Arthroscopic bankart repair for recurrent anterior dislocation of the shoulder. Two year follow-up

The higher failure rates reported with arthroscopic Bankart repair of recurrent anterior shoulder dislocation compared with open stabilization remains a concern. The purpose of this study was to evaluate the outcome of arthroscopic Bankart repairs with the use of suture anchors. A prospective study of twenty five patients with recurrent anterior traumatic dislocation was identified clinically and with CT arthrography or MRI to confirm a Bankart lesion. The patients underwent arthroscopic stabilization with the use of three suture anchors and non absorbable sutures. Twenty two patients were males and three were females. The average age was 24.4 years. Preoperatively and at the time of follow-up the patients were assessed with the modified shoulder rating scale of Rowe and Zarins. The recurrence rate and range of motion were evaluated. Follow-up X-rays were evaluated as well. The patients were followed up for a mean of twenty four months. Twenty three patients had no additional dislocations or subluxations and had a Rowe score of at least 80 points. The recurrence rate was 8% [2 patients]; one actual dislocation and one subluxation with a positive apprehension. The mean loss of external rotation was 5 degrees. Arthroscopic Bankart repair offers very good results compared to open surgery. The recurrence rates are comparable to open surgery. There is early rehabilitation and return of level of activity and less stiffness compared to open surgery

Closed reduction and percutaneous pinning in three-part fractures of the proximal humerus

Three and four- part fractures of the proximal humerus occurring in the elderly population usually result from low energy trauma in osteoporotic patients. Closed reduction and percutaneous fixation of three- part fractures may offer a stable fixation to allow early rehabilitation. An attempt is made to study the results of this minimally invasive procedure. Thirty patients with three- part fractures of the proximal humerus were treated with closed reduction and percutaneous pinning of the shoulder. All patients were above 50 years of age. They were seventeen women and thirteen men. Patients were followed for a minimum of six months after surgery. Physiotherapy was initiated on the second day after surgery. The results were evaluated radiographically for union and clinically for pain and range of motion. The results were evaluated using the Constant score and the complications were minimal. The average Constant score was 80 at six months postoperatively. The procedure is minimally invasive in this old age group and offers an alternative to the more invasive open procedures. This study demonstrates that this procedure provides very good results with very little complications

Fractures of the femoral neck: results of cannulated screw fixation in patients above 50 years old

The results of stabilization of an intracapsular fracture of the femoral neck with cannulated screws placed in 40 patients between 2002 and 2003 were reviewed. Fourteen patients [35%] had a non-displaced fracture [Garden Stage I or II] and twenty-six [65%] had a displaced fracture [Garden Stage HI or IV]. The mean age of the patients was sixty-two years [range, fifty-four to seventy-five years]. The minimum duration of follow-up was two years [range twenty-four to thirty-six months]. No patient died, had a wound infection or D VT during the stay in the hospital. The hospital stay averaged 3 days [range two to five]. Two patients died within six months after treatment; one of them aged seventy-five years and the other sixty-eight and both were excluded from the study. There was a loss of position or a non-union of the fracture in five patients [12.5%] and healing of the fracture in 35 patients [87.5%]. Nine patients [22.5%] had roentgeno-graphic evidence of osteonecrosis within the first twenty-four months after treatment. Seven of these patients have had a displaced fracture, one had a non-displaced fracture and one was on top of non-union. Osteonecrosis developed in one of the nine patients [11%] who had a Garden Stage-H fracture, in three of the fifteen patients [20%] who had had a Garden Stage-Ill fracture, and in five of the eleven patients [45%] who had had a Garden Stage-IV fracture. The twenty-sevenpatients [67.5%] in whom the fracture healed without complications were found to be functioning well more than eighteen months after the fracture treatment

Surgical management of low to moderate grade isthmic spondylolisthesis

In this study, 50 patients with low to moderate grade lytic spondylolisthesis underwent a single staged surgical procedure. The average age at surgery was 43 years. Both plain X-rays and an MRI were done for all patients. All patients had a wide decompression, pedicle screw instrumentation and posterolateral fusion. The patients were followed up for an average of 2.5 years. Forty patients had a favorable outcome. The fusion rate was 92%. There was no permanent deterioration in the neurological state postoperatively in any patient. The study demonstrated that an instrumented posterolateral arthrodesis in combination with a wide laminectomy and nerve root decompression results in a high rate of fusion and satisfactory clinical success

Hemiprosthetic replacement in four-part fractures of the proximal humerus

Fifteen patients with four-part fractures of the proximal humerus were treated by hemiarthroplasty of the shoulder. They were followed up for a minimum of 12 months. The shoulder was protected for four weeks before the initiation of physiotherapy. The results were evaluated clinically for pain and range of motion and radiographically for the union of the greater tuberosity. The average constant score was 60 points at 12 months postoperatively and the complications were acceptable. The study demonstrated that this procedure results in a satisfactory clinical success