ABSTRACT
BACKGROUND: Surgical treatments have been selected to treat advanced osteochondritis dissecans (OCD) of the humeral capitellum. PURPOSE: To evaluate the clinical results of surgical treatments for advanced capitellar OCD lesion and to clarify problems of poor clinical results. METHODS: Cases were reviewed for 27 patients with advanced OCD lesions treated operatively. All patients were male baseball players, with a mean of 13.3 years at the time of surgery. Drilling only was performed for 3 patients, fragment fixation for 13 patients, and removal of the detached fragment with drilling for four patients. Since 2004, reconstruction of the articular surface with use of osteochondral autograft from the rib has been performed for 7 patients with osteochondral defect. Mean follow-up was 37.4 months. Follow-up assessment included modified elbow rating system, evaluation of radiographs, and return to sports. RESULTS: Mean subjective score improved significantly from 70 to 96 postoperatively. Mean objective score improved significantly 71 to 81 postoperatively. A postoperative return to baseball was achieved by 25 patients. On the final radiographs, 4 patients showed flattening of >70% of the capitellum or degenerative changes, including insufficient remodeling of the lateral margin of the capitellum. Although patients could return to baseball, postoperative total arc of the elbow was decreased compared with the preoperative total arc. CONCLUSION: Surgical treatments were useful to restore advanced OCD lesions. Our results suggest that reconstruction of the lateral margin of the capitellum is important for achieving good clinical results. LEVEL OF EVIDENCE: Level 4.
Subject(s)
Elbow Joint/surgery , Humerus/surgery , Orthopedic Procedures/methods , Osteochondritis Dissecans/surgery , Range of Motion, Articular/physiology , Adolescent , Cartilage, Articular/pathology , Cartilage, Articular/surgery , Child , Cohort Studies , Elbow Joint/diagnostic imaging , Elbow Joint/pathology , Follow-Up Studies , Humans , Humerus/pathology , Magnetic Resonance Imaging , Male , Osteochondritis Dissecans/diagnostic imaging , Osteochondritis Dissecans/pathology , Pain Measurement , Patient Satisfaction , Probability , Recovery of Function , Retrospective Studies , Risk Assessment , Severity of Illness Index , Statistics, Nonparametric , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
BACKGROUND: Fractures of the proximal humerus are common and the repair of displaced fractures generally requires an operative approach. In elderly patients, osteoporosis makes internal fixation problematic and frequently contributes to failed fixation and poor clinical results. We have developed a new intramedullary nail (pin lock nail) for the repair of surgical neck fractures of the proximal humerus in patients with osteoporotic bones. A retrospective review is presented of the cases of 19 elderly patients with two-part or three-part fractures of the proximal humerus treated using the pin lock nail. METHODS: We treated 19 elderly patients with a mean age of 70.5 years. There were 13 two-part surgical neck fractures, 3 two-part surgical neck fractures with non-displaced greater tuberosity fracture, and 3 three-part surgical neck fractures with greater tuberosity fracture. All fractures were treated using the pin lock nail. Clinical results were evaluated using the Japanese Orthopaedic Association score at the last follow-up examination. On radiographic evaluation, duration to bone union of the fracture, backing out of the pin and screw, penetration of the proximal pin, and varus angulations of the humeral neck were examined. RESULTS: Mean duration of follow-up was 14 months (range 6-54 months). All fractures had united at an average of 3.3 months after surgery. No backing out of the pin and screw or penetration of the proximal locking pin was seen at the time of last follow-up. Thirteen of the 16 patients had no or minimal varus angulations of the humeral neck (< or =10 degrees). The mean overall JOA score was 84.3 points (range 65.5-100). CONCLUSIONS: Our data show that using the pin lock nail for the treatment of two-part and three-part humeral fractures is a reliable procedure, providing good results with careful postoperative management.
Subject(s)
Bone Nails , Fracture Fixation, Intramedullary/instrumentation , Shoulder Fractures/surgery , Aged , Aged, 80 and over , Cohort Studies , Equipment Design , Female , Fracture Fixation, Intramedullary/methods , Humans , Male , Middle Aged , Radiography , Range of Motion, Articular , Recovery of Function , Retrospective Studies , Shoulder Fractures/diagnostic imaging , Shoulder Fractures/physiopathology , Treatment OutcomeABSTRACT
The purpose of this study was to investigate glenohumeral translation in-vivo during active shoulder abduction in the scapular plane. Three-dimensional (3D) models of 9 shoulders were created from CT scans. Fluoroscopic views aligned to the plane of the scapula were recorded during active arm abduction with neutral rotation. 3D motions were determined using model-based 3D-to-two-dimensional (2D) registration. Humeral translation was referenced to the glenoid center in the superior/inferior direction. The humerus moved an average of 1.7 mm superior with arm abduction, from an inferior location to the glenoid center. The humeral head was centered within 1 mm from the glenoid center above 80 degrees abduction. Variability in glenohumeral translation between shoulders decreased significantly from initial to final arm abduction. Our findings agree with some authors' observations of inferior-to-central translation of the humerus and behavior as a congruent ball and socket. We believe this information will help improve the understanding of shoulder function.
