Open reduction and plate fixation reduces the rate of nonunion after acute displaced midshaft clavicular fracture compared with nonoperative treatment and is associated with better functional outcomes. However, the improved outcomes appear to result from the prevention of nonunion by open reduction and plate fixation. Open reduction and plate fixation is more expensive and is associated with implant-related complications that are not seen in association with nonoperative treatment. The results of the present study do not support routine primary open reduction and plate fixation for the treatment of displaced midshaft clavicular fractures.

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The objective of this pilot study was to determine the effect of 6 different abdominal exercises on the electrical activity of the upper rectus abdominis (URA) and lower rectus abdominis (LRA). Eight healthy, adult volunteers completed 6 random abdominal exercises: curl up, Sissel ball curl up, Ab Trainer curl up, leg lowering, Sissel ball roll out, and reverse curl up. Action potentials were recorded and analyzed from the URA and the LRA using surface electromyography (EMG) during a 2-second concentric contraction. The average normalized data were compared between the URA and the LRA in order to determine the behavior of the different muscle sites and between exercises in order to determine which exercises elicited the highest EMG activity. There were no significant differences (p > 0.05) between the EMG activity of the URA and LRA during any exercise. There were no significant interactions between subject and muscle site or between exercise and muscle site. Significant differences were found among the 6 exercises performed, and due to the interaction between subject and exercise performed. Both the URA and the LRA recorded significantly higher mean amplitudes during the Sissel ball curl up than during all other exercises. In addition, the curl up, Sissel ball curl up, and Ab Trainer curl up had significantly higher normalized EMG activity in both muscle sites than the reverse curl up, the leg lowering exercise, and the Sissel ball roll out. The curl up and the Ab Trainer curl up exercises were not significantly different in terms of their normalized EMG activities for both the URA and the LRA.

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Background: Nonoperative management of complete acromioclavicular (AC) joint dislocation has yielded reasonable results, although patients may report dissatisfaction with the outcome. The purpose of this prospective, randomized, controlled trial was to compare patient outcome following nonoperative care versus operative treatment with open reduction and tunneled suspension device (ORTSD) fixation for acute, type-III or IV disruptions of the AC joint. Methods: Sixty patients aged 16 to 35 years with an acute type-III or IV disruption of the AC joint were randomized to receive ORTSD fixation or nonoperative treatment, following a power analysis to determine sample size. Functional outcomes were assessed with use of the Disabilities of the Arm, Shoulder and Hand (DASH) as the primary outcome measure and the Oxford Shoulder Scores (OSS) and Short Form (SF-12) as secondary outcome measures at 6 weeks, 3 months, 6 months, and 1 year after treatment. Reduction was evaluated with use of radiographs. Any complications were noted at each assessment. The economic implication of each treatment was evaluated. Results: ORTSD and nonoperative groups were similar with regard to demographics at baseline. The mean degree of radiographic displacement was significantly less in patients following ORTSD fixation (1.75 mm) compared with patients who received nonoperative treatment (10.61 mm, p < 0.0001). At 1 year postoperatively, the mean DASH score was 4.67 in the nonoperative treatment group and 5.63 in the ORTSD group, and the mean OSS was 45.72 and 45.63, respectively. Patients managed with ORTSD fixation had inferior DASH scores at 6 weeks (p < 0.01). There were 5 patients who experienced failed nonoperative treatment and subsequently underwent a surgical procedure. ORTSD fixation (£3,359.73) was associated with significantly higher costs than nonoperative treatment (£796.22, p < 0.0001). Conclusions: ORTSD fixation confers no functional benefit over nonoperative treatment at 1 year following type-III or IV disruptions of the AC joint. Although patients managed nonoperatively generally recovered faster, a substantial group of patients remained dissatisfied following nonoperative treatment and required delayed surgical reconstruction. We were unable to identify any demographic or injury-related factors that predicted a poorer outcome in these patients. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.