Introduction Fractures of the clavicle are common injuries, accounting 2.6-4% of all fractures in adults. Of these fractures, 21-28% are lateral clavicle fractures and 2-3% are medial clavicle fractures. Bipolar clavicle fractures are defined as a lateral and medial fracture and are uncommon. There is no consensus on the treatment of these fractures. The aim of this study is to provide a treatment on bipolar clavicle fractures based on the current literature. Methods The electronic databases PubMed, the Cochrane library and EMBASE were searched up on September 25th, 2017. Two reviewers (KR and TG) independently screened titles and abstracts for their relevance. Studies designed to evaluate the outcomes of conservative and/or operative treatment of segmental bipolar clavicle fractures in adults (> 16 years) were included. Editorials and commentaries were excluded, as well as synthetic, cadaveric and animal studies. Primary outcomes considered were pain reduction and shoulder function. Secondary outcomes considered are complications. Results Ten studies reporting results from ten patients were included for the review. In most patients, if treated operatively, surgical treatment with the use of double plating was performed. Only in elderly patients conservative treatment was adopted. All included patients were pain free and had a full range of motion after 3-6 months. Only two case reports provided a DASH score, while in eight studies no functional outcome score was measured. Conclusion A missed bipolar fracture can complicate the clinical progress. Surgical management of these fractures may be necessary; however, the treatment of choice depends on the age of the patient, daily activities and comorbidity.
Rib fractures due to blunt trauma are a common chest injury seen at the emergency department; however, injuries to the costovertebral joints are very rare. We present a case of a 24-year-old man who was admitted after a high-speed car collision and was assessed in a level 1 trauma centre in Amsterdam. He had multiple injuries, including dislocation of the costovertebral joint of ribs 7–10. After performing a literature search we concluded that patients with traumatic costovertebral joint dislocations have a high incidence of vertebral fractures, neurological deficits and additional fractures. We believe that isolated dislocation of one or multiple costovertebral joint(s) can safely be treated conservatively. Close monitoring of the patients is advisable as these injuries are caused by high impact and are associated with other injuries.
Background:The aim of this study was to compare the postoperative pain levels in patients undergoing osteosynthesis of the calcaneus with either a popliteal nerve block or an ankle block.Methods:A retrospective analysis of all consecutive patients undergoing operative fixation of a calcaneal fracture via a sinus tarsi approach between August 2012 and April 2017 in a single foot/ankle specialized center was performed. Single-shot popliteal blocks were placed using ultrasound guidance by an anesthesiologist while ankle blocks were placed by a foot/ankle specialized surgeon. Pain levels were measured through the numerical rating scale (NRS). In total, 83 patients were included in this study; 33 received a popliteal block, and 50 received an ankle block. No statistically significant differences were present in baseline characteristics between the 2 groups.Results:Comparable postoperative pain levels were observed in both groups. There was no statistically significant difference in amount of morphine used between the 2 groups.Conclusion:No differences were found in postoperative pain levels between patients receiving a single-shot popliteal block and patients who received a single-shot ankle block following calcaneal fracture surgery.Level of Evidence:III, comparative series.
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