Tag Archive | ORIF

Nov. 15 Webinar—Treating Clavicle Fractures

Capture_Clavicle FX for OBuzzOn November 15, 2017 at 7 PM EDTJBJS will join with JSES (Journal of Shoulder and Elbow Surgery) to present a webinar looking at the current paradigm for treating  clavicle fractures. Co-moderated by Drs. William Mallon, editor-in-chief of JSES, and Andrew Green, deputy editor of JBJS, the webinar will focus on two recent clavicle-fracture papers:

  • Dr. Philip Ahrens will discuss his recent JBJS paper, “The Clavicle Trial: A Multicenter Randomized Controlled Trial Comparing Operative with Nonoperative Treatment of Displaced Midshaft Clavicle Fractures.”
  • Dr. Brian Feeley will discuss his 2016 JSES paper, “Plate Fixation of Midshaft Clavicular Fractures: Patient-Reported Outcomes and Hardware-Related Complications.”

After each author presentation, expert commentary will be provided. Discussing Dr. Ahrens’ paper will be Dr. Michael McKee, recently named chairman of orthopaedics at the University of Arizona. Dr. Gus Mazzocca, chairman of orthopaedics at the University of Connecticut, will comment on Dr. Feeley’s paper. The webinar will then be open to addressing viewer-submitted questions for the authors and the commentators.

Seats are limited, so register now!

Webinar—Patient-Centered Treatment of Clavicle Fractures

pic of Nov speakers to use

Clavicle fractures are among the most common injuries treated by orthopaedists. Until 2005, no matter the amount of displacement, standard treatment was immobilization for a few weeks, followed by gradually increased activity until the fracture healed. In 2007, Dr. Mike McKee published a landmark article in JBJS that concluded that clavicle fractures with displacement greater than 100% had better outcomes if treated with open reduction and internal fixation (ORIF). Since that time, numerous studies have re-examined this question, some supporting Dr. McKee’s 2007 findings, and some disputing them.

On November 15, 2017 at 7 PM EDTJBJS will join with JSES (Journal of Shoulder and Elbow Surgery) to present a webinar looking at the current paradigm for treating  clavicle fractures. Moderated by Dr. William Mallon, editor-in-chief of JSES, the webinar will focus on two recent clavicle-fracture papers:

  • Dr. Philip Ahrens will discuss his recent JBJS paper, “The Clavicle Trial: A Multicenter Randomized Controlled Trial Comparing Operative with Nonoperative Treatment of Displaced Midshaft Clavicle Fractures.”
  • Dr. Brian Feeley will discuss his 2016 JSES paper, “Plate Fixation of Midshaft Clavicular Fractures: Patient-Reported Outcomes and Hardware-Related Complications.”

After each author presentation, expert commentary will be provided. Discussing Dr. Ahrens’ paper will be Dr. Michael McKee, recently named chairman of orthopaedics at the University of Arizona. Dr. Gus Mazzocca, chairman of orthopaedics at the University of Connecticut, will comment on Dr. Feeley’s paper. The webinar will then be open to addressing viewer-submitted questions for the authors and the commentators.

Seats are limited, so register now!

 

More Clinical Data on the “Clavicle Question”

clavicle_fracture_for_obuzzThe last time OrthoBuzz reported on a JBJS randomized trial looking at treatment of midshaft clavicle fractures, the authors concluded that “neither treatment option [nonoperative or surgical] is clearly superior for all patients” and that “the clavicular fracture is preeminently suitable for shared treatment decision-making.”

Now, a multicenter randomized trial by Ahrens et al. published in the August 16, 2017 JBJS adds more data for that shared decision-making discussion. In this trial, 300 patients with a displaced midshaft clavicle fracture were randomized to receive either open reduction and internal fixation (ORIF) with a plate or nonoperative management. Patients were recruited from a range of UK hospitals, and a single implant and standardized technique were used in the operative group. The rehabilitation protocol was the same for both groups.

The union rate in both groups at 3 months was low, approximately 70%. But at 9 months after the injury, the nonunion rate was <1% in the surgically treated patients, compared to 11% in the nonsurgically treated patients. The patient-reported scores (DASH and Constant-Murley) were significantly better in the operative group at 6 weeks and 3 months, but were equivalent to those in the nonoperative group at 9 months.

“Overall,” the authors conclude, “we think that surgical treatment for a displaced midshaft clavicle fracture should be offered to patients, and [these findings] can provide clear, robust data to help patients make their choices.”

JBJS Editor’s Choice: How Best to Treat Femoral Neck Fractures in Younger Adults

ORIF or THA for Femoral Neck Fx.gifIn the January 4, 2017 issue of The Journal, Swart et al. provide a well-done Markov decision analysis on the cost effectiveness of three treatment options for femoral neck fractures in patients between the age of 40 and 65: open reduction and internal fixation (ORIF), total hip arthroplasty (THA), and hemiarthroplasty. Plugging the best data available from the current orthopaedic literature into their model, the authors estimated the threshold age above which THA would be the superior strategy in this relatively young population.

For patients in this age group, traditional thinking has been to perform ORIF in order to “save” the patient’s native hip and avoid the likelihood of later revision arthroplasty. However, in this analysis THA emerges as a cost-effective option in otherwise healthy patients >54 years old, in patients >47 years old with mild comorbidity, and in patients >44 years old with multiple comorbidities.

On average, both THA and ORIF have similar outcomes across the age range analyzed. But ORIF with successful fracture healing yields slightly better outcomes and considerably lower costs than THA, whereas patients whose fracture does not heal with ORIF have notably worse outcomes than THA patients. This finding supports my personal bias that anatomical reduction and biomechanically sound fixation must be achieved in this younger population with displaced femoral neck fractures. The analysis confirmed that, because of poor functional outcomes with hemiarthroplasty in this population, hemiarthroplasty should not be considered. Poor hemiarthroplasty outcomes are likely related to the mismatch between the metal femoral head and the native acetabular cartilage, leading to fairly rapid loss of the articular cartilage and subsequent need for revision.

This analysis by Swart et al. provides very valuable data to discuss with younger patients and families when engaging in shared decision making about treating an acute femoral neck fracture. In my experience, most patients in this age group prefer to “keep” their own hip whenever possible, which puts the onus on the surgeon to gain anatomic reduction and biomechanically sound fixation with ORIF.

Marc Swiontkowski, MD
JBJS Editor-in-Chief