Long-stemmed Hemiarthroplasty with Cerclage Wiring for the Treatment of Split-Head Fractures of the Proximal Humerus with Metaphyseal Extension: A Report of 2 Cases.

Introduction: Complex fractures of the proximal humerus with splitting-head component and metaphyseal propagation are very rare injuries that are difficult to treat. Preservation of the humeral head is always considered except in cases with severe comminution and compromised vascularity where shoulder hemiarthroplasty is an alternative option. Case Report: We present two male patients, 57- and 62-years-old who sustained such a complex proximal humeral fracture after a high-energy injury. They both managed with long-stemmed shoulder hemiarthroplasty and cerclage wiring of the metaphyseal area. They both demonstrated good clinical and radiological outcome at 32- and 24-months postoperatively. Conclusion: We report the functional and radiological outcomes of two cases of a rare proximal humeral fracture's pattern - combination of splitting-head and metaphyseal comminution - that were managed with long-stemmed hemiarthroplasty and cerclage wire and demonstrated good midterm clinical outcome.

Short-term clinical and radiological results of two different design metaphyseal fitting femoral stems in total hip arthroplasty: a prospective, randomized trial.

BACKGROUND: There is great design variability on short femoral stems available on the market. This study aims to evaluate the short-term clinical and radiological results of two different design short femoral stems, both classified as shortened tapered stems. METHODS: From March 2016 to March 2018, a prospective, randomized, parallel-group design study was conducted to compare functional and radiological outcomes of 45 patients underwent THA using the Tri-Lock Bone Preservation Stem and 45 patients underwent THA with the Minima S stem at a minimum 2 years of follow-up. Patients were assessed clinically and radiographically prior to surgery as well as at 3, 6, 12, and 24 months postoperatively. Primary outcomes were the change in health-related quality of life assessed with Western Ontario and McMaster Universities Osteoarthritis Index and 36-Item Short Form Health Survey and also the incidence of all hip-related complications. Secondary aims included hip function evaluated with the Harris hip score, rates of patient satisfaction, and the outcomes of a detailed radiological analysis. RESULTS: There were no significant differences between the 2 study groups in terms of patient-reported outcomes measurements, satisfaction scores, and complication rates at any of the measurement times. In both groups, stable fixation and radiographic osseointegration were achieved. However, analysis of the calcar region showed that 57.8% and 28.9% of patients had grade 1 or 2 stress shielding, in Tri-Lock and Minima S implantation group, respectively (p=0.015). Regarding coronal alignment, stems were placed in slight varus, valgus, and neutral position in 51.1%, 13.3%, and 35.6% of patients, respectively, in Tri-Lock BPS group. The Minima S stem was implanted at slight varus and valgus in 60% and 40% of patients, respectively, and neither stem in the exact neutral position. CONCLUSIONS: Both different design short femoral stems demonstrated excellent clinical performance at short-term follow up. Nevertheless, concerns were raised regarding the incidence of stress shielding phenomenon and mild discrepancies in coronal stem alignment during implantation. The clinical impact of these observations should be further evaluated through larger cohorts and longer follow-up. TRIAL REGISTRATION: ISRCTN registry, ISRCTN10096716 . Registered on May 8, 2018-Retrospectively registered.