Hemiarthroplasty for proximal humerus fracture and consequences of a comminuted greater tubercle fragment.

BACKGROUND: A prerequisite for a satisfying functional result in the treatment of comminuted fractures of the proximal humerus with hemiarthroplasty is anatomical reduction, fixation and healing of the tuberculi around the prosthetic neck in order to restore normal function of the rotator cuff. PURPOSE: This was a retrospective study to examine the outcome after hemiarthroplasty using a prosthetic stem designed to optimise re-attachment and healing of the tuberculi (Aequalis; Tornier and Global Fx, DePuy). A special emphasis was on the effect on outcome a comminuted greater tubercle might have. MATERIALS AND METHODS: At follow-up, clinical results were evaluated using the Constant score and WOOS index. All patients had radiographs taken of the injured shoulder. Quality of tubercle healing and prosthetic height were estimated; acromiohumeral distance was registered as well as greater tubercle comminution and resorption. RESULTS: Thirty-four patients with 35 hemiarthroplasties were included. Mean age was 71 years (range 47-88) at the time of injury. At follow-up (mean 38 months, range 23-67), the mean Constant score was 44 points (range 18-87). The mean WOOS index was 58 (range 15-96). A comminuted tubercle was associated with tubercle resorption and superior migration of the arthroplasty. Also, there was a correlation for the functional Constant score, but for the WOOS index, there was none. CONCLUSION: Like several other studies, we generally saw a group of patients with limited pain but poor range of movement in the shoulder. Our hypothesis was that comminution of the greater tubercle would correlate with both rotator cuff arthropathic radiographical features and more detrimental functional scores than average. Thus, a subtype of fracture could be identified at the time of injury and perhaps be allocated to a different treatment than hemiarthroplasty. Due to a limited number of patients in this study, we are unable to make any strong statistically supported conclusions regarding this hypothesis. LEVEL OF EVIDENCE: Level 4 evidence.

[Evaluation of clinical tests in meniscal injuries]. / Evaluering af kliniske menisktest.

The values of clinical tests in general use were calculated in a group of patients who were not selected in advance as suffering from meniscal damage. Arthroscopic examination was employed to control the diagnosis. Employing Smillie's, Bragard's and McMurrays's tests, it was possible to exclude meniscal lesions with 75-95% probability and these could be demonstrated with 25-60% probability. Böhler's test was not correlated significantly with meniscal lesions and the true positive nosographic frequency of Apley's and Jones' tests were so low that their value was limited.

[Subtalar luxation]. / Subtalaer luksation.

Fourteen cases of subtalar dislocation were reviewed after an average period of observation of 13 years (5-27 years). Ten dislocations were medial and four were lateral. Two dislocations were open and, in seven of the cases, dislocation fractures were present. No cases of avascular necrosis of the talus were found. Three patients developed severe arthrosis and arthrodesis was performed in two of these. In cases of subtalar dislocation without fractures or dislocation fractures which did not involve the joints surrounding the talus, the prognoses were good. In cases of open dislocations or dislocations with intra-articular fractures, the prognoses were less favorable.