Arthroscopic lateral release and the lateral patellar compression syndrome.

An isolated arthroscopic lateral release can provide dramatic relief of anterior knee pain in a select group of patients. We believe this procedure is indicated for patients with lateral patellar compression syndrome without significant chondrosis who have not responded to nonoperative treatment. During the procedure, care must be taken to perform a complete release and to achieve hemostasis. The postoperative rehabilitation emphasizes control of swelling, patellar mobilization, and quadriceps strengthening. We strongly agree with Schonholtz et al who report that the "lateral retinacular release is not a minor procedure and should not be performed simply because it may help and it can't hurt."

Open reduction and internal fixation of two- and three-part displaced surgical neck fractures of the proximal humerus.

Twenty-two patients aged 20 to 82 years (average 56 years) were followed for 1.1 to 8.9 years (average 3.3 years) after open reduction and internal fixation of two- and three-part displaced surgical neck fractures of the proximal humerus. There were 14 two-part displaced surgical neck fractures, seven three-part displaced greater tuberosity and surgical neck fractures, and one three-part displaced lesser tuberosity and surgical neck fracture. Fixation was achieved with heavy nonabsorbable sutures or wire that incorporated the rotator cuff tendons, tuberosities, and shaft. In cases with significant surgical neck comminution, humeral Enders nails were incorporated in a tension-band construct to provide longitudinal stability. Eighteen (82%) of the 22 patients had good or excellent results. Three (14%) of the 22 had satisfactory results, and one (5%) had an unsatisfactory result. The use of a technique of limited internal fixation for these displaced fractures without the use of plates and screws achieved fracture stability and a high percentage of acceptable results.

Open reduction and internal fixation of two-part displaced fractures of the greater tuberosity of the proximal part of the humerus.

Twelve patients, ranging in age from thirty-four to seventy-two years (average, fifty-three years), were evaluated an average of five years (range, two to eight years) after open reduction and internal fixation of a two-part displaced fracture of the greater tuberosity of the proximal part of the humerus. The indication for operative reduction was one centimeter or more of displacement of the fracture as seen on the diagnostic radiographs. The anterosuperior deltoid-splitting approach, combined with rotation of the humerus, allowed adequate exposure of the retracted tuberosity. Internal fixation of the greater tuberosity with heavy, non-absorbable sutures and careful repair of the rotator cuff permitted early passive motion. All fractures healed without postoperative displacement. Six patients had an excellent result and six had a good result; active elevation averaged 170 degrees. There was one partial, transient palsy of the axillary nerve.