These observations reveal that joint instability resulting from ACL injury rapidly results in degenerative changes characteristic of those seen in idiopathic OA at arthroplasty and in experimental OA following ACL surgery. These changes may contribute to the development of post-traumatic OA that is commonly observed following ACL injury. The observations support and extend conclusions from other studies on human and animal articular cartilage and synovial fluids post-ACL injury that have revealed a rapid onset of damage to type II collagen and an initial increase in proteoglycan content characteristic of experimental OA post-ACL injury. This study provides direct evidence for the rapid development of degenerative changes characteristic of OA following ACL injury.

Oral contraceptive pill use yielded statistically significant decreases in anterior translation of the tibia as compared with nonusers. The OCP may have a role to play in the prevention of ACL injuries by prophylactically targeting 1 of the variables responsible for the increased ACL injury rates in women.

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We have reported the case of a nonunion of a clavicle fracture in which the Dacron had eroded the bone and acted as a stress riser contributing to the fracture. The Dacron then became interposed in the fracture site preventing union.

L arge studies have shown some safety in treating isolated sternal fractures with nonoperative management outside of an intensive care setting. Sternal fractures in highvelocity injuries may indicate more severe underlying abnormalities such as cardiac arrhythmias and aortic contusions. [1][2][3] This type of fracture occurs usually as a result of motor vehicle collisions and involves the upper and middle thirds of the sternal body. If nondisplaced, they are treated with analgesics and rest. 2 When displaced, sternal fractures may require operative intervention. 4 The indications for operative treatment have been severe pain limiting respiratory efforts, displaced fractures that cannot be corrected by closed reduction, or fractures leading to mechanical instability of the thorax. If sternal fractures are not stabilized, pseudoarthrosis of the sternum can result in ongoing pain and instability. 5 Several reports have demonstrated that the sternum can be rigidly fixed with either custom plates or posterior dissection and circumferential wiring. 6 Circumferential wiring has been the standard of fixation after cardiac surgery but has been associated with complications including cutout of wires, osteomyelitis, and nonunion. 7 We wish to report on three cases treated with internal fixation with standard plates and screws from a minimally intrusive anterior approach. This approach decreases soft tissue dissection, which ensures maintenance of anatomic blood supply and could decrease pulmonary complications from retrosternal dissection. CASE REPORTS Case 1A 55-year-old man complained of sharp chest pain and dyspnea after an motor vehicle crash in which he was the front passenger. Anteroposterior and lateral radiographs of his thorax showed no evidence of a fracture. A thoracic computed tomographic scan revealed no internal trauma. At 4-month follow-up, the patient reported sternal pain that worsened on movement. Physical examination revealed a protuberance over the middle third of the sternal body that reproduced the patient's symptoms when palpated. A new thoracic computed tomographic scan showed a nondisplaced transverse fracture across the middle third of the sternum. At surgery, open reduction and internal fixation (ORIF) with a six-hole plate stabilized the sternum. Autogenous bone graft was accomplished with asymmetric sternal osteotomy with no complications. The patient had marked decrease in pain immediately postoperatively and was free of all pain related to the fracture at 1 month. Twelve months postoperatively, the patient had normal range of neck and shoulder motion and reported a decrease in pain. The patient was able to feel the plate under his skin even though it was causing him no discomfort, and he requested hardware removal. Case 2A young karate practitioner felt a sharp pain in his chest when struck by a kick while sparring. Radiographs showed a 50%, posterior, displaced, transverse fracture across the middle third of the sternal body. The fracture was treated by ORIF on postinjury day 3 using an anter...

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