Functional outcomes for surgically treated 3- and 4-part proximal humerus fractures.

Surgical treatment of 3- and 4-part proximal humeral fractures remains challenging. This study retrospectively evaluated functional outcomes of locked plate fixation vs hemi-arthroplasty in 57 patients with 3- and 4-part proximal humerus fractures from 2003 to 2005 with a mean follow-up time of 35 months (range, 15.7-52.7 months). Mean patient age was 56.9 years (range, 29-81.7 years) for the open reduction and internal fixation group (n=42) and 66.4 years (range, 38.1-90 years) for hemiarthroplasty group (n=15). All 57 patients completed the American Shoulder and Elbow Surgeons score, the Simple Shoulder Test, the Euroqol EQ-5D, [corrected] and the visual analog pain scale. Range of motion, the Constant Score, and the UCLA Shoulder score were used to evaluate a subset of 33 patients. Forty-one patients in the open reduction and internal fixation group achieved union, and 1 had symptomatic avascular necrosis requiring subsequent hemiarthroplasty. Two patients had implant removal for impingement symptoms. In the hemiarthroplasty group, there was 1 revision for a loose prosthesis. The American Shoulder and Elbow Surgeons score (P=.023), Simple Shoulder Test (P=.012), patient satisfaction (P=.034), Constant Score (P=.008), Kelsh Adjusted Constant Score (P=.015), UCLA Shoulder score (P=.01), and range of motion (forward flexion, P=.002; abduction, P=.001) were significantly better in the open reduction and internal fixation group than the hemiarthroplasty group. No significant differences between the groups existed in terms of SF-12 (physical, P=.118; mental, P=.134), Euroqol EQ-5D [corrected] (P=.169), or visual analog pain scale scores (P=.135), but all trended toward better with open reduction and internal fixation.

Unicompartmental and total knee arthroplasty in the over 70 population.

This retrospective study compares the short-term outcomes of small-incision unicompartmental knee arthroplasty (41 patients) with standard total knee arthroplasty (TKA) (50 patients) in 91 consecutive patients older than 70 years. Knee Society Scores and range of motion (ROM) were assessed preoperatively, at 6 weeks and 6 months, and through a minimum of 2 years. Postoperative comparisons included blood loss, transfusions, narcotic consumption, length of hospital stay, and complications. While Knee Scores and ROM were similar preoperatively, both were better in the unicompartmental group at each postoperative time interval. Patients with unicompartmental replacements had a much quicker return of function and discontinuation of pain medication. Blood loss was significantly more for the TKA group, as was the need for blood transfusion. None of the unicompartmental patients required transfusion. Narcotic use and length of hospital stay were also significantly less for the unicompartmental group. The overall rate of postoperative medical and surgical complications was similar for the 2 groups, with 1 major complication in each. Overall, the physiologic impact of unicompartmental knee arthroplasty was much less than TKA in this older patient population and resulted in a faster recovery.

Treatment of large segmental bone defects with reamer-irrigator-aspirator bone graft: technique and case series.

Treatment of large segmental defects using conventional autogenous iliac crest bone graft can be limited by volume of cancellous bone and donor site morbidity. The reamer-irrigator-aspirator (RIA) technique allows access to a large volume of cancellous bone graft containing growth factors with potency equal to or greater than autograft material from the iliac crest. The purpose of this study was to evaluate the effectiveness of RIA-harvested autogenous bone graft for treating large segmental defects of long bones.