Reverse shoulder arthroplasty for the treatment of acute complex proximal humeral fractures: Influence of greater tuberosity healing on the functional outcomes.

PURPOSE: To investigate the influence of greater tuberosity healing on the functional outcomes of reverse shoulder arthroplasty (RSA) for the treatment of acute complex proximal humeral fractures (PHFs), and to investigate the influence of patient- and surgery-related factors in the healing of the greater tuberosity. METHODS: Retrospective study including 41 consecutive PHFs treated using RSA with minimum 2-year follow-up. In all the cases, tuberosities were reattached with a standardized technique. All the patients were assessed at the last follow-up with constant score. Body mass index, surgery delay, comorbidities, polyethylene size, glenosphere size, overhanging of glenosphere, and scapular notch were recorded, and their influence in final constant score and in greater tuberosity healing was analyzed. RESULTS: Mean final constant score was of 60.7 points (standard deviation (SD) = 9.9). Greater tuberosity healed in proper position in 68% of the cases. There were no significant differences in constant score between patients with (mean = 61; SD = 9.5) and without (mean = 61; SD = 11.3) the healing of greater tuberosity. All patients scored above 90° in forward elevation. Scapular notch was reported in 14.6% of the cases. Age significantly affected the constant score ( p = 0.008). Comorbidities significantly interfered with greater tuberosity healing ( p = 0.03). There was one reoperation after dislocation. CONCLUSION: In spite of expecting good functional outcome with low complication rate after RSA for acute PHFs, the influence of greater tuberosity healing on shoulder function could not be demonstrated. The presence of comorbidities, but not age or gender, negatively influenced the healing of the greater tuberosity.

An Evaluation of the Association Between Radiographic Intercondylar Notch Narrowing and Anterior Cruciate Ligament Injury in Men: The Notch Angle Is a Better Parameter Than Notch Width.

PURPOSE: To evaluate the association of anterior cruciate ligament (ACL) injuries with the intercondylar notch angle and notch width in male patients. The secondary purpose was to evaluate the association of these injuries with other novel morphologic parameters. METHODS: Male patients undergoing primary ACL reconstruction between 2010 and 2013 for injury through noncontact mechanisms with preoperative magnetic resonance imaging were compared with an age-matched control group of male patients (patients who underwent knee operations other than ACL reconstruction) regarding the following magnetic resonance imaging-assessed parameters: intercondylar notch angle, width, and depth; condylar width; medial/lateral condylar widths; medial/lateral posterior tibial plateau slopes; anterior sagittal tibial slope (corresponding to the level of the tibial ACL footprint); coronal tibial slope; and angle between the Blumensaat line and anterior tibial slope. RESULTS: In both the coronal and axial planes, patients with ACL injury had a significantly lower intercondylar notch angle (P < .001 and P = .008, respectively) than the control group, but there were no significant between-group differences for intercondylar notch width (P = .9 and P = .97, respectively). In the sagittal plane, patients with ACL injury had significantly higher medial (P < .001) and lateral (P = .02) posterior tibial slopes, a significantly lower anterior tibial slope (P = .01), and a significantly higher angle between the Blumensaat line and anterior tibial slope (P = .02) than the control group. CONCLUSIONS: Narrowing of the intercondylar notch may be associated with ACL injury in male patients. However, the intercondylar notch angle may be a better parameter to evaluate notch narrowing and its potential association with ACL injuries compared with the notch width. The association between the angle formed by the Blumensaat line and anterior tibial slope and ACL injuries in male patients needs more investigation. This study further suggests that increased posterior tibial slope may be associated with ACL injury in male patients. LEVEL OF EVIDENCE: Level III, case-control study.

Distal Clavicle Osteolysis after Modified Weaver-Dunn's Procedure for Chronic Acromioclavicular Dislocation: A Case Report and Review of Complications.

Distal clavicle osteolysis after acromioclavicular joint stabilization has only been described after the use of hardware for clavicle stabilization or synthetic graft causing a foreign body reaction. This paper reports a very rare case of distal clavicle osteolysis after modified Weaver-Dunn procedure for the treatment of chronic acromioclavicular joint dislocation. The paper also provides a comprehensive review of complications of this surgical technique and discusses a potential vascular etiology and preventive strategies aimed at avoiding clavicle osteolysis.