Influence of glenosphere design and material on clinical outcomes of reverse total shoulder arthroplasty.

BACKGROUND: The aim of this multicentre retrospective study was to compare reverse total shoulder arthroplasty clinical outcomes with glenospheres of different diameters, designs and materials. METHODS: Between 2003 and 2008, 133 patients were divided into three groups: 60 (45%) with 36-mm standard CoCrMo (group A), 21 (16%) with 36-mm eccentric cobalt-chromium-molybdenum (CoCrMo) (group B) and 52 (39%) with 44-mm cross-linked ultra-high molecular weight polyethylene (X-UHMWPE) (group C) glenospheres. Mean (SD) follow-up was 38.7 (17.4) months. Clinical evaluation included Constant score and range of motion. Radiographic analysis included radiolucent lines, instability, loosening and assessment of scapular notching. RESULTS: Mean Constant score significantly increased for all groups (Wilcoxon test, p < 0.001). Group C allowed a higher and stable increase in range of motion. After 12 months and 24 months, groups C and B showed less pain than group A (Mann-Whitney U-test, p < 0.05). Group C had significantly lower scapular notching than group B (Mann-Whitney U-test, p = 0.001) and A (Mann-Whitney U-test, p = 0.009) at 12 months, 24 months and 36 months. Groups A and C presented 5 (8.3%) and 4 (7.6%) early complications, respectively. CONCLUSIONS: The present study reported good results for all groups, although groups C and A presented better clinical outcomes, significantly lower notching and instability. A 44-mm X-UHMWPE glenosphere allowed a faster and more stable functional recovery, despite poorest pre-operative conditions. Additional long-term studies are needed to evaluate survivorship.

Mid-term results of complex distal humeral fractures.

The aim of this study was to assess outcomes following open reduction and internal fixation in complex fractures of the distal humerus. Between 2000 and 2006, 34 patients were operated for complex fractures of the distal humerus. Bone fixation was obtained with a reverse Y-shaped reconstruction plate in 13 cases and with double plating in 21 cases. At final follow-up, all the patients were assessed with the Mayo Elbow Performance Score. Satisfactory results were observed in 71% of the cases despite a high rate of complications. Age over 65 years is correlated with increased risk for an inferior postoperative result. Complex distal humeral fractures are difficult to treat and are associated with a high incidence of complications. It is therefore mandatory to obtain good anatomical reduction and a stable fixation of lateral and medial columns of the distal humerus. The results observed in older patients suggest that an alternative treatment for these patients may be joint replacement.

The four-strand staggered suture for flexor tendon repair: in vitro biomechanical study.

PURPOSE: To assess in vitro biomechanical properties of a 4-strand flexor tendon suture compared to 3 established suture techniques. This technique, which is made of 2 alternating and staggered sutures, one external to the tendon and the other internal, must be sufficiently resistant to withstand loads applied by modern, early active mobilization protocols. METHODS: Forty flexor hallucis longus tendons were harvested from fresh cadavers, cut, and repaired using 4 different suture techniques (Strickland, Wolfe, modified Savage, and a new technique called 4-strand staggered). All repaired tendons were submitted to static loading trials to measure gap formation (2 mm) in relation to tensile force and breaking force of all 4 sutures. Twenty additional tendons were repaired with the new suture technique and submitted to dynamic trials under cyclic loading. RESULTS: The 4-strand staggered suture technique proved to be statistically superior to Strickland and modified Savage techniques following the static loading trials for gap formation and breaking force. This technique is statistically superior to the Wolfe cruciate suture for breaking force and superior but not statistically significant for gap formation. The dynamic loading trials have shown that the 4-strand staggered suture can tolerate in vitro loads similar to those exerted by modern, early active mobilization protocols. CONCLUSIONS: The suture technique created by the authors proved to hold superior biomechanical properties than the other techniques tested in this study and might be suitable for early active mobilization protocols.

Linked semi-constrained total elbow prosthesis in chronic arthritis: results of 18 cases.

During the second half of the 1900s, total elbow joint replacement began its ascent. Since then, many prosthetic models have been used. The main objective of elbow joint replacement in arthritic diseases is to decrease pain, increase joint stability and improve overall range of motion. In this study, 18 patients affected with elbow arthritis were treated with the Coonrad-Morrey and Discovery total elbow prostheses. All patients were assessed clinically before and after surgery using the Mayo Elbow Performance Score, the Disabilities of the Arm, Shoulder and Hand questionnaire and through radiograph analysis. Excellent and good results were observed in 88.9% of the cases at a mean follow-up of 5 years. Significant statistical differences in all parameters between preoperative and final follow-up values confirm the efficacy of these devices.

Tibial plateau fractures in elderly patients.

Tibial plateau fractures are complex injuries which, if not adequately treated, can lead to invalidating sequelae. They constitute on average about 1% of all fractures, and up to 8% in patients over 65 years, and can be caused by both high- and low-energy trauma. Unlike in younger subjects, treatment of tibial plateau fractures in the elderly is not univocal and depends on the patient's functional needs, bone quality and systemic comorbidities. In this retrospective study, 49 patients with a mean age of 72 years, who underwent surgical treatment of a tibial plateau fracture, were assessed by the Rasmussen's clinical and radiological grading systems. Clinical and radiographic outcomes were satisfactory in 75.5 and 59.1% of cases, respectively. Data were also analyzed, in terms of fracture type, age and gender, to detect any statistically significant correlation between these parameters and clinical and radiographic outcomes.

Complex fractures of the distal radius treated with angular stability plates.

Complex fractures of the distal radius are articular lesions and comminuted at the level of the epiphysis and metaphysis. Their treatment is difficult and in most cases surgical. Of all the different osteosynthesis methods available, internal fixation with plate and screws is the most commonly used. In particular, angular stability plates are superior in terms of rigidity and stability to conventional volar and dorsal plates. DVR plate has these mechanical characteristics, and its low profile has reduced frictions with surrounding soft tissues. For these reasons, this device implanted through a single volar approach, can stabilize the majority of volarly and dorsally displaced unstable distal radius fractures. In this study, 48 patients, affected by complex fractures of the distal radius treated with DVR volar plates, were assessed by the Mayo modified wrist score, the Italian version of the disability of the arm, shoulder and hand. The satisfactory results observed confirm the efficacy of this device.

Talar fractures: long-term results.

BACKGROUND: talar fractures are rare and potentially invalidating injuries. Traditional x-ray projections often do not provide comprehensive and exhaustive view of the talus; in order to determine the best therapeutic strategy and obtain early and precise prognostic data diagnostic examination usually includes oblique projections and computed tomography scans. In displaced fractures treatment is surgical, with percutaneous or open osteosynthesis. METHODS: 16 patients affected by talar fractures were treated and assessed with the Ankle Hindfoot Scale, the Ankle Osteoarthritis Scale and radiographic investigation. RESULTS: consolidation was obtained in all cases. None avascular bone necrosis was observed at the follow-up. Mean score divided into the two components was 69.3 on the first scale and 38.4% on the second scale. CONCLUSIONS: talar fractures are challenging injuries for orthopedic surgeon. The evolution of this type of fractures, above all in the most complex fractures of the body and of the neck, is often poor and characterized by severe complications. Early treatment is important for recovery.

Combined arthroscopic and radioscopic management of tibial plateau fractures: report of 18 clinical cases.

Tibial plateau fractures are complex lesions capable of causing severe consequences if not appropriately treated. They are often the result of a high-energy trauma and, not rarely, are associated with significant soft-tissue and intra-articular injuries. Different therapeutic options can be managed in the treatment of these lesions. Minimally invasive surgery offers several advantages compared to other surgical techniques and allows, with less additional soft tissue damages, good reduction and stable fixation of the fracture. In this study we assessed the results of the combined arthroscopic and radioscopic assisted reduction and internal fixation of tibial plateau fractures in 18 patients affected by Schatzker type I, II, III, IV fractures. According to Hohl's and Rasmussen's grading system, 16 out of 18 patients scored a satisfactory result. We experienced no complications due to arthroscopy.