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Purpose: To investigate the role of linezolid in the treatment of skeletal methicillin-resistant Staphylococcus aureus (MRSA) infections in a university clinic for trauma surgery with regard to treatment results, side effects, practicability, and costs. Patients and Methods: Data were recorded retrospectively in a single center over a 1-year period. Four patients with MRSA osteitis/infected pseudarthrosis of the upper extremity following prolonged fracture treatment were administered linezolid, after therapy with established antibiotics such as vancomycin had failed. In two patients with vertebral osteitis due to progressive spondylodiscitis, linezolid was used as the only effective antibiotic with oral availability, when intravenous application was technically impossible (central venous line complications/vena cava thrombosis). Adequate surgical treatment (debridement, stabilization, osteosynthesis) was performed in all patients. Results: Linezolid was administered for a mean of 2.2 months (1.5-3 months). Side effects of intravenous or oral linezolid treatment were not seen. One patient died after 6 weeks (heart failure). Mean follow-up time was 17.4 months (13-24 months). MRSA arthritis after 12 months was observed in one patient. A second critically ill patient was diagnosed with MRSA infection of a prosthetic hip 15 months later. Reinfection was excluded in four patients. High daily costs also of oral linezolid application compete with advantages of an early ambulatory treatment. Conclusion: Linezolid is a potent antibiotic that should be left to skeletal MRSA infection after stabilization and debridement if (1) vancomycin treatment has failed and (2) intravenous application of vancomycin is not possible. [ABSTRACT FROM AUTHOR]

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Background: Conservative treatment was long recommended for midclavicular fractures because of the excellent results that were reported in the 1960's and 70's. Recently, however, the rucksack bandage has received competition from surgical treatment. The spectrum of operations ranges from classic plate osteosynthesis to intramedullary techniques and angle-stable implants., Methods: We present and evaluate the current treatment options on the basis of a selective review of the literature., Results: Recent studies have confirmed some long-held concepts and refuted others. The risk of non-union after conservative treatment was previously reported as 1% to 2% but has turned out to be much higher in selected subgroups such as in patients with severe displacement, female patients, and patients of advanced age. Furthermore, new implants and techniques have made surgery safer and more likely to result in bony union., Conclusion: In any case of midclavicular fracture, the type of fracture should be precisely analyzed and an individual treatment strategy should be developed in view of the patient's particular situation. Current studies show with a high level of evidence (level 1) that patients with dislocated fractures benefit from surgery.

Intramedullary fixation is used increasingly to treat clavicular fractures. Anatomical variations in the clavicle of relevance to this procedure are analyzed. The length, diameters and curvature of the clavicle were measured in 196 specimens from the dissecting room. The calcium bone density was analyzed in 300 cross-sectional samples of 100 specimens. The thickness of cortical and medullary bone of 70 slices was analyzed from freshly plastinated clavicles with implants in place. The female clavicle was shorter, less curved, and had a lower concentration of calcium than the male clavicle. Measurement of cortical thickness showed a mean value of 1.05 +/- 0.23 mm at the most sternal measuring point, 2.05 +/- 0.29 mm at the midpoint of the clavicle, and 0.95 +/- 0.35 mm at the acromial end. The thinnest regions were the medial ventral cortex and the dorsal acromial cortex. These measurements explain clinical observations on nail perforation. The diameter of the medullary canal measured 6.7 +/- 2.6 mm at its narrowest part, so that reaming (i.e., predrilling the medullary canal) prior to 3.5 mm titanium nail insertion is not necessary. The main difficulties encountered when placing a nail are secondary to the S-curvature of the clavicle. In 80% of fractures, the break is located at the narrowest diameter of the medullary canal. Thus, the clavicle displays definite gender- and side-specific anatomical features in terms of length, diameter, curvature, and calcium concentration. These should be considered when performing intramedullary fixation.

This prospective study investigated medium-term outcomes for 51 children treated from 1997 to 2001 for displaced diaphyseal forearm fractures with elastic stable intramedullary nailing. Forty-three patients included achieved excellent/good functional results at an average follow-up of 38 months. Four patients required open fracture-manipulation at surgery. Complications included eight cases of soft-tissue irritation at nail-insertion site (three required shortening procedures), two temporary radial nerve branch injuries, four minimal rotational mobility deficits, one 10 degrees elbow extension deficit after splinting, and five small keloid scars. All patients were pain-free, without limitations in activities for daily life or sport/play activities by 12 months after hardware removal. Elastic stable intramedullary nailing is appropriate therapy for these injuries.