Subtrochanteric (ST) femur fractures are proximal femur fractures, which are often difficult to manage effectively because of their deforming anatomical forces. Operative management of ST fractures is the mainstay of treatment, with the two primary surgical implant options being intramedullary (IM) nails and extramedullary plates. Of these, IM nails have a biologic and biomechanical superiority, and have become the gold standard for ST femur fractures. The orthopaedic surgeon should become familiar and facile with several reduction techniques to create anatomical alignment in all unique ST fracture patterns. This article presents a comprehensive and current review of the epidemiology, anatomy, biomechanics, clinical presentation, diagnosis, and management of subtrochanteric femur fractures. Cite this article: EFORT Open Rev 2021;6:145-151. DOI: 10.1302/2058-5241.6.200048

Background: Pediatric tibial eminence fractures constitute a complex injury with multiple treatment options. We have described a technique that combines direct visualization through an open approach and stable fixation using a bioabsorbable screw. The purpose of this study is to describe our surgical technique for tibial eminence fractures and to compare the radiographic and functional outcomes to previous open or arthroscopic methods. Methods: We retrospectively reviewed a series of five pediatric patients who underwent open reduction and internal fixation of a tibial eminence fracture with a headless, bioabsorbable poly-L lactic acid (PLLA) screw (Bio-Compression screw, Arthrex Inc, Naples, FL) from 2016 to 2017. The surgical technique involves an open approach, direct fracture reduction, and fixation with a PLLA screw without violating the epiphyseal plate. Postoperative assessment was quantified using the Lysholm knee score (LKS), knee arc of motion (AOM), presence of a pivot shift or Lachman, and knee radiographs with an average of 18.4 months of follow-up. Results: Five patients (average age of 11.3 years) were treated with a biobsorbable screw and followed for an average of 18.4 months. Average LKS was 99.6, AOM was 98.4%, all patients had negative pivot shift and Lachman exams, and all patients went on to radiographic union. No patients required re-operation or implant removal. Conclusions: The goals of tibial eminence fracture management are fracture union, restoring knee stability, and regaining normal knee motion and kinematics. Our study demonstrates that open treatment with a bioabsorbable screw is an excellent alternative surgical method as it reliably results in rigid fixation, fracture union, excellent knee function scores, and it mitigates the possible need for hardware removal.

Hip fractures are one of the most common major orthopaedic injuries in the United States, with an incidence that is growing with the aging population. These fractures vary significantly in anatomy, pathogenesis, and treatment. Orthopaedists must be able to carefully distinguish between femoral neck, intertrochanteric, and subtrochanteric femoral fractures because diagnosis is essential in guiding treatment. The extent of complex decision-making and management is often underappreciated in this diverse group of fractures. In this review, the relevant background, anatomy, and current treatment considerations essential to optimize management of these common and significant injuries are discussed.

Clavicle fracture is a common orthopaedic injury, which represents up to 5% of all fractures. The middle third of the clavicle is the most commonly fractured region, primarily because of its unique osseous anatomy and surrounding soft tissue attachments. Management of midshaft clavicle fractures has shifted substantially over the past 20 years, as the operative indications have become increasingly better defined with newer randomized controlled trials. This article presents a comprehensive review of the epidemiology, relevant anatomy, clinical assessment, and management of midshaft clavicle fractures.