Journal of Musculoskeletal Trauma

Current concepts in distal clavicle fractures: an evidence-based update: Du-Han Kim, Hyuk-Joon Sohn, Byung-Chan Choi, Chul-Hyun Cho; Received June 24, 2026 Accepted July 20, 2026 Published online September 4, 2026; DOI: https://doi.org/10.12671/jmt.2026.00241 [Epub ahead of print]

Abstract PDF: Distal clavicle fractures (DCFs) account for 10%–30% of all clavicle fractures and remain difficult to manage because fracture stability depends heavily on coracoclavicular ligament integrity, plain radiographic classification has limited reliability, and distal fragment size varies substantially, complicating fixation planning. This review provides an evidence- based update on the anatomy, classification, imaging, and management of DCFs, incorporating recent literature, including population-specific cadaveric data and three-dimensional fracture mapping. The conoid and trapezoid ligaments have distinct osseous footprints that influence fracture stability in both the Neer/Craig and Cho classification systems; however, interobserver reliability remains only fair-to-moderate for both systems, particularly when conoid ligament integrity must be inferred. Three-dimensional computed tomography mapping has shown that posterior displacement and angulation are nearly universal but often underrecognized on standard radiographs, supporting selective computed tomography use when radiographs do not adequately characterize fracture morphology, comminution, or multiplanar displacement. Magnetic resonance imaging should be reserved for cases in which ligament integrity remains diagnostically ambiguous. Stable fractures generally have excellent outcomes with conservative treatment using a simple arm sling. For unstable fractures, operative and conservative treatment yield similar 1-year functional outcomes despite different union rates (96% vs. 63%), with conservative treatment carrying a nonunion risk of approximately one-third and operative treatment carrying a technique-dependent reoperation burden, ranging from planned implant removal in most hook plate cases to less than 10% with coracoclavicular stabilization constructs. When surgery is indicated, technique selection should be guided by fracture morphology and surgeon experience: anatomic locking plate fixation with or without coracoclavicular augmentation for Neer IIA/Cho IIA fractures, dedicated coracoclavicular stabilization for Neer IIB fractures (Cho IIB/IIC), and hook plate fixation as a salvage construct for Neer V/Cho IID fractures. Management should integrate classification, imaging findings, union risk, reoperation risk, expected recovery, and patient-specific factors through shared decision- making.

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Locked plating in older patients with distal femur fractures: strategies to avoid complications: Je-Hyun Yoo; Received June 2, 2026 Accepted June 29, 2026 Published online August 24, 2026; DOI: https://doi.org/10.12671/jmt.2026.00234 [Epub ahead of print]

Abstract PDF: Distal femur fractures in older patients with osteoporosis are difficult to treat because poor bone quality reduces screw purchase and fixation stability. Minimally invasive locked plating with an angularly stable locking compression plate is widely used to obtain secure fixation in osteoporotic distal femur fractures and offers improved biomechanical performance. However, complications such as implant failure and peri-implant fracture continue to occur. This narrative review summarizes current principles of minimally invasive lateral locked plating for osteoporotic distal femur fractures in older patients and discusses practical strategies to reduce fixation-related complications based on the available literature and the author’s clinical experience.

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Minimally invasive plate osteosynthesis of the clavicle and humerus: indications, surgical techniques, and clinical outcomes: Hoon-Sang Sohn, Yunjong Choi, Sang-Jin Shin; Received May 24, 2026 Accepted June 29, 2026 Published online August 21, 2026; DOI: https://doi.org/10.12671/jmt.2026.00220 [Epub ahead of print]

Abstract PDF: Minimally invasive plate osteosynthesis (MIPO) is an established strategy for lower-extremity fractures because it preserves periosteal vascularity, maintains fracture hematoma, and promotes secondary bone healing through relative stability. Its use has expanded to fractures around the shoulder girdle, including fractures of the clavicle, proximal humerus, humeral shaft, and distal humerus. However, adoption in the upper extremity has been more cautious because of complex regional anatomy, narrow soft-tissue corridors, and the proximity of major neurovascular structures. This review summarizes current evidence on the indications, surgical techniques, clinical outcomes, and complications of MIPO for clavicle and humerus fractures. For clavicle fractures, MIPO is most commonly indicated for displaced multifragmentary midshaft fractures and provides union rates and functional outcomes comparable to those of conventional open reduction and internal fixation, with potential advantages in soft-tissue preservation and cosmesis. In proximal humerus fractures, MIPO performed through a deltoid-splitting approach has yielded favorable outcomes in selected two- and three-part fractures, whereas four-part fractures have less predictable outcomes and higher complication rates. In humeral shaft fractures, anterior MIPO provides stable fixation without routine radial nerve exploration and has shown reliable union with fewer complications in selected fracture patterns. For extra-articular distal humerus fractures, minimally invasive anterior and posterior plating techniques, including the use of an inverted proximal humeral internal locking system plate, have shown favorable clinical and radiographic outcomes despite technical challenges related to limited distal fixation. Overall, MIPO can achieve high union rates and satisfactory functional outcomes in clavicular and humeral fractures when indications are appropriate, safe anatomical corridors are respected, and surgical technique is meticulous.

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Reconstruction of a 20-cm tibial bone defect after recurrent fracture-related infection using the induced membrane technique and rhBMP-2 augmentation with limited autogenous bone availability: a case report: Whee Sung Son; Received March 30, 2026 Accepted June 29, 2026 Published online August 21, 2026; DOI: https://doi.org/10.12671/jmt.2026.00143 [Epub ahead of print]

Abstract PDF: Fracture-related infection (FRI) poses the combined challenges of infection control and reconstruction of critical-sized bone defects. These challenges are amplified in recurrent cases with severely limited autogenous bone availability. We report a 61-year-old male patient with recurrent right tibial FRI after multiple operations and a 20-cm segmental defect. Suspected residual infectious foci were mapped by comparing preoperative fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) with post-debridement CT and were evaluated using site-specific pre- and post-debridement cultures. After a second targeted debridement, all post-debridement cultures were negative, and no clinical or laboratory evidence of active infection was observed during a 2-week antibiotic-free interval. The defect was subsequently reconstructed using the induced membrane technique with 30 cm³ of autogenous cancellous bone, 60 cm³ of demineralized bone matrix, and 9 mg of recombinant human bone morphogenetic protein-2 (rhBMP-2) delivered on a 20 cm³ hydroxyapatite carrier. Radiographic union was achieved, and no clinical evidence of infection recurrence was observed at 1 year. This case suggests the feasibility of combining PET/CT- and culture-guided anatomically targeted debridement with rhBMP-2-augmented induced membrane reconstruction when autogenous graft volume is severely limited. Level of evidence: V.

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Progressive forearm instability after anatomical union of a radial head fracture: a case report of a challenging Essex-Lopresti injury: SeongJu Choi; Received April 6, 2026 Accepted May 26, 2026 Published online July 20, 2026; DOI: https://doi.org/10.12671/jmt.2026.00157 [Epub ahead of print]

Abstract PDF: Essex-Lopresti injuries remain challenging because anatomical restoration of bony structures does not always re-establish functional forearm stability. We report the case of a 51-year-old male patient who sustained an elbow dislocation, comminuted radial head and neck fracture, and distal radioulnar joint (DRUJ) dissociation after falling from a bicycle. He underwent open reduction and internal fixation of the radial head, interosseous membrane augmentation using a suture-button construct, and temporary DRUJ pinning. Immediate postoperative radiographs showed apparent restoration of radial length, and radiographic union of the radial head was achieved. However, ulnar-sided wrist pain initially improved but progressively recurred by 6 months, with increasing ulnar-positive variance and DRUJ widening. Elbow motion was preserved, but forearm rotation was limited, and computed tomography demonstrated heterotopic ossification around the radial head. Ulnar shortening osteotomy and radial head arthrolysis were performed as a second procedure, after which mechanical instability developed, with irreducible anterior dislocation of the radial head. A third operation, consisting of annular ligament reconstruction using a palmaris longus autograft, restored proximal radioulnar joint stability, although substantial limitation of forearm rotation persisted. This case highlights that even radiographic union and multistructural initial management may fail to restore balanced forearm mechanics in Essex-Lopresti injury. Level of evidence: V.

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