Comparison of functional outcome and complications of locking plate versus coracoclavicular fixation in the treatment of unstable distal clavicle fractures: the multicenter, propensity-matched TRON study

Operative Management for Displaced Distal Clavicle Fractures

This article reviews techniques and outcomes of surgical fixation for distal clavicle fractures. Near 100% union has been reported for several techniques. The most common are locked plating, coracoclavicular fixation and a combination of plating with CC fixation. Hook plates are useful for particular fracture patterns, but there can be complications specific to this implant. Low-profile constructs are favored due to the high rates of symptomatic hardware. Fixation of subacute and chronic injuries can provide reliable functional improvements, but is inferior to acute fixation. Surgery is generally the treatment of choice for displaced fractures in athletes.

A double tapered fully hydroxyapatite-coated stem has less contact area to femoral cortical bone than a tapered-wedge stem: a three-dimensional computed tomography-based density mapping analysis

INTRODUCTION

It is clinically important to analyze the initial contact state between an implant and femoral cortical bone as it affects clinical outcomes, such as stress shielding, stem subsidence, thigh pain, and patient-reported outcomes after total hip arthroplasty. Whether the initial contact state of a double-tapered fully hydroxyapatite (HA)-coated stem is achieved with the preserved cancellous or cortical bone remains to be established. This study aimed to compare the contact area with the femoral cortical bone between a double-tapered fully HA-coated stem (HA group) and a tapered wedge cementless stem (TW group) using three-dimensional computed tomography (3DCT)-based templating software.

MATERIALS AND METHODS

Forty-seven total hip arthroplasties in the HA and TW groups each were retrospectively analyzed. The contact area between the implant and femoral cortical bone in the whole stem and at each Gruen zone was measured using density mapping with 3DCT-based templating software.

RESULTS

The demographic data were not significantly different between the two groups. The contact area in the whole stem area was lower in the HA group (HA 5.4 ± 1.8% vs. TW 9.0 ± 4.8%, p < 0.01). The HA group had a lower contact area in zone 2 (HA 6.7 ± 6.5% vs. TW 15.6 ± 10.8%, p < 0.01) and zone 6 (HA 1.8 ± 3.5% vs. TW 6.3 ± 3.6%, p < 0.01) than the TW group. The implant type (β = 0.41, p < 0.01) and stem coronal alignment (β = - 0.29, p < 0.01) were significant predictors of the contact area in the whole stem area in a multiple regression analysis (adjusted R² = 0.27, p < 0.01).

CONCLUSION

The contact area of the double-tapered fully HA-coated stem was significantly lower than that of the tapered wedge cementless stem.