Os acromiale: frequency and a review of 726 shoulder MRI.

Os acromiale consist in a lack of fusion between the different ossification spots of the acromial side of scapula from the age of 23-25 years. A relation between os acromiale and some shoulder pathology like impingement syndrome, cuff tear and subacromial bursitis has been described. The etiology is not already known. The aim of this study was to evaluate the frequency of os acromiale in our population, the link between os acromiale and sex, side and shoulder pathology. 1042 shoulder MRI were evaluated to find out os acromiale and the linked cuff pathology. In our population, the frequency of os acromiale was 3.44% without differences between sexes, with prevalence on the right shoulder. No differences in cuff and bursa pathology were present between affected and unaffected subjects. Os acromiale is an anomaly still underdiagnosed. It is important to be recognized because it allows to make an accurate pre-surgical plan. To make a correct diagnosis, axial MRI cut or TC is necessary.

Double-locking precontoured plating system for malunited fractures of the distal end of humerus.

BACKGROUND: Distal humeral malunions are uncommon injuries, often associated with limited elbow motion, pain, instability, weakness, and sometimes ulnar neuritis. The complex anatomy of the elbow joint makes this condition one of the most complex elbow injuries to treat. MATERIALS AND METHODS: Four patients were treated by the same surgeon between 2011 and 2013 using a double-locking precontoured plating system for malunited intra-articular or extra-articular fractures of the distal end of the humerus. RESULTS: At a mean 3 years of follow-up, a significant improvement in the elbow motion and functional outcome, evaluated with the Mayo Elbow Performance Index and the Disability of the Arm, Shoulder, and Hand, were observed. Articular reduction obtained after the surgery was maintained in all patients without evidence of avascular necrosis. No other complications (i.e., infection, nervous iatrogenic lesions) were reported. CONCLUSIONS: Corrective osteotomy using double-locking precontoured plating system preceded by preoperative planning using a CT scan allowed an improvement in the functional outcome and elbow motion, without complications.

Hemiarthroplasty versus reverse shoulder arthroplasty: comparative study of functional and radiological outcomes in the treatment of acute proximal humerus fracture.

PURPOSE: To compare functional and radiographic results of reverse prosthesis versus hemiarthroplasty after complex displaced proximal humeral fractures in elderly patients when adequate ORIF cannot be achieved and prosthetic shoulder replacement is required. METHODS: From 2008 to 2012, 67 patients were treated with hemiarthroplasty or reverse arthroplasty. We evaluated 53 cases with an average follow-up of 27.5 months (range 12-64). Twenty-eight patients with an average age of 71.4 years were treated with a hemiarthroplasty and 25 patients with an average age of 77.3 years with a reverse prosthesis. All patients were assessed before and after surgery by Constant-ASES-DASH score, strength in abduction, ER1, ER2, and X-rays. RESULTS: In hemiarthroplasty group, we observed a mean Constant score of 42.3 pt, ASES score 51.3 pt, and DASH score 46.1, with an average strength of 1.3 lb in abduction and of 3.7 lb in ER1 and 1.8 lb in ER2. In reverse arthroplasty group, we measured a mean Constant of 56.2 pt, ASES 69.3 pt, and DASH score 40.4, with an average strength of 4.3 lb in abduction and of 3.3 lb in ER1 and 3.2 lb in ER2. Radiographically, it is interesting to observe that greater tuberosity healing rate was 37 % in hemiarthroplasty group compared to 84 % in reverse arthroplasty group. About complications, the highest rate was recorded in the hemiarthroplasty group. CONCLUSION: Reverse shoulder arthroplasty indication is steadily increasing in acute displaced proximal humeral fracture. Pain and articular movement results appear better than those with hemiarthroplasty. Our data are similar to the international literature.

Transplant of the teres major in the treatment of irreparable injuries of the rotator cuff (long-term analysis of results).

Purpose of this study is to evaluate the effectiveness of muscle transfer of the teres major in the treatment of irreparable posterosuperior injuries of the rotator cuff. Long-term monitoring of the results obtained in 20 patients treated at our clinic using this method are reported, comparing the data obtained in evaluations of results with preoperative values. Clinical evaluations were obtained using the Constant Score System, while X-ray examination showed the presence of osteoarticular modifications, and MRI and electromyography the preserved morphology and function of transplant. The mean Constant Score increased from 31.6 points preoperatively to 66.1 points postoperatively at the time of follow-up. At follow-up, MRI allowed us to evaluate any fatty degeneration of the muscle fibers of transfer and the integrity of tendinous insertion on the humeral greater tuberosity. The obtained results allowed us to reveal the advantages and the disadvantages of teres major transplant in irreparable posterosuperior ruptures of the cuff.

Transplantation of teres major muscle for infraspinatus muscle in irreparable rotator cuff tears.

The authors suggest transfer of teres major muscle for a detached and atrophic infraspinatus muscle in irreparable rotator cuff tears. Original studies were done on cadavers. In the period between November 1993 and June 1994, we used this technique on 6 patients. Those patients were evaluated with the Constant-Murley test and improved from an average of 40 points (minimum 27 to maximum 54) before surgery to an average of 62 points (minimum 47 to maximum 78) after surgery. Active external rotation recovered 35 degrees in abduction and 24 degrees in adduction. The teres major transferred on great tuberosity is able to restore continuity of the cuff and to depress the head of the humerus. It is important to re-educate the transferred muscle because it initially contracts more in adduction and internal rotation than in external rotation. One patient was very satisfied and 5 patients were satisfied after surgical treatment.

Some new aspects of the functional anatomy of the shoulder.

The authors investigated the functional role of the shoulder muscles in various active movements using simultaneous polymyographic recordings. Ten muscles were investigated in both normal subjects and in patients with pathological conditions. Ten patients were also studied during the course of operations for nonrelated conditions by "tetanizing" stimulation of nerves to individual muscles to determine their action as single muscles.

Ischaemic isolated retraction of the abductor digiti minimi.

A case of hyperabduction of the little finger due to ischaemic retraction is presented. Operative release of the abductor digit minimi produced good result. The differential diagnosis is discussed.