Glenohumeral Arthropathy After Arthroscopic Surgery for Shoulder Instability: Outcomes at 16-Year Follow-up.

Background: Glenohumeral arthropathy after surgery for traumatic shoulder instability is a condition whose etiology and long-term course are still unknown. Purpose: To evaluate the risk factors for the onset of arthropathy and to assess the relationship between the degree of arthropathy and final outcomes. Study Design: Case series; Level of evidence, 4. Methods: We included patients who underwent surgery for a shoulder instability at a single institution between 2000 and 2004. The following variables were studied for relationship with functional outcomes: sex, age, body mass index, smoking at the time of surgery, number of episodes of shoulder dislocation, and time from first dislocation to surgery. The number of anchors used and their position were also evaluated. Functional outcomes were assessed using the Constant-Murley, Western Ontario Shoulder Instability Index, and Rowe scores, and results were compared with the onset of arthropathy according to Buscayret classification. Spearman and Pearson correlations were performed for the association between glenohumeral arthritis (Buscayret grade) and the study variables, the Mann-Whitney U test and Student t test were used to compare outcome scores with the study variables, and the Kruskal-Wallis test was used to compare Buscayret grade and outcome scores. Results: A total of 26 shoulders in 25 patients were analyzed, finding a high rate (54%) of arthropathy at a minimum follow-up of 16 years. Patients with Buscayret grade 4 had the worst functional results (P = .007). However, 80% of patients with Buscayret grade ≤3 had excellent Constant-Murley scores. A significant relationship was found between degree of arthropathy and patients who were smokers before surgery (P < .01). No relationship was found between the onset of arthropathy and the other variables analyzed. Conclusion: Postinstability glenohumeral arthropathy was not correlated with functional outcomes except in those patients with advanced arthroplasty (Buscayret grade 4). A direct relationship was found between smoking before surgery and the onset of glenohumeral arthropathy.

Reverse shoulder arthroplasty in complex fractures of the proximal humerus: results after 7 years of follow-up.

BACKGROUND: There is still little information about the long-term results of clinical and radiological evolution in patients older than 65 years with complex proximal humerus fractures (CPHF) treated acutely with reverse shoulder arthroplasty (RSA). The aim of this paper was to evaluate function and results 7 years after surgery. MATERIAL AND METHODS: A prospective cross-sectional cohort study was designed for this purpose. Patients who underwent RSA surgery during 2012 because of a CPHF were included. The surgical approach was randomized (deltopectoral vs anterosuperior). Functional activity, evolution of tuberosities and evidence of scapular notching 7 years after surgery were analyzed. RESULTS: After evaluating 32 patients, the Constant score improved from 64.83 in the first year to 69.54 at 7 years postoperative. Results were independent of the approach used. Functional outcomes were poorer in patients with scapular notching and when tuberosities were resorbed or displaced. CONCLUSIONS: At 7 years, function in patients undergoing RSA after CPHF demonstrated improvement in all patients except those who developed scapular notching or when tuberosities did not consolidate in an anatomical position. These results are completely independent of the approach used. LEVEL OF EVIDENCE: III Controlled cohort study.

Fracturas de sacro por insuficiencia como causa poco conocida de dolor lumbar bajo / Sacral insufficienty fractures as a little known cause of low back pain. Five cases reports

Objetivo: Dar a conocer mediante casos clínicos las fracturas de sacro por insuficiencia y su presentación clínica como dolor lumbar bajo, pues a pesar del aumento en su incidencia, suelen no diagnosticarse o hacerlo de forma tardía al no formar parte de nuestro diagnóstico diferencial habitual. Aparecen fundamentalmente en pacientes de edad avanzada y en personas con diferentes factores de riesgo asociados. El diagnóstico de sospecha es clínico, siendo necesario el uso de pruebas complementarias para llegar a un diagnóstico definitivo. Para su manejo disponemos de un tratamiento conservador y de tratamientos intervencionistas como la sacroplastia y la cirugía. Material y método: Presentación de cinco casos de fracturas de sacro por insuficiencia en pacientes con diferentes factores de riesgo y con una clínica similar, consistente en dolor lumbar bajo de inicio insidioso y empeoramiento progresivo. Las radiografías simples no fueron útiles para el diagnóstico en ningún caso. Dos se diagnosticaron mediante TC y tres mediante RMN. Todos fueron tratados de forma conservadora con reposo relativo, ejercicios de rehabilitación y analgésicos. Resultados:. En cuatro de ellos la mejoría del dolor fue completa, mientras que en otro se consiguió una mejoría importante, necesitando analgésicos de forma esporádica. Conclusión: El tratamiento conservador es una buena opción para el manejo de estas fracturas aunque el tratamiento quirúrgico debe ser tenido en cuenta

Purpose: Introduce through clinical cases sacral insufficiency fractures and its clinical presentation as low back pain. Despite being a disease with increasing incidence rate, it is often diagnosed late or not even diagnosed, as it is not part of the normal differential diagnosis. They mainly appear in the elderly and in people with associated risk factors. The suspected diagnosis is clinical although additional tests are necessary to reach a definitive diagnosis. Conservative and interventional treatments like surgery and sacroplasty have been used. Materials and method: Presentation of five cases of sacral fractures by failure in patients with different predisposing factors and similar symptoms, consisting of low back pain of insidious onset and progressive deterioration. Plain radiographs were not useful for diagnosis in any case. Two were diagnosed by CT and three by NMR. All patients were treated conservatively with relative rest, rehabilitation exercises and painkillers. Results: In four cases the pain relief was complete, while in one case significant improvement was achieved sporadically requiring analgesics. Conclusion: Conservative treatment is a viable option for the treatment of these fractures although the interventional treatment should be considered