Only a few randomised, controlled studies have compared different non-operative methods of treatment of mid-shaft fractures of the clavicle. In this prospective, randomised controlled study of 60 participants (mean age 31.6 years; 15 to 75) we compared the broad arm sling with the figure of eight bandage for the treatment of mid-shaft clavicle fractures. Our outcome measures were pain, Constant and American Shoulder and Elbow Surgeons scores and radiological union. The mean visual analogue scale (VAS) pain score on the first day after treatment was significantly higher (VAS 1 6.8; 4 to 9) in the figure of eight bandage group than the broad arm sling group (VAS 1 5.6; 3 to 8, p = 0.034). A mean shortening of 9 mm (3 to 17) was measured in the figure of eight bandage group, versus 7.5 mm (0 to 24) in the broad arm sling group (p = 0.30). The application of the figure of eight bandage is more difficult than of the broad arm sling, and patients experience more pain during the first day when treated with this option. We suggest the broad arm sling is preferable because of the reduction of early pain and ease of application.

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IntroductionThe aim of this study was to evaluate the clinical and radiological outcomes of total hip arthroplasty (THA) in patients with Ankylosing Spondylitis (AS).Patients and methodsOne hundred five hips of 61 AS patients (mean age: 41.3 ± 10.2 years) who underwent THA between 1997 and 2012 were included into the study. Dorr's classification of proximal femoral geometry, acetabular protrusio, bone ankylosis, acetabular protrusion, Brooker classification of heterotopic ossification (HO), Gruen and Charnley classifications of implant loosening were used in radiographic assessments. Patients were called back to return for an additional long-term follow-up for functional assessment.ResultsCementless total hip arthroplasty was used in 83 hips (79%) and cemented TKA was used in 22 hips (21%). The overall rate of aseptic loosening was 7.6% at a mean follow-up of 5.4 years. Femoral loosening was statistically similar in cemented and cementless femoral components (14% vs. 8%, p = 0.089). Acetabular component loosening was statistically higher in patients with any degree of HO (p = 0.04). Regardless of the type of femoral implant (cemented or cementless), femoral component loosening was higher in Dorr's type C patients (p = 0.005). The average pre-operative HSS was 46.6 ± 16.3, and it improved to 80.7 ± 18.7 at last follow-up (p < 0.01).ConclusionRevision incidence was similar in between ankylosed and non-ankylosed hips. While complication rates are high, significant functional improvement can be achieved after THA in patients with AS.

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ElderlyHip fracture Mortality Comorbidity a b s t r a c t Aims: The purpose of this study was to report a less seen age-group (>90) of hip fractures and to assess the predictors of functional loss, complications and mortality.Methods: Thirty-two patients at a mean age of 92.8 (±2.7) were treated in a single institution and reported at a mean follow-up of 2.02 (±1.35) years. Conclusion: Hip fractures are challenging in extremely old patients and associated with increased mortality and disability.

ObjectivesIn intraarticular distal humerus fractures, internal fixation with double plates is the gold standard treatment. However the optimal plate configuration is not clear in the literature. The aim of this study was to compare the biomechanical stability of the parallel and the orthogonal anatomical locking plating systems in intraarticular distal humerus fractures in artificial humerus models.MethodsIntraarticular distal humerus fracture (AO13-C2) with 5 mm metaphyseal defect was created in sixteen artificial humeral models. Models were fixed with either orthogonal or parallel plating systems with locking screws (Acumed elbow plating systems). Both systems were tested for their stiffness with loads in axial compression, varus, valgus, anterior and posterior bending. Then plastic deformation after cyclic loading in posterior bending and load to failure in posterior bending were tested. The failure mechanisms of all the samples were observed.ResultsStiffness values in every direction were not significantly different among the orthogonal and the parallel plating groups. There was no statistical difference between the two groups in plastic deformation values (0.31 mm–0.29 mm) and load to failure tests in posterior bending (372.4 N–379.7 N). In the orthogonal plating system most of the failures occurred due to the proximal shaft fracture, whereas in the parallel plating system failure occurred due to the shift of the most distal screw in proximal fragment.ConclusionOur study showed that both plating systems had similar biomechanical stabilities when anatomic plates with distal locking screws were used in intraarticular distal humerus fractures in artificial humerus models.

Scoring systems and the ischemic time are not the only predictors of amputation. The decision of the treatment mode should be made by the patient and the care team after discussing the options and outcomes rather than relying on a scoring system.

Level III-retrospective cohort.