Rown Parola

Purpose: To evaluate whether immediate weight bearing as tolerated (WBAT) following open reduction and internal fixation of clavicle fractures with a dual mini-fragmentation plate construct increases complications, implant failure, or worsens functional and patient-reported outcomes compared to a restricted weight-bearing protocol. Methods: Adult patients (≥ 18 years) who underwent open reduction and internal fixation of a clavicle fracture were retrospectively identified and stratified into restricted weight-bearing or weight bearing as tolerated (WBAT) cohorts. Cohorts were matched for demographic and injury characteristics. All WBAT fractures were treated with dual orthogonal mini-fragmentation plate fixation, whereas restricted weight-bearing fractures were treated with either single- or dual-plate fixation. Outcomes included complications (infection, wound dehiscence, hardware prominence, implant failure, and loss of reduction) and PROMIS Physical Function and Pain Interference scores. Results: Among 378 initial patients, 93 were included after propensity score matching: 62 in the restricted weight-bearing group and 31 in the WBAT group. Complication rates were similarly infrequent between groups (all p ≥ 0.326), with no fixation failures or deep surgical site infections occurring in the WBAT group. Conclusions: Early weight bearing as tolerated may be safe following dual mini-fragmentation plate fixation of clavicle fractures, with comparable complication rates, union rates, and patient-reported outcomes to restricted weight-bearing protocols. These findings support the use of early mobilization in patients with rigid internal fixation constructs and may facilitate improved functional recovery and earlier return to activity.

» The propensity score is a patient's modeled probability of receiving a treatment given measured baseline characteristics (covariates). Matching patients with similar scores balances those covariates between groups, approximating the comparability achieved by randomization. » Target trial emulation specifies the protocol of the ideal randomized trial and then reproduces it in observational data, enforcing an explicit eligibility window, time zero (the single point at which eligibility, treatment assignment, and the start of follow-up coincide), and analysis plan. » Regression adjusts for confounders within the outcome model, whereas propensity score matching balances those confounders before outcomes are examined. Propensity matching is preferred for rare outcomes or many confounders, where regression tends to overfit. » Neither propensity matching nor target trial emulation addresses unmeasured confounding, and both lose validity in small single-center cohorts with limited overlap (few treated and untreated patients who resemble one another closely enough to be fairly compared); a randomized trial remains the reference standard when feasible. » When appraising studies using propensity matching or target trial emulation, look for 3 key features: (1) Postmatching covariate balance: Are the treatment groups well balanced after matching? (standardized mean difference <0.10). (2) Positivity: Is there enough overlap in patient characteristics that treated and untreated patients can be fairly compared? (3) Unambiguous “time zero”: Did follow-up begin at the same well-defined starting point for all patients?

Purpose: To compare reoperation rates and radiographic outcomes between parasymphyseal fracture location and those in extra-symphyseal zones for lateral compression (LC) pelvic ring injuries. Methods: This retrospective study included patients with acute, operatively treated LC injuries. Anterior ring fractures were classified based on a modified Nakatani classification as parasymphyseal (zone Ia), extra-symphyseal (zone Ib), zones II or III. Patient, fracture and implant characteristics were collected. The primary outcome was unplanned reoperation; secondary was radiographic loss of reduction. Comparisons were made across zones, with a sub-analysis restricted to LC1 injuries. Multivariable logistic regression was performed. Results: Among 275 LC injuries (mean age 59.8 ± 21.3 years; 56% [n = 155] female; reoperation rates were 6.5% (n = 18) overall and did not differ significantly across zones (Ia 12% [7/60], Ib 5.7% [3/53], II 6.8% [7/103], III 1.7% [1/59]; p = 0.2). Radiographic deformity differed significantly across zones (Ia 27% [16/60], Ib 23% [12/53], II 24% [25/103], III 3.4% [2/59]; p = 0.004), driven by the markedly lower rate in zone III. Multivariable regression confirmed deformity was associated with the low rate in zone III, while older age (OR 1.02 per year, 95% CI 1.00–1.04) and ramus comminution (OR 2.11, 95% CI 1.06–4.20) were independently associated with deformity. Reoperation did not differ by zone. When restricted to 183 LC1 injuries (mean age 64.1 ± 19.5 years; 61% [n = 112] female), findings were similar. Conclusion: Parasymphyseal fractures represent a challenging LC cohort. Loss of reduction is common but driven primarily by comminution and patient age rather than fracture location alone.