Characterization of the dysplastic Walch type C glenoid.

Aims: The Walch Type C dysplastic glenoid is characterized by excessive retroversion. This anatomical study describes its morphology. Patients and Methods: A total of 29 shoulders with a dysplastic glenoid were analyzed. CT was used to measure retroversion, inclination, height, width, radius-of-curvature, surface area, depth, subluxation of the humeral head and the Goutallier classification of fatty infiltration. The severity of dysplasia and deficiency of the posterior rim of the glenoid were recorded. Results: A type C glenoid occurred in 1.8% of shoulders referred to our tertiary centres. The mean retroversion, inclination, height, width, radius-of-curvature, surface area, and depth of the glenoid were 37°, 3°, 46 mm, 30 mm, 37°, 1284 mm3, and 16 mm, respectively. The mean posterior subluxation was 90%. The Goutallier class was < 2 in 25 shoulders (86%). Glenoid dysplasia was mild in four, moderate in 14, and severe in 11 shoulders. The typical appearance of the posterior glenoid rim had a rounded or 'lazy J' morphology. The glenoid neck was deficient in 18 shoulders (62%). Conclusion: A dysplastic Type C glenoid characteristically has a uniconcave retroverted morphology, a deficient posteroinferior rim and scapular neck, and a reduced depth. These findings help to define the unique anatomical variations and may aid the planning of surgery and the development of components for these patients. Cite this article: Bone Joint J 2018;100-B:1074-9.

La artroplastia invertida de hombro ante defectos óseos glenoideos / Reverse shoulder arthroplasty due to glenoid bone defects

Objetivo. La artroplastia invertida se está convirtiendo en una herramienta útil para afecciones muy variadas en el hombro. Un defecto óseo importante de la glena puede afectar a la fijación del componente glenoideo. El propósito de nuestro estudio es evaluar a medio plazo los resultados de la artroplastia invertida de hombro asociados a una glenoplastia. Material y métodos. Se realizó un estudio retrospectivo de 5 pacientes de nuestro hospital con defectos glenoideos de distinta etiología que fueron tratados mediante artroplastia invertida de hombro asociada a glenoplastia. Resultados. El seguimiento mínimo de estos pacientes fue de un año (con una media de 30,4 meses). Todos los injertos estaban radiológicamente integrados, sin observarse signos de resorción o necrosis. A los 12 meses el test de Constant era de 66,75 de media y el EVA medio era de 1. Discusión. La glenoplastia es una intervención de alta demanda técnica que consigue restaurar el remanente óseo en pacientes con defectos estructurales, permitiendo así implantar una artroplastia invertida. De esa forma podemos mejorar la función y la clínica en pacientes con diversas afecciones glenohumerales, proporcionándoles una solución (AU)

Objective. Reverse shoulder arthroplasty is becoming a useful tool for many diseases of the shoulder. Any severe glenoid bone defect may affect the fixing of the glenoid component. The aim of this paper is to evaluate the medium-term outcomes of reverse shoulder arthroplasty associated with a glenoplasty. Materials and methods. A retrospective study was conducted on 5 patients from our hospital, selected due to glenoid defects of different etiology. All of them where treated with reverse shoulder arthroplasty associated with glenoplasty with bone graft. Results. The minimum follow-up was one year (mean 30.4 months). All grafts were radiologically integrated, with no signs of resorption or necrosis being observed. At 12 months, the Constant score was 66.75 and the mean EVA score was 1. Discussion. Glenoplasty surgery is technically demanding for restoring original bone size in patients with glenoid structural defects, enabling a reverse shoulder arthroplasty to be implanted. Thus improving both the function and clinical outcomes in selected patients with glenohumeral pathology and providing them with a solution (AU)

Húmero varo: corrección mediante osteotomía proximal valguizante con placa de osteosíntesis preconformada en edad infantil / Humerus varus: correction by proximal valgus osteotomy with precontourned plate fixation in children

La deformidad en varo del húmero proximal en la infancia es una enfermedad poco conocida debido a su baja incidencia de presentación. En los últimos años se ha progresado en el conocimiento de su posible etiología y fisiopatología de producción. Su etiología puede ser muy variada, tanto con causas traumáticas como no. También han sido bien definidos los criterios radiológicos de diagnóstico y la discapacidad funcional que produce. Sin embargo, existen pocos trabajos en la literatura sobre el tratamiento quirúrgico de esta deformidad en la infancia. En este artículo presentamos un caso tratado mediante osteotomía valguizante fijada con una placa de osteosíntesis preconformada maleolar externa (AU)

Varus deformity of the proximal humerus in children is a little known pathology due to its low incidence of presentation. Progress has been made in recent years in understanding the possible etiology and pathophysiological causes. Radiological criteria for diagnosis and functional impairment that occurs have also been defined. However, there are few reports in the literature about the surgical treatment of this deformity in children. In this paper we present a case of surgical treatment of this deformity by corrective osteotomy fixed with precontoured external maleolar plate osteosynthesis (AU)

Cirugía de revisión de la inestabilidad anterior de hombro / Results of revision after failed surgical treatment for traumatic anterior shoulder instability

Introducción y objetivos. Aunque las tasa de recidiva tras la cirugía primaria de la inestabilidad no son despreciables, son pocos los estudios que encontramos sobre su cirugía de revisión. Los objetivos de esta serie son establecer la frecuencia de recidiva de la inestabilidad en la misma y de su cirugía de revisión; analizar los resultados funcionales obtenidos, y determinar un protocolo quirúrgico de actuación ante la necesidad de realizar una cirugía de revisión. Material y métodos. Análisis retrospectivo: 16 pacientes con recidiva de inestabilidad tras cirugía previa en 164 pacientes intervenidos entre 1999-2011. Seguimiento medio de 57 meses y edad promedio 29 años. Evaluación de resultados mediante las escalas Constant, Rowe y UCLA. Resultados. De los 12 casos de cirugía artroscópica que recidivaron, en 6 se reparó el labrum mediante artroscopia, en 4 mediante reparación abierta y plicatura capsular, y en 2 mediante trasferencia de coracoides. En los 2 casos de cirugía abierta se realizó una cirugía de trasferencia de coracoides. Las puntuaciones obtenidas en la escala de Constant en el hombro intervenido fueron excelente/buena en el 64% de los pacientes. Conclusiones. Aunque las técnicas de estabilización primaria abierta y/o artroscópica se han perfeccionado mucho, el porcentaje de recurrencia no resulta nada despreciable. De ahí la importancia de establecer un protocolo quirúrgico de actuación como existe para la indicación quirúrgica de una estabilización primaria. Podemos afirmar que los resultados funcionales obtenidos tras la cirugía de revisión resultan satisfactorios para las elevadas demandas funcionales que presentan este tipo de pacientes (AU)

Introduction and objectives. Persistent or recurrent glenohumeral instability after a previous operative stabilization can be a complex problem. Our aim is to establish the incidence of recurrence and its revision surgery, and to analyse the functional results of the revision instability surgery, as well as to determine surgical protocols to perform it. Materials and methods. A retrospective analysis was conducted on 16 patients with recurrent instability out of 164 patients operated on between 1999 and 2011. The mean follow-up was 57 months and the mean age was 29 years. To evaluate functional outcome we employed Constant, Rowe, UCLA scores and the visual analogue scale. Results. Of the 12 patients who failed the initial arthroscopic surgery, 6 patients underwent an arthroscopic antero-inferior labrum repair technique, 4 using open labrum repair techniques, and 2 coracoid transfer. The two cases of open surgery with recurrences underwent surgery for coracoid transfer. Results of the Constant score were excellent or good in 64% of patients. Conclusions. Surgical revision of instability is a complex surgery essentially for two reasons: the difficulty in recognising the problem, and the technical demand (greater variety and the increasingly complex techniques) (AU)

Recurrent anterior shoulder instability: accuracy of estimations of glenoid bone loss with computed tomography is insufficient for therapeutic decision-making.

OBJECTIVE: To evaluate the reliability of glenoid bone loss estimations based on either axial computed tomography (CT) series or single sagittal ("en face" to glenoid) CT reconstructions, and to assess their accuracy by comparing with actual CT-based bone loss measurements, in patients with anterior glenohumeral instability. MATERIALS AND METHODS: In two separate series of patients diagnosed with recurrent anterior glenohumeral instability, glenoid bone loss was estimated on axial CT series and on the most lateral sagittal (en face) glenoid view by two blinded radiologists. Additionally, in the second series of patients, glenoid defects were measured on sagittal CT reconstructions by an independent observer. RESULTS: In both series, larger defects were estimated when based on sagittal CT images compared to axial views. In the second series, mean measured bone loss was 11.5% (SD = 6.0) of the total original glenoid area, with estimations of 9.6% (SD = 7.2) and 7.8% (SD = 4.2) for sagittal and axial views, respectively. Correlations of defect estimations with actual measurements were fair to poor; glenoid defects tended to be underestimated, especially when based on axial views. CONCLUSION: CT-based estimations of glenoid bone defects are inaccurate. Especially for axial views, there is a high chance of glenoid defect underestimation. When using glenoid bone loss quantification in therapeutic decision-making, measuring the defect instead of estimating is strongly advised.