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IntroductionThe purpose of this study was to determine factors that affect the early failure of femoral neck fracture healing after internal fixation with a dynamic locking plate implant.Patients and methodsRetrospective analysis of all cases of femoral neck fracture (FNF) primarily treated with dynamic locking plate implant from 04/2014 to 04/2017 with a minimum of 6 month follow-up. For the purpose of the study age, sex and time from admission to surgery were retrieved from the hospital medical database. Patient’s pre- and postoperative hip radiographs were reviewed by the authors. Radiographically detected fracture healing failure (non-union and screw cut-out) was recorded.ResultsFor the period of the study, there were 77 consecutive FNF (76 patients) treated with the dynamic locking plate implant. Eight (10%) patients were lost to follow-up, 13 (17%) patients died within 6 months after surgery. Healing failure was identified in 23 (41%) of remaining 56 cases. Three of four (75% failure rate) failures were observed in cases with fair-quality reduction and two of two (100% failure rate) failures were noticed in the case of none telescoping screw located within subchondral bone. Multiple logistic regression showed an increased risk of fracture failure in cases with at least one completely collapsed telescoping screw (OR = 73.2; 95% CI 9.4–568.5, p < 0.01), while telescoping screws’ location around centre of the femoral head reduces the risk of failure (OR = 14.7; 95% CI 1.6–135.1, p = 0.02).ConclusionIn our group of patients, fracture healing failure of the FNF treated with dynamic locking plate reached 41%. This high failure rate was associated with poor fracture reduction, not subchondrally and centrally placed telescoping screws and in the case of complete collapse on at least one of the telescoping screws.

IntroductionThe aim of this study was to determine factors that affect post-operative subsidence in split-depression lateral plateau tibial fracture (OTA/AO 41B3.1) which was treated with raft construct through a locking plate.Patients and methodsThe retrospective study evaluated all split-depression lateral plateau tibial fracture cases treated with raft construct through a locking plate between 01/2015 and 04/2020 with a minimum of 12-month follow-up. Data on the patients’ age, sex, time from injury to surgery, type of plate, and use of subchondral bone defect filler were retrieved from the hospital database. The measurements of total plateau area (TPA), depressed lateral plateau area (DPA), and maximal plateau depression (MPD) were performed on the patients’ pre-operative CT scans. The percentage of DPA to TPA (%DPA) was calculated. Post-operative radiographs were used for the evaluation of plateau subsidence. A subsidence greater than 2 mm was considered a failure.ResultsThere were 41 consecutive cases of split-depression lateral plateau tibial fracture in the reviewed period. Five cases were excluded, three of them were lost to follow up, 1 patient had no pre-operative CT scan and 1 had a history of cancer. A failure was identified in 11 (31%) cases. Patients in the failure group were older (61.0 vs 50.7 years, p = 0.01), and had a higher incidence of fractures extending into intercondylar eminence (100% vs 56%, p = 0.02). Multiple logistic regression identified DPA (OR = 3.6; 95%CI 1.4–9.5, p < 0.01) and age (OR = 1.2; 95% CI 1.0–1.4, p = 0.02) as predictive factors for plateau subsidence.DPA cut-off value for predicting subsidence greater than 2 mm was 5.8 cm2 [Area Under the ROC Curve 0.89 (95% CI 0.74–0.97), sensitivity 91%, specificity 80%, p < 0.01)].ConclusionAge and depressed lateral plateau area (DPA) in split-depression lateral plateau tibial fracture treated with raft construct through a locking plate are risk factors for post-operative subsidence greater than 2 mm.

Background Recent papers present pectoralis major muscle rupture as a rare injury with about 200 reported cases in the literature. In the last years, we were able to find many references to pectoralis major muscle rupture in the literature. Objectives To determine the real number and occurence of published cases. Methods A review of the recent literature published between January 2000 and December 2010 was performed. We used the PubMed and Google Scholar search and applied the keywords: pectoralis major muscle rupture. The search strategy was also complemented by looking at the reference lists of the papers retrieved. Results A review of the recent literature succeeded in identifying 283 published cases on pectoralis major muscle rupture since the year 2000. Previous reviews and our search identified about 163 cases prior to the year 2000 for a total, including our case, of 447 cases of pectoralis major rupture reported in the world literature since its initial description by Patissier in 1822. Conclusions Until recently, about 200 cases of the pectoralis major muscle rupture reported in the literature were underevaluated. This previously rare injury has thus become more common and reflects contemporary lifestyle and the more frequent athletic, strenuous, and weightlifting activities of the population. Awareness of the possibility of this injury is therefore important, because patients with pectoralis major rupture may be initially misdiagnosed.