Aims

We assessed the value of the Clinical Frailty Scale (CFS) in the prediction of adverse outcome after hip fracture.

Introduction. Sternoclavicular dislocations are well-known adult injuries. The same traumatism causes growth-plate fracture of the medial clavicle in children and young adults. At this location, the emergence of the secondary ossification center and its bony fusion are late. We report the results of 20 cases hospitalized in the Toulouse University Hospital Center that were treated surgically. Materials & Methods. 20 patients were treated between 1993 and 2007, 17 boys and 3 girls, 16 years old (6–20). The traumatism was always violent (rugby 75%). Two physeal fractures were anteriorly displaced, and 18 posteriorly. The follow-up is 64 month (8–174). Clinical, radiographic and therapeutic characteristics were assessed. The long-term results were analysed with: an algo-functional scale (Oxford shoulder score), the subjective Constant score, a functional disability scale (Shoulder simple test), a quality of life scale (DASH), and global indicators (SANE and global satisfaction). Results. all the patients were symptomatic before surgery: pains, oedema and partial functional impotence. Only 2 dysphagia, 1 dyspnea and 1 venous circulation alteration were observed. The first clinical and radiological examination, before CT scan, didn't diagnose the injury in 8 cases. The CT scan were realized for all the patients: it diagnosed the physeal fracture and showed 4 cases of vascular or respiratory compressions. There were 5 attempts of closed reduction, without success: all the patients were surgically-treated. The open reduction were completed by pinning (12 cases) or cerclage with absorbable suture (3 cases). Per-operatory findings lead to realize costo-clavicular repair plasties with the sub-clavicular muscle (3 cases) and/or capsular-ligamentous-perosteal selective plasties (13 cases). Two cases of broken Kirschner wires were noticed, without migration. Functional outcomes are largely good or excellent: STT 11,74/12 (10–12)–OSS 12,95/60 (12–19)–DASH 2,07/100 (0–17,6)–SANE 93,16% (60–100). Discussion and Conclusion. we present the largest case series in the literature. CT scanner is the essential element of the diagnostic process and may allow the distinction between true sterno-clavicular dislocation and displaced physeal fractures. This distinction is difficult at younger ages and is facilitated by the progression of ossification. Very good results were obtained, but classical pitfalls of treatment were found: instability after closed reduction, broken K-wires, recurrent anterior instability, inesthetic scars

We retrospectively analysed the clinical results of 30 patients with injuries of the sternoclavicular joint at a minimum of 12 months’ follow-up. A closed reduction was attempted in 14 cases. It was successful in only five of ten dislocations, and failed in all four epiphyseal disruptions. A total of 25 patients underwent surgical reduction, in 18 cases in conjunction with a stabilisation procedure.

At a mean follow-up of 60 months, four patients were lost to follow-up. The functional results in the remainder were satisfactory, and 18 patients were able to resume their usual sports activity at the same level. There was no statistically significant difference between epiphyseal disruption and sternoclavicular dislocation (p > 0.05), but the functional scores (Simple Shoulder Test, Disability of Arm, Shoulder, Hand, and Constant scores) were better when an associated stabilisation procedure had been performed rather than reduction alone (p = 0.05, p = 0.04 and p = 0.07, respectively).

We recommend meticulous pre-operative clinical assessment with CT scans. In sternoclavicular dislocation managed within the first 48 hours and with no sign of mediastinal complication, a closed reduction can be attempted, although this was unsuccessful in half of our cases. A control CT scan is mandatory. In all other cases, and particularly if epiphyseal disruption is suspected, we recommend open reduction with a stabilisation procedure by costaclavicular cerclage or tenodesis. The use of a Kirschner wire should be avoided.

Osteoporosis and fragility fractures in men constitute a considerable burden in healthcare. We have reviewed 2035 men aged over 50 years with 2142 fractures to clarify the epidemiology of these injuries and their underlying risk factors. The prevalence of osteoporosis ranged between 17.5% in fractures of the ankle and 57.8% in those of the hip. The main risk factors associated with osteoporosis were smoking (47.4%), alcohol excess (36.2%), body mass index < 21 (12.8%) and a family history of osteoporosis (8.4%). Immobility, smoking, self-reported alcohol excess, a low body mass index, age ≥72 and loss in height were significantly more common among men with fractures of the hip than in those with fractures elsewhere.