < 0.001). Overall patient satisfaction and objective scar ratings also showed significant improvement. Conclusions: ADM (WITHderm®) spacer grafting during subciliary incision repair appears to be a safe and effective strategy for preventing early postoperative lower eyelid ectropion and achieving favorable scar outcomes. Further studies are warranted to confirm these findings.

Iatrogenic risk and anatomical variability of the posterior tibial nerve bifurcation relative to the Dellon-McKinnon line: Assessing safety in medial ankle procedures.

Managing Vancouver B2 periprosthetic femoral fractures: is open reduction and internal fixation superior to stem revision? : A comparative analysis with a minimum 5-year follow-up.

Bilateral clavicle fractures represent one of the rarest patterns of shoulder girdle trauma, occurring predominantly after high-energy mechanisms and posing unique challenges in diagnosis and management. Their simultaneous disruption compromises both clavicular struts, resulting in impaired shoulder biomechanics and necessitating timely stabilization for optimal functional recovery. A 25-year-old male sustained high-velocity trauma following a motorcycle accident and presented with severe bilateral shoulder pain, deformity, swelling, and markedly restricted arm elevation. Neurological and distal vascular examinations were normal. Radiographs demonstrated displaced bilateral midshaft clavicle fractures (Allman Group I), with no associated thoracic or systemic injuries. Due to significant displacement and bilateral involvement, open reduction and internal fixation was performed using 8-hole titanium anatomical locking plates on both sides through an anterior approach. Stable fixation was confirmed intraoperatively. Early pendulum exercises were initiated, followed by progressive passive and active range-of-motion rehabilitation. Postoperative recovery was uneventful. At 1 month, the patient achieved shoulder abduction of 110° on the right and 100° on the left, with full muscle strength bilaterally. Serial imaging demonstrated progressive fracture consolidation with maintained anatomical alignment. Bilateral displaced midshaft clavicle fractures, though rare, can be effectively managed with anatomical locking plate fixation, providing stable reconstruction and permitting early mobilization. This case reinforces the value of operative intervention in high-energy bilateral clavicular injuries, contributing to the limited but growing evidence guiding treatment of this uncommon trauma pattern.

This paper describes a pelvic procedure that is technically simpler, quicker to perform, and equally effective as all existing pelvic osteotomies. It is used alongside hip open reduction for the treatment of the associated acetabular dysplasia. It is a minimal additional procedure that is intended to ignite the growth of the dysplastic acetabulum. A total of 167 hips (in 154 infants) treated with open reduction and growth-stimulating minimal acetabuloplasty, all with follow-up between 4 and 16 years postoperatively, are reported. The surgical technique is described. Sequential radiographs were analyzed through to final follow-up, which for 21% is to skeletal maturity. Patient demographics, preoperative and sequential postoperative indices, and outcomes are recorded. Preoperative IHDI position was grade IV dislocation in 77% and grade III in 33%. Mean starting acetabular index (AI) was 41.3 degrees (range 30 to 54 degrees) and median age at operation was 13 months (range from 1 to 2.5years). At final follow-up, 98.2% of hips have a Severin 1 (excellent) or 2 (good) outcome, with the AI normalized. These are all IHDI grade 1 and have a mean center-edge-angle of 35.7 degrees. Only 6 of these (3.6%) have warranted a subsequent pelvic osteotomy for residual acetabular dysplasia. The growth-stimulating minimal acetabular procedure is technically straightforward. It is simpler than standard existing pelvic osteotomies, yet it is shown to be at least as effective. With up to 16 years follow-up, we can highly commend its routine use alongside hip open reduction in infants aged 1 to 2.5 years old. Level III-case-control study.