PurposeArthroscopically assisted acromioclavicular joint (ACJ) stabilization techniques use bone tunnels in the clavicle and coracoid process. The tunnel size has been shown to have an impact on the fracture risk of clavicle and coracoid. The aim of the present study was to radiographically evaluate the alterations of the clavicular tunnel size in the early post‐operative period. It was hypothesized that there would be a significant increase of tunnel size. MethodsTwenty consecutive patients with acute high‐grade ACJ (Rockwood type IV–V) injury underwent arthroscopic‐assisted ACJ stabilization. The median age of the patients was 40 (26–66) years. For all patients, a single tunnel button–tape construct was used along with an additional ACJ tape cerclage. Radiologic measurements were undertaken on standardized Zanca films at two separate time points, immediate post‐operative examination (IPO) and at late post‐operative examination (> 4 months; LPO). The LPO radiographs were taken at a median follow‐up period of 4.5 (3–6) months. Clavicular tunnel width (CT) and coracoclavicular distance (CCD) were measured using digital calipers by two independent examiners and the results are presented as median, range, and percentage. ResultsThe median CCD increased significantly from 9.5 (8–13) mm at IPO to 12 (7–20) mm at LPO (p < 0.05). Median tunnel size showed significant difference from 3 (3–4) mm at IPO to 5 (4–7) mm at LPO (p < 0.05). Despite a significant increase of 2 mm (66.6%) of the initial tunnel size, there was no correlation between tunnel widening and loss of reduction. ConclusionArthroscopic ACJ stabilization with the use of bone tunnels led to a significant increase of clavicular tunnel size in the early post‐operative period. This phenomenon carries a higher fracture risk, especially in high‐impact athletes, which needs to be considered preoperatively. Level of evidenceIV

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Background Application of a posterior plate for tibia plateau fractures associated with posterior column involvement is becoming a widespread standard practice as previous studies have shown that additional fixation of the posterior column with a posteromedial buttress plate creates strongest fixation in terms of fracture stabilization This study evaluated the clinical and radiological results of patients undergoing surgery for complex tibial plateau fractures involving the posterior column with a posteromedial plate applied via a medial midline incision. Methods Medical records of patients undergoing surgery for Schatzker type IV, V, and VI tibia plateau fractures involving the posterior column in our institution were reviewed retrospectively. Patients with a follow-up of less than 1 year, pathological fractures, posterolateral column fractures requiring separate fixation, and open fractures were excluded from the study. Three-dimensional computed tomography (3D CT) was performed in all patients before surgery. The study population consisted of 25 patients (21 males and 4 females) with a mean age of 41.5 (19–66) years. The etiologies of the fractures were traffic accidents in seven cases, pedestrian falls in five cases, falls from a height in seven cases, and motor vehicle accidents in six cases. Results The mean follow-up period was 15.9 months (12–25), mean time to union was 14.32 (9–20) weeks, mean Knee Society score (KSS) was 88 (81–95), and range of movement (ROM) was 123° (95°–140°). Loss of reduction was detected in only one patient (4%). A superficial incisional infection occurred in an anterolateral incision in only one patient (4%), and it recovered after oral antibiotic therapy. None of the patients required early implant removal and none had vascular or nerve complications in the postoperative period. Postoperatively, 23 (92%) patients had anatomical reduction and 2 (8%) had acceptable reduction in the sagittal plane CT sections. Acceptable reduction was achieved in 6(24%) patients and anatomical reduction was achieved in 19 (76%) in the coronal plane CT sections (Table 2). Conclusions Clinical results of posteromedial plate application using a single medial midline incision is promising as complication rates were very low and knee scores were high.

Oxford Phase 3 UKA with mobile bearing has good mid-term results in obese patients over 60 years of age.