Clavicle Hook Plate for Neer Type II Lateral Clavicle Fractures.

Abstract

To the Editor: We read the study by Renger et al entitled ‘‘The Clavicle Hook Plate for Neer Type II Lateral Clavicle Fractures’’ (J Orthop Trauma 2009;23:570–574) with great interest. However, there were a few questions we had in mind and would be very grateful if the authors could clarify these areas. There are two important points that we would like to draw your attention to in the ‘‘Methods’’ section regarding the radiologic outcome. First, the hook plate was removed after consolidation of the fracture. Consolidation was defined radiologically as ‘‘the disappearance of the fracture line and the appearance of a trabecular pattern in 3 of 4 cortices in 2 radiologic views.’’ Then the radiologic outcome was determined by assessing for the adequate reduction of the displaced clavicle by measuring the distance between the coracoid process and the clavicle. Both the assessment of the consolidation and adequate reduction of the clavicle are integral to the results of the study. We were wondering whether there were one or multiple people involved in performing these radiologic measurements and in that case, how was interobserver bias avoided? Being a retrospective study, how were the authors able to use the Constant-Murley scoring system to assess the functional outcome? Patients were included retrospectively between January 2003 and December 2006 so how was the scoring system applied during the follow-up period? There were five participating hospitals in this study. Did all the hospitals have a prearranged agreement to manage these injuries by similar methods? Otherwise, how was the uniformity of the sample maintained? Overall, it was a good study and we thoroughly enjoyed reading the article. Rahul Bhattacharyya, MBChB Kavita Sharma, MBChB Pavel Mukherjee, MBBS, MRCS Rotherham District General Hospital Rotherham, UK

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