[Traumatic rupture of subscapularis with avulsion of tuberculum minor and subluxation of the biceps tendon in a 13-year-old].

Traumatic ruptures of the subscapularis tendon in children are rare and often missed. In this case report, a 70 kg person landed on a 13-year-old boy with his arm abducted and rotated, causing pain and restricted motion. An MRI showed a total rupture of the subscapularis with avulsion of the minor tubercle and subluxation of the biceps tendon. The avulsion was fixed to the foot print and the biceps tendon in the bicipital groove, by delto-pectoral approach, using three anchors. It is important to avoid missing these injuries. They may cause chronic shoulder pain and decreased motion if left untreated.

Elbow hemiarthroplasty versus open reduction and internal fixation for AO/OTA type 13 C2 and C3 fractures of distal humerus in patients aged 50 years or above: a randomized controlled trial.

BACKGROUND: Intraarticular distal humeral fractures of AO/OTA type 13 C2 and C3 pose a surgical challenge despite the evolution of surgical implants and techniques. Open reduction and internal fixation (ORIF) is often preferred as the first choice of treatment, but the results vary and are sometimes disappointing. Total elbow arthroplasty (TEA) has been widely used for fractures that are not amenable to ORIF in elderly patients, but the mechanical complications remain a challenge, especially in active patients. Elbow hemiarthroplasty (EHA) provides a modern alternative that might avoid the mechanical complications and weight bearing restrictions related to the linked articulation in semi-constrained TEA. No studies have compared the results of EHA to that of ORIF, but case series have reported promising results. METHODS/DESIGN: This is a study protocol describing an investigator-initiated, non-blinded randomized controlled trial comparing the outcome of EHA with ORIF for AO/OTA type 13 C2 and C3 fractures of the distal humerus in patients who are 50 years or older. Forty-four patients with AO/OTA type 13 C2 and C3 fractures of distal humerus will be randomized to either EHA or ORIF. The Oxford Elbow Score (OES) will be used as primary outcome. Mayo Elbow Performance Score (MEPS), pain severity score (VAS), range of motion, and patient satisfaction will be used as secondary outcomes. Reoperations, complications, and the length of sick leave will be recorded. The patients will be examined after the operation and at 3 months and 1, 2, 5, and 10 years. DISCUSSION: The main objective of this study is to investigate the best treatment option for AO/OTA type 13 C2 and C3 fractures of distal humerus in patients aged 50 years or above. We hypothesize that EHA results in fewer complications and superior functional outcome compared with ORIF and that the mechanical complications related to the linked articulation of TEA can be avoided. TRIAL REGISTRATION: ClinicalTrials.gov, PRS, NCT04163172. Registered November 13, 2019. https://clinicaltrials.gov/ct2/results?cond=&term=evori&cntry=&state=&city=&dist= (Table 2). The protocol has been approved by The Scientific Ethics Committee of the Capital Region of Denmark (Jr. no.: H- 19,035,590). The processing of personal data has been approved by the Danish Data Protection Agency (Jr. no. P-2019-246). Inclusion started on February 1, 2020.

Good outcome after elbow hemiarthroplasty in active patients with an acute intra-articular distal humeral fracture.

BACKGROUND: This study reported the clinical outcomes and complications after elbow hemiarthroplasty (EHA) for acute distal humeral fractures Arbeitsgemeinschaft für Osteosynthesefragen (AO)/Orthopaedic Trauma Association (OTA) type C2 and C3. METHOD: During a 6-year period, 24 active patients with acute intra-articular and multifragmentary distal humeral fractures were treated with an EHA by 1 of 4 experienced elbow surgeons. Mean age was 65 years (range, 47-80 years). Median follow-up time was 20 months (range, 12-70 months). RESULTS: The median Oxford Elbow Score was 40 points (range, 17-48 points), where 48 points represents a normal elbow. Outcomes were "good to excellent results" in 21 patients, "fair" in 2 patients, and "poor" in 1 patient. The median Mayo Elbow Performance Score was 85 points (range, 50-100 points), where 100 points represents a normal elbow. Outcomes were "good to excellent" in 19 patients, "fair" in 4 patients, and "poor" in 1 patient. The median pain severity score was 2 (range, 0-7) in a scale from 0 to 10 where 0 represents a pain-free elbow. The median flexion/extension and supination/pronation arcs were 110° (range, 60°-140°) and 160° (range, 115°-180°), respectively. Complications were recorded in 7 patients, and 3 of them underwent reoperation because of stiffness, which was treated with open release. CONCLUSIONS: EHA provides a good and reliable option in the treatment of an acute intra-articular distal humeral fracture unsuitable for open reduction and internal fixation, especially in active patients.

High reliability of an algorithm for choice of implants in hip fracture patients.

PURPOSE: Hip fracture treatment is controversial, with high complication rates. An algorithm for hip fracture surgery has shown reduced reoperation rates, but choice of implant is based on the commonly used fracture classifications, which were previously evaluated to be unreliable. The purpose of this study was to investigate the reliability of the algorithm. METHODS: From two hospitals, four observers (orthopaedic consultant, fellow, resident and intern) used the algorithm to classify into 15 hip fracture types [Garden type I-IV femoral neck including posterior tilt, vertical femoral neck, basocervical and Arbeitsgemeinschaft für Osteosynthesefragen (AO)-31 A1.1 to A3.3 trochanteric fractures] and to choose between five surgical procedures [parallel implants, prosthesis, two-or four-hole sliding hip screw (SHS) and intermedullary (IM) nail]. After individual assessment, each hospital made a consensus decision. Observations were performed twice, ten weeks apart, on pelvic, anteroposterior (AP) and axial X-rays from 100 consecutive patients. RESULTS: For fracture classification, mean kappa values were 0.60 for intra and 0.62 for interobserver variation, with interobserver variation between hospitals at 0.65. For posterior tilt, mean intraclass correlation coefficient was 0.91 for intra and 0.87 for interobserver variation. For choice of implant type, mean kappa values were 0.86 for both intra and interobserver variation. The two hospital consensus decisions chose same implant in 91 of 100 patients, giving a kappa value at 0.88. CONCLUSION: Although hip fracture classification confirmed to be somewhat unreliable in this study, posterior tilt measurement and subsequent choice of implant type by the algorithm was found to be reliable, which opens up the possibility for a more standardized treatment of hip fracture patients between hospitals.