Open Reduction and Tunneled Suspensory Device Fixation of Displaced Lateral-End Clavicular Fractures: Medium-Term Outcomes and Complications After Treatment.

Background: Fractures of the lateral aspect of the clavicle with complete displacement have a high nonunion rate and are associated with poor functional outcomes following nonoperative treatment. Various techniques are available to treat these fractures, but preliminary studies of open reduction and tunneled suspensory device (ORTSD) fixation have shown good early functional outcomes with a low rate of complications; our goal was to assess the functional outcomes and complications in the medium term in a larger series of patients treated using this technique.

Methods: Sixty-seven patients with displaced lateral-end clavicular fractures were treated with ORTSD fixation.

The epidemiology, risk of recurrence, and functional outcome after an acute traumatic posterior dislocation of the shoulder.

Background: Posterior glenohumeral dislocation is less common than anterior dislocation, and less is known about its epidemiology, functional outcome, and complications. The purposes of this study were to determine the epidemiology and demographics of posterior dislocations and to assess the risk of recurrence and the functional outcome after treatment.

Methods: We performed a retrospective review of a prospective audit of the cases of 112 patients who sustained 120 posterior glenohumeral dislocations.

The Plate-Joystick technique to reduce proximal humeral fractures and nonunions with a varus deformity through the extended deltoid-splitting approach.

Fractures and nonunions in which there is a varus deformity of the humeral head producing posterinferior subluxation of the articular surface are increasingly recognized as an important subgroup of proximal humeral fractures. Operative open reduction and internal fixation of these injuries is often recommended when the varus deformity is severe. We describe a simple technique to assist in the open reduction and locking plate stabilization of this challenging and complex fracture subtype using tools and implants that are readily available in most modern orthopaedic trauma operating rooms.

Open reduction and endobutton fixation of displaced fractures of the lateral end of the clavicle in younger patients.

Displaced fractures of the lateral end of the clavicle in young patients have a high incidence of nonunion and a poor functional outcome after conservative management. Operative treatment is therefore usually recommended. However, current techniques may be associated with complications which require removal of the fixation device.

Fractures of the lesser tuberosity of the humerus.

Background: Fractures of the lesser tuberosity are rare injuries, and little is known of their epidemiology. Operative treatment is generally recommended for displaced fractures; however, the outcome of this method of treatment has not previously been studied. The aims of our study were to determine the approximate incidence of lesser tuberosity fractures, as well as the functional outcome following operative treatment in a consecutive series of patients.

Assessment of axillary nerve function and functional outcome after fixation of complex proximal humeral fractures using the extended deltoid-splitting approach.

Background And Purpose: The extended deltoid-splitting approach was developed as an alternative to the deltopectoral approach in the treatment of three- and four-part proximal humeral fractures. The aim of our prospective study was to determine whether this approach was associated with evidence of nerve injury, functional deficits or other complications in these cases, during the first year following reconstruction.

Methods: Over a 1-year-period, we treated 14 people (median age 59 years) with open reduction and plate fixation using the extended deltoid-splitting approach.

Complex posterior fracture-dislocation of the shoulder. Epidemiology, injury patterns, and results of operative treatment.

Background: Complex posterior fracture-dislocations of the shoulder are rare and often associated with poor long-term function regardless of the choice of treatment. The purposes of this study were to evaluate the epidemiology and pathological anatomy of posterior fracture-dislocations of the shoulder and to assess the clinical and radiographic outcomes of a specific treatment protocol of open reduction and internal fixation.

Methods: We studied the demographic details of a consecutive series of twenty-six patients (twenty-eight shoulders in nineteen men and seven women with a mean age of fifty-three years) who sustained acute posterior dislocation of the humeral head with an associated Neer two, three, or four-part fracture.

Treatment of anterior fracture-dislocations of the proximal humerus by open reduction and internal fixation.

Over a seven-year period we treated a consecutive series of 58 patients, 20 men and 38 women with a mean age of 66 years (21 to 87) who had an acute complex anterior fracture-dislocation of the proximal humerus. Two patterns of injury are proposed for study based upon a prospective assessment of the pattern of soft-tissue and bony injury and the degree of devascularisation of the humeral head. In 23 patients, the head had retained capsular attachments and arterial back-bleeding (type-I injury), whereas in 35 patients the head was devoid of significant soft-tissue attachments with no active arterial bleeding (type-II injury).