Background: Congenital pseudoarthrosis of the clavicle (CPC) is rare and may require treatment, usually because of an unacceptable appearance or occasionally because of pain in an adolescent patient. Spontaneous union is unknown, and consequently any desired union requires open reduction and bone grafting. Many authors recommend performing the operation at the age of 3-5 years and using different fixation methods. We present our experience with three cases and literature review in an attempt to further elucidate the appropriate timing of the procedure and the fixation method. Methods: This was a retrospective review of three cases presenting with pseudoarthrosis of the clavicle. All cases were treated by curettage of the pseudoarthrosis, with the void filled using full-thickness ileac crest autologous bone graft and bridging plate-one compression and two anatomical, at different ages. We performed a literature review with emphasis on timing of the procedure, fixation method and complications. Results: All patients healed with good callus formation. One patient (5-year-old female treated using a compression plate) experienced overlying skin irritation and underwent removal of the plate. There were no restriction of movement, pain or any other complaint on the final follow-up. We did not find any difference in the operating complexity at different ages, but when a compression plate was used, it had to be removed later due to bulging of the plate. Discussion: No clinical difference was observed between earlier and late operation. Therefore, we suggest performing a curettage of the pseudoarthrosis, gapping the void using autologous bone graft, and using an anatomical bridging plate.

Background:Treatment for osteoporosis in the community in patients who were operated for hip fracture appears to be suboptimal at best. Evidence regarding treatment beyond the 1st year after surgery is scarce. We examined the association between discharge recommendations for treatment of osteoporosis in patients suffering from hip fractures and treatment beyond the 1st year.Methods and materials:We performed a retrospective observational cohort study in patients age 50 to 90 years operated for osteoporotic hip fractures between the years 2008 and 2014. We investigated the correlation between discharge recommendations and rates of osteoporosis treatment postdischarge 1 to 7 years, and the influence of osteoporosis diagnosis upon treatment. Exclusion criteria besides age included high-energy trauma, pathologic or periprosthetic fractures, and patients deceased within 1-year postsurgery.Results:A total of 602 patient files were examined. Univariate analysis showed that, of 283 patients who were prescribed dietary supplementation of vitamin D and calcium, a significantly higher percentage of patients received treatment if they had a recommendation (50.3% vs 36.1%, P = 0.0005), were diagnosed (43.8% vs 14.4%, P < 0.0001), or were of female gender (84.1% vs 57.3%, P < 0.0001). Multivariate analysis showed that the odds ratio (OR) for receiving treatment compared with the control group (patients without a recommendation and a diagnosis) was higher among patients who had both a recommendation and a treatment (OR = 5.4, P < 0.0001) than the group with a diagnosis only (OR = 4.75, P < 0.0001) or a recommendation only (OR = 2.06, P = 0.0006).Conclusions:A formal recommendation for osteoporosis treatment in the discharge letters of patients who suffered hip fragility fractures increases treatment rate of osteoporosis in the community compared with patients without a recommendation. Patients who receive such a recommendation but also have a formal coded diagnosis of osteoporosis in their medical files have an even higher chance of receiving treatment in the community. Our observations may assist in amplifying the overall treatment rates, which are still undoubtedly low.

Background: Many Wheelchair users experience adverse effects specific to their situation, some of which might be avoided if suspension systems are integrated into the wheelchair. Objectives: Our study aimed to compare the user experience using a novel wheelchair suspension system with normal wheels. We tried to quantify the user feelings and impressions while using the different wheels. Study Design: Double blinded comparative randomized study. Methods: The patients were randomized into 2 groups. One used shock absorbing wheels, and the other group had a set of standard wheels with the same exact wheelchairs. The patients were taken to a daily trip by the caregivers and given questionnaires in the second and fourth days. On the morning of the third day the wheels were interchanged, creating a cross over between the groups. We collected general and medical information from the participants. The main outcome measures were the questionnaires filled by the patients and the caregivers aiming to quantify the user experience with the suspension equipped wheels. Results: Statistical significance was reached in 2 questions referred to the patients: “In general—During the ride I didn’t feel the bumps” and “I feel very confident when riding the chair” and in one question referred to the caregiver—“It was easy to push the chair in suboptimal ground.” Conclusions: We conclude that the shock absorbing system provided a better user experience in the immediate term than standard wheels. Further study is needed to assess the long-term implications.

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