Open reduction and internal fixation for unstable fractures of the lateral end of the clavicle (Neer type II) is not complication-free. Most clavicle fractures can be successfully treated by conservative methods. Neer type II fractures have a reportedly high rate of nonunion, therefore internal fixation is recommended. However, the need for surgical treatment remains controversial as nonunion seldom produces a poor functional outcome. We report 3 cases of fixation failure following treatment with a clavicular hook plate. None of the patients required re-fixation surgery and all achieved bony union with a good functional result.

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We describe a case of osteomyelitis and secondary septic arthritis caused by Sphingomonas paucimobilis in an immunosupressed adolescent which did not present typically, leading to a delay in diagnosis. This case highlights the need to thoroughly investigate musculoskeletal pain in the immunocompromised patient in order to exclude an infection as a cause.

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ObjectiveThe aim of this study was to review the radiological alignment outcomes of patient Specific (PS) cutting blocks and Standard Instrumentation in Primary Total Knee Arthroplasty.MethodsWe hypothesized that the use of PS techniques would significantly improve sagittal, coronal and rotational alignment of the prosthesis on short term. We performed a systematic review and a meta-analysis including all the randomised controlled trials (RCT) using PS and standard (ST) total knee arthroplasty to date.ResultsA total of 538 PS TKA and 549 ST TKA were included in the study. Statistical analysis of the outliers for femoral component sagittal, coronal and rotational positioning, tibial component sagittal and coronal positioning and the overall mechanical axis were assessed. We found that there was no significant benefit from using PS instrumentation in primary knee arthroplasty to aid in the positioning of either the tibial or femoral components. Furthermore sagittal plane tibial component positioning was worse in the PS than the traditional ST group.ConclusionOur results suggest that at present PS instrumentation is not superior to ST instrumentation in primary total knee arthroplasty.Level of evidenceLevel 1, Systematic review of therapeutic studies.