The aims of this study were to determine union rates and hardware complications, and to assess whether the “non-toggle” proximal locking option prevented screw back-out.
Thirty-six fractures (95%) went on to unite following treatment with the Polarus nail. Of the two fractures that failed to unite one had an infective non-union and the other developed avascular necrosis with non-union of the surgical neck. Twelve patients (32%) developed post-operative hardware complications. In nine (24%) there was backing out of the proximal locking screws, but only two patients had symptoms requiring screw removal. In five patients (13%) the nail was prominent proximally, causing impingement. In one patient (3%) the proximal screws penetrated the gleno-humeral joint, although this was asymptomatic. There was backing-out in six of the 21 patients (29%) in which the standard 5.0 mm proximal locking screws were used. This compared with three out of 14 patients (21%) in which the 5.3 mm “non-toggling” screws were used. The difference in the rate of screw backing-out between the two groups was significant (P = 0.0474, Fisher’s Exact test). In three patients a mixture of 5.0 and 5.3 mm screws was used.
We present one of the largest reported series of such fractures in which we have explored the above statements.
The patients were followed up in the outpatients clinic for a mean period of 2 months (group 1) and 16 months (group 2). The distance of the fracture site from the proximal tip of the metatarsal was measured on the radiographs.
All group 1 fractures healed well following symptomatic management and none required surgical intervention. Acute fractures in group 2 did better with non-weight bearing mobilization. Stress related fractures in group 2 took longer to heal when managed non-operatively. In group 2 patients, the difference in the site of acute &
stress fractures was not statistically significant. No statistically significant correlation between distance from the proximal tip of the fifth metatarsal to the fracture site and union.
A standardized classification is important because there is great variability in the types of fractures and appropriate treatment. Nonunion in fractures distal to the tuberosity is not related to the distance of the fracture from the metaphyseal-diaphyseal region Acute and stress fractures distal to the tuberosity do not occur at different anatomic sites.
We set up a trial to test whether the KT1000 arthrometer would give consistent measurements of anteroposterior laxity when used by the same and different examiners on the knees of the same subjects on the same day. The results showed substantial inter- and intra-examiner variation in the measurements both of absolute displacement in single knees and of side-to-side differences between pairs of knees. This casts doubt on the reliability of the instrument when used to compare the results of different techniques for reconstructing injured cruciate ligaments.
The place and effectiveness of surgery for acromioclavicular dislocation is disputed. We have reviewed 29 patients all treated by an operation which holds the clavicle down to the coracoid process. This was effective in both acute and late cases, with rapid return to work, a low incidence of complications and no requirement for secondary procedures. We consider it to be the method of choice when operation is indicated.