Most clavicle fractures heal without difficulty. However, radiographic nonunion after distal clavicle fracture has been reported in 10% to 44% of patients. Type II distal clavicle fractures, which involve displacement, are associated with the highest incidence of nonunion. Several studies have questioned the clinical relevance of distal clavicle nonunion, however. Nonsurgical and surgical management provide similar results. The decision whether to operate may be influenced by the amount of fracture displacement and the individual demands of the patient. Surgical options to achieve bony union include transacromial wire fixation, a modified Weaver-Dunn procedure, use of a tension band, screw fixation, plating, and arthroscopy. Each technique has advantages and disadvantages; insufficient evidence exists to demonstrate that any one technique consistently provides the best results.

Catastrophic cervical spine injuries can lead to devastating consequences for the collision athlete. Improved understanding of these injuries can facilitate early diagnosis and effective on-field management. This article is the first of a 2-part series. The first part reviews the current concepts regarding the epidemiology, functional anatomy, and diagnostic considerations relevant to cervical spine trauma in collision sports. In the second part, to be published later, the principles of emergency care of the cervical spine-injured athlete are reviewed. This article provides a rational approach to the early recognition of the different clinical syndromes associated with catastrophic cervical spine injury. Rapid on-field diagnosis can help to optimize the outcomes of these catastrophic injuries.

The tibiofemoral compressive force and neutral joint position were best replicated with a low graft tension (1-15 N) when using a patellar tendon graft.

Fractures of the calcaneal tuberosity are relatively uncommon and are seen most frequently in elderly and diabetic patients. These injuries are typically avulsion fractures caused by concentric contraction of the gastrocnemius-soleus muscle complex. Displacement of these fractures can compromise the skin over the posterior aspect of the heel; therefore, early recognition and management are imperative. Surgical management of calcaneal tuberosity fractures requires reduction and stable fixation of the displaced fragment. When the patient has preexisting tightness of the gastrocnemius-soleus complex, successful management must also address this pathology to improve outcome.

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Sixty-eight patients undergoing outpatient knee arthroscopy for treatment of meniscal tears or loose bodies were divided into three treatment groups (zolpidem [24 patients], control [24 patients], and placebo [20 patients]). All groups received postoperative hydrocodone and ibuprofen. Patients in the zolpidem group received a single dose of zolpidem tartrate for the fi rst seven postoperative nights. Patients in the placebo group received a gelatin capsule similar in appearance to zolpidem and patients in the control group received only hydrocodone and ibuprofen. Patients in the control group demonstrated signifi cantly worse mean daily postoperative pain and more daily postoperative fatigue on visual analog scales when compared with the zolpidem group (Pϭ.03 and Pϭ.04, respectively). Patients in the placebo group had worse daily postoperative pain and more daily postoperative fatigue when compared to the zolpidem group, although these differences did not reach statistical signifi cance (Pϭ.15, powerϭ0.6; and Pϭ.27, powerϭ0.48, respectively). Patients in the control group consumed signifi cantly higher quantities of hydrocodone/acetaminophen postoperatively (Pϭ.04) than patients in the zolpidem group. Finally, patients in the placebo group consumed higher quantities of hydrocodone/acetaminophen than the zolpidem group although the difference did not reach statistical signifi cance (Pϭ.4; powerϭ0.15). Power was calculated for each insignifi cant relationship based on observed effect and sample sizes and variances.This study demonstrates that sleep and fatigue may be an important factor in the effective pain management following knee arthroscopy. Future postoperative treatment regimens should address sleep and fatigue to maximize analgesic effects in these patients.

A mucinous cystadenoma of the mesentery and two borderline mucinous cystadenocarcinomas of the mesentery and retroperitoneum are reported. The patients were females, aged 38, 47 and 58 years. The cysts showed identical features to those commonly seen in the appendix and ovary. One of our cases, with 'borderline' histology, developed metastases to mediastinal lymph nodes, 4 years after diagnosis. We suggest that these tumours develop through mucinous metaplasia in pre-existing mesothelium-lined cysts, the latter being the commonest cysts in this location.