Effectiveness of extracorporeal shockwave therapy in three major tendon diseases.

BACKGROUND: Extracorporeal shockwave therapy is a conservative treatment for several painful musculoskeletal disorders. The aim of the study was the assessment of the relief from pain by the shockwave therapy in a population of consecutive patients affected by specific pathologies. MATERIALS AND METHODS: A group of consecutive patients were studied and treated. They were affected by calcific tendonitis of the shoulder (129 patients), chronic Achilles tendinopathy (102 patients), and lateral epicondylitis of the elbow (80 subjects). Each patient had 3 applications with a monthly interval, and was followed up at 1, 6, and 12 months after treatment. Results were evaluated by the numeric rating scale (NRS) in all cases, the Constant Murley Score for the assessment of the shoulder function, the American Orthopaedic Foot and Ankle Society Score for subjects affected by chronic Achilles tendinopathy, and the Oxford Elbow Score for those affected by a lateral epicondylitis of the elbow. RESULTS: One year after treatment, the results were considered satisfactory with an almost complete resolution of symptoms. There were statistically significant results at the 12-month follow-ups regarding the mean NRS score (from 6.25 to 0.2), the Constant Murley Score (from 66.7 to 79.4), the Oxford Elbow Score (from 28 to 46), and the AOFAS (from 71 to 86). CONCLUSIONS: Extracorporeal shockwave therapy may be considered a safe, economic, and effective treatment for several chronic musculoskeletal disorders, allowing satisfactory pain relief and improvement of function ability. LEVEL OF EVIDENCE: Level IV.

Displaced fragility fractures of proximal humerus in elderly patients affected by severe comorbidities: percutaneous fixation and conservative treatment.

BACKGROUND AND AIMS: Proximal humerus is a common site of fracture in elderly patients, mainly related to bone fragility. Comorbidities are often present in these patients and may limit the surgical options. Not or minimal invasive treatments are commonly indicated however with variable results. The authors present their experience with conservative approach and percutaneous fixation by K-wires, focusing on their indications and main advantages on this population: mini-invasivity, acceptable reduction and recovery, and low costs. METHODS: A study group of 51 consecutive patients with a mean age of 75.5 and affected by severe comorbidities (mainly cardiac, circulatory, pneumologic, neurologic, metabolic, and nephrologic pathologies) were evaluated clinically (ASA score, VAS, muscular strength, Constant-Murley score), and with radiologic analysis: 28 patients were treated by percutaneous fixation, while 23 subjects were treated conservatively. RESULTS: Fractures treated by K-wires fixation healed after a mean interval of 8.2 weeks in all fractures but one, with improvements in mean Constant-Murley score (up to 80.6 points), in mean VAS (2.9), in muscular strength (4.1), and in range of motion. Fractures treated by brace healed in a mean time of 10.2 weeks. Mean Constant-Murley score improved to 76.4 points, VAS to 3.0, muscular strength to 3.8 points, and significant recovery of range of motion. CONCLUSIONS: Results of the study confirm that both percutaneous fixation and conservative treatment may represent suitable options for proximal humerus fragility fractures in elderly patients, not candidated to open surgery for severe associated comorbidities. LEVEL OF EVIDENCE: IV (case series study).

Long term results of percutaneous fixation of proximal humerus fractures.

BACKGROUND: Proximal humerus fracture in elderly osteoporotic patients usually leads to severe displaced and multifragmentary fractures. Associated comorbidities may limit surgical options and conservative treatment is commonly indicated, however, with variable results. In most cases, surgery is the treatment of choice in order to restore anatomical integrity, and allow early functional recovery. Several techniques were used over the years, each with specific indication. Percutaneous pinning after closed reduction, a mini-invasive technique and fixation by use of K-wires is not preferred commonly. We present our experience with this approach, focusing on its indications and advantages. PATIENTS AND METHODS: A study group of 41 consecutive patients with a mean age of 65.5 years were evaluated clinically (VAS, Constant-Murley score, range of motion), and with radiological analysis: 35 patients finally completed a minimum followup of 24 months. RESULTS: K-wires were removed after a mean interval of 4 weeks. Clinical and radiographic healing occurred in a mean time of 8.2 weeks in all fractures but one, with improvements in mean Constant-Murley score of 87.6 points, mean VAS of 2.3. In 33 patients, the reduction was considered satisfactory. In two cases, reduction was poor, but the patients however presented acceptable functional outcome. CONCLUSIONS: Percutaneous pinning may represent a suitable option of treatment for 2-or 3-part proximal humerus fractures in selected subjects.

Advances in the surgical treatment of fragility fractures of the upper femur.

Fragility fractures typically occur in elderly patients. They are related to osteoporosis, because of the weakening of the bone structure, and are the result of low-energy injuries and often involve the metaphyseal segments of bone. The fracture of the upper extremity of the femur are one of the most typical of the elderly patients. They may be intracapsular (femoral neck fractures) or extracapsular (intertrochanteric fractures). Each kind of fracture can be treated in several ways: the intracapsular fracture can be treated with screws, unipolar or bipolar hemiarthroplasty or even with total arthroplasty. The extracapsular fractures instead can be treated with sliding hip screw, intramedullary nail, femoral neck screws, helical blade or primary arthroplasty. What must be remembered is that osteoporotic bone has distinct morphologic characteristics that influence its biomechanical properties and therefore the choices and techniques for internal fixation. Therefore only a complete understanding of the biology of the osteoporotic bone will lead to a good quality of the treatment of the fragility fractures.

A case of bilateral extensor digitorum brevis manus.

We report a case of symptomatic dorsal mass in a 72-year-old man, with onset of pain during daily life efforts. On the other side, the dominant hand, a similar mass without any impairment was present. Before surgery, the mass on the left nondominant wrist was diagnosed by ultrasound as synovial ganglion: during excision, a muscular belly was found and sent to isthological evaluation, confirming the existence of an alive aberrant muscular tissue, named Extensor Digitorum Brevis Manus. Being reported in literature as occasionally bilateral, we decided to perform, 3 months later, an MRI in the contralateral asymptomatic wrist: it was possible to reveal the presence of a similar but asymptomatic mass.