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BACKGROUND It is unknown whether locking or nonlocking superior plate fixation is better for managing displaced midshaft clavicle fractures. Therefore, we aimed to compare the clinical and radiographic outcomes of locking and nonlocking superior plate fixation of displaced midshaft clavicle fractures. METHODS A total of 102 consecutive patients with displaced midshaft clavicle fractures (2B1 and 2B2 in Robinson classification) participated in this randomized controlled trial; 12 patients were excluded. Surgeries were performed using a 3.5-mm Locking Compression Plate (LCP) between 2007 and 2015. Patients were treated either with a locking plate (group L, n = 45) or a nonlocking plate (group N, n = 45). In both groups, the plates were fixed to the proximal and distal clavicle with two and/or three screws, respectively. The main outcome measures were complication rates, time to bone union, and Constant score. RESULTS Forty-two patients in group L (mean age, 45.9 years) and 41 in group N (mean age, 43.6 years) were followed. The overall complication rates in groups L and N were 7.2% (three peri-implant fractures) and 7.3% (non-union, deformed plate, and peri-implant fracture), respectively (p = .98). The average time to union significantly differed between groups (L vs. N: 13.0 ± 4.1 vs. 17.5 ± 6.3 weeks; p

OBJECTIVES To evaluate the influence of posterior hook position on subacromial bone erosion during surgical treatment of distal clavicle fractures with locking compression plate (LCP) clavicle hook plate (CHP). DESIGN Single-center retrospective study. SETTING Level V trauma center (university hospital). PATIENTS Twenty-one patients (mean age, 45.8 years) treated with CHP were included. One, three, 15, and two patients had Neer type I, IIa, IIb, and V fractures, respectively. INTERVENTION Open reduction and internal fixation were performed with LCP CHP. All implants were removed after a mean of 6.1 months postoperatively. MAIN OUTCOME MEASUREMENTS Japanese Orthopaedic Association (JOA) shoulder scores were used to assess recovery. Radiographically, the coracoclavicular distance (CCD) was measured as the distance between the tip of the coracoid process and the undersurface of the clavicle. Three-dimensional computed tomography was performed to identify bone erosion at the hook tips after implant removal. The distance from the acromioclavicular joint center to the bone erosion was divided into five areas at 5-mm intervals, and the position and depth of bone erosion were measured in each area. RESULTS The mean follow-up period was 17.4 months; mean ± standard deviation (SD) JOA score was 75.9 ± 4.7 at the final follow-up, while the mean duration of bony union was 4.4 ± 1.0 (SD) months. Delayed bony union was observed in one patient, while a second surgery was required in another due to acromion cut-out. Radiography showed over reduction in 95% of cases. The correlation coefficient showed a difference between CCD and the position of bone erosion measured by CT (Rs=0.32, p=0.006). Erosion under the acromion surface was found in all patients. The depth of erosion correlated with the posterior hook position (Rs = 0.29, P = 0.023). CONCLUSIONS Posterior hook tip placement increased the likelihood of bone erosion and complications due to over reduction. CHP should be set more anteriorly beneath the acromion to prevent complications. LEVEL OF EVIDENCE Therapeutic level IV. See Instructions for Authors for a complete description of levels of evidence.

Background This study aimed to assess the long-term outcomes of the open modified inferior capsular shift procedure across more than 20 years in patients with traumatic anterior shoulder instability. Methods Participants in this study comprised 84 patients (86 shoulders; 67 men, 17 women). Mean follow-up was 28.0 years. We compared the recurrent instability rate after surgery, apprehension, revision rate, satisfaction, return to preinjury sporting activity, and patient background characteristics between recurrent and nonrecurrent groups. Twenty-seven patients who were examined directly were evaluated for differences in range of motion and muscle strength between affected and nonaffected sides. Clinical outcome scores used for this study were the Western Ontario Shoulder Instability Index and the Rowe score. Results Nine shoulders (10.5%) showed recurrent instability, as dislocation in 3 shoulders and subluxation in 6 shoulders, but no revisions were required. All patients with recurrent instability were males with new trauma. Three shoulders developed recurrent instability ≤5 years after surgery, and the remaining 6 shoulders showed recurrent instability >5 years after surgery. No significant differences in any patient characteristic were identified between the recurrent and nonrecurrent groups. Significant differences between affected and nonaffected sides were seen in the mean active range of motion or muscle strength for external rotation in the anatomic position or in 90° of abduction. Western Ontario Shoulder Instability Index and Rowe score were significantly worse in the recurrent group than in the nonrecurrent group. Patients reported that 84 shoulders (97.7%) were “much better.” Most athletes (88.4%) had returned to sports activity at a level >70%. Conclusion We investigated long-term outcomes of the open modified inferior capsular shift procedure for traumatic anterior shoulder instability. Our data suggest that recurrent instability might result from new trauma even if a long time has passed since the open modified inferior capsular shift procedure, so follow-up should be continued as long as possible after surgery. As in other reports, satisfaction was high and clinical scores were good. We thus believe this surgical method offers good results even after more than 20 years.

Introduction Using a rat model of nontraumatic early arthritis induced by intra-articular administration of low-dose monoiodoacetic acid (MIA), we transplanted allogeneic chondrocyte sheets and examined the effects on tissue repair. Methods MIA (0.2 mg/50 μl) was injected into the right knee of 20 male Wistar rats. Four weeks later, rats were randomly allocated into three groups: Group A was examined 4 weeks after administration of MIA; Group B, 8 weeks after MIA injection and chondrocyte sheet transplantation, and Group C, 8 weeks after MIA injection but without chondrocyte sheet transplantation. Allogeneic chondrocyte sheets were transplanted into the right knee of Group B rats. Pain was assessed as the weight distribution ratio of the damaged to undamaged limb. The OARSI score was used for histological scoring. Results The limb weight distribution ratio indicated significantly less pain in Group B. Histological scoring showed significant differences in cartilage repair and inhibition of the progression of cartilage degeneration between Groups B and C, but not between Groups A and B, or Groups A and C. Conclusions These findings suggest that, in this rat model of nontraumatic early arthritis induced by low-dose MIA injection, allogeneic chondrocyte sheet transplantation induces cartilage repair and suppresses cartilage degeneration., Highlights • Therapeutic effects of allogeneic chondrocyte sheets were examined using an arthritis model of rat induced by low-dose MIA. • Chondrocyte sheets exhibited sufficient expression of genes important to maintaining a stable cartilage matrix. • Transplantation of chondrocyte sheets alleviated pain and induced cartilage repair and suppressed cartilage degeneration.

OBJECTIVE We examined the factors related to a reduction in the use of low-intensity pulsed ultrasound (LIPUS) for patients at both our hospital and other affiliated institutions. MATERIALS AND METHODS Of 350 patients who used LIPUS at our and other affiliated institutions from May 2010 to April 2015, 279 (168 males, 111 females) were evaluated, after excluding mortalities and those with unexplained bone adhesion. Those patients with LIPUS compliance [calculated as: (number of days LIPUS was used/number of days LIPUS was available) × 100] below 80% were defined as the non-compliant group (170 patients), and those patients with a compliance rate of 80% or above were defined as the compliant group (109 patients). Factors related to a reduction in compliance were examined and included duration of use, age, sex, fracture side (right or left), and fracture site. RESULTS The duration of use was longer in the non-compliant group compared with that in the compliant group (mean ± SD: 160 ± 118 days vs. 126 ± 81 days; P = 0.01), and the mean age was younger in the non-compliant group (42 ± 20 years vs. 50 ± 21 years; P = 0.002). Additionally, there was a higher ratio of females/males in the compliant group (60/49 vs. 120/50; P = 0.008). However, the side of the fracture was not significantly different between the groups (P = 0.449). Fractures of the forearm were more frequent in the non-compliant group than that in the compliant group (25/170 vs. 7/109; P = 0.003). DISCUSSION The results suggest that the factors predictive of a reduction in the use of LIPUS are a long period of use, younger age, male gender, and use on fractures of the forearm.