Grammont versus lateralizing reverse shoulder arthroplasty for proximal humerus fracture: functional and radiographic outcomes.

PURPOSE: The aim of this study is to retrospectively compare clinical and radiographic outcomes of patients treated with non-lateralizing reverse shoulder arthroplasty (RSA) and with humeral lateralizing RSA after proximal humerus fracture (PHF). METHODS: In total, 32 patients (8 men and 24 women), with a mean age of 77.4 (67-92), have been reevaluated (follow-up of 14.3 months) and divided into Grammont group (G-group-16 patients, 2 men and 14 women, mean age 82.3) and lateralizing group (L-group-16 patients, 4 men and 12 women, mean age 72.5). The dominant side was affected in 21 patients. Pain, Constant-Murley score (CMS), range of motion accurately measured with inertial sensors (SHoWlder, NCSLab®) and complications. Anatomic tuberosity healing, signs of loosening or mobilization of the implants and scapular notching (according to Sirveaux classification) have been measured on standard X-ray series (antero-posterior view in neutral, external and internal rotation; axillary view; outlet view). RESULTS: Similar CMS was recorded between the two groups (G-group: 61/100; L-group: 64/100). G-group had higher forward flexion (128° vs. 112°) and abduction (126° vs. 114°), L-group had higher external rotation in abduction (35° vs. 41°); similar internal rotation (sacrum) and rotation with elbow in adduction were measured (12° vs. 19°). No statistically significant differences emerged. Anatomic healing of the tuberosity was higher in G-group (87.5% vs. 50%); low-grade scapular notching was higher in L-group (18.25% grade 1-2 vs. 0). Anatomic healed tuberosity guaranteed highly statistically significant improved functional outcomes. No revisions of the implant were performed. CONCLUSIONS: RSA can be considered a valid solution for the treatment of PHF in elderly low-demanding population. Cuff conditions should be investigated before surgery for the indication of the adequate model.

[The short-stay observation unit: an experience of the Pediatric Department in Modena]. / Osservazione breve intensiva (OBI) in pediatria: l'esperienza del Policlinico di Modena.

The use of a short-stay observation unit (OBI) in a pediatric department has reduced the number of admissions. Significant cost savings and a better care for children and their families have been also achieved. During the year 2003 in our department 1759 children received OBI. 226 (12.8%) were then admitted. 1553 (87.2%) were discharged after a nine-hour mean stay. Descriptive statistics are used to outline the sample of patients and used treatments.

[Osteonecrosis of the femoral head in HIV-positive patients]. / Osteonecrosi della testa femorale in pazienti HIV-infetti.

Since the introduction of more effective antiretroviral therapy in HIV treatment, an increase in survival and in the quality of patients' life has been observed, due to the dramatic reduction in commonly occurring opportunistic diseases. The appearance of new clinical cases has, however, been observed, previously unrecorded probably due to the quicker negative evolution of AIDS. Pathologies such as lypodistrophy, cardiomyopathy, immune disease, are extremely widespread and partly linked to the natural history of HIV infections, and partly to the side effects of the treatments. Among such diseases, femoral head necrosis seems to occur fairly frequently and is characterised by a quick evolution. The emergence of coxalgia in HIV patients requires an early diagnosis through NMR or bone scan. Given the usual evolution of this pathology and the problems related to antiviral treatment, conservative treatment seems to have little possibility of success. A surgical replacement becomes essential in cases of invalidating necrosis, but there are still unresolved questions as regards risks of infection, bone integration, as well as local and systemic reactions to the prosthetic debris.

[Isolated atrophy of the infraspinatus muscle in baseball players]. / Atrofia isolata del muscolo sottospinoso nel giocatore di baseball.

Atrophy of infraspinatus muscle caused by suprascapular nerve entrapment is a typical disease of overhead sports such as volleyball, baseball and javelin. The chronic distress of suprascapular nerve infraspinatus branch may derive from nerve kinking and friction caused by an entrapment at the spino-glenoid notch, often repeated during external-rotation and abduction of shoulder. From 1999 to 2000 4 athletes, out of 143 professional baseball players, were found suffering from this disease. The diagnosis was confirmed by MNR and EMG, while a isokinetic test quantified a loss of strength in external-rotation and allowed a standard parameter for the treatment result evaluation. The 4 athletes were submitted to a non-invasive rehabilitation protocol, thanks to electrostimulation and isokinetic exercises, aiming at strengthening the extrarotator muscles and restoring a suited musclar balance. A subjective improvement was verified and confirmed by isokinetic test in all the players; moreover no surgery was needed.

[Rotator cuff rupture. Diagnostic imaging]. / Rottura della cuffia dei rotatori. Diagnostica per immagini.

Conventional radiography, ultrasound, Magnetic Resonance (MR), Arthrography Computed Tomography (Arthro-CT) and Arthrography Magnetic Resonance (Arthro-MR) are available for diagnosis of rotator cuff tears. Our purpose is to assess the specificity and sensitivity of these examinations and if they could give to the surgeon all the informations to select the more accurate treatment. We have evaluated retrospectively the images of 68 patients, 43 male and 25 female (average age 51 years), which then have been surgically treated for rotator cuff pathology. On the basis of our findings, we think that conventional radiography and ultrasound are excellent in a first evaluation. MR images, particularly in the coronal and sagittal oblique planes, are able to demonstrate partial or complete rotator cuff tears. The use of intra-articular contrast medium (arthro-CT, arthro-MR) should be reserved for partial lesions on specific cases.

Traumatic dislocation of the knee. A review of the literature and our experience.

It is the purpose of this study to analyze the data found in the literature and to compare our experience with that of other traumatology centers. A series of patients observed between 1985 and 1996 were reviewed. Nine out of 12 patients with sequelae related to dislocation of the knee were re-evaluated. Based on an analysis of the results, obtained by using the International Knee Documentation Committee (IKDC) form, it was concluded that the patients treated surgically are better overall. It is possible only rarely to obtain satisfactory recovery in work and/or sports activity, as the lesion is severe and even when treated it leaves functional and/or structural sequelae of varying importance.

Post-traumatic reflex sympathetic dystrophy in the ankle and foot: a study of 32 cases.

The etiopathogenesis of reflex sympathetic dystrophy is still undefined, and diagnosis and treatment are difficult. It is the purpose of this study to propose precise diagnostic and therapeutic criteria for post-traumatic reflex sympathetic dystrophy of the ankle and foot. Diagnosis is pre-eminently clinical. Clinical progression of the disease occurs in three stages: acute, dystrophic, chronic. Radiographic examination cannot be used to classify the stage of the syndrome. Bone scan with Tc 99M methylendiphosphonate aids diagnosis, and helps establish the prognosis of the disease. Clinical symptoms and instrumental tests (x-ray, bone scan, CT scan, MRI) are discussed in relation to differential diagnosis with other pathologies of the ankle and foot. Furthermore, the effective use of drugs, physiokinesitherapy, and hyperbaric oxygen therapy is discussed. The authors present a study of 32 patients, paying close attention to early clinical signs of the disease. X-ray examination and bone scan were routinely carried out in established diagnostic protocols.

The Wagner prosthesis for femoral reconstruction by transfemoral approach.

The authors report their experience at the Orthopaedic Clinic of the University of Parma regarding 20 cases of revision surgery by transfemoral approach using the Wagner long-stem cementless prosthesis for the treatment of prosthetic failure. The authors observed that in 19 cases out of 20 after at least 2 years there was stability of the implant and progressive skeletal reconstruction of the femoral metadiaphysis.

The trans-femoral approach in prosthesis replacements: results after two years.

The Authors relate their experience in 14 cases of prosthesis revision using a long stem implant by H. Wagner, performed in 12 cases with transfemoral approach. Notwithstanding the aggressive procedure, that consists of splitting the proximal extremity of the femur for a length of 16 cm to 25 cm, to perform the complete removal of the first implant and of all the cement, after a 2 year check-up, the Authors observed: the complete mechanical stability of the new implant, the rapid process of ossification replacing the surgical fractures and bone loss.