Glenoid morphology in light of anatomical and reverse total shoulder arthroplasty: a dissection- and 3D-CT-based study in male and female body donors.

BACKGROUND: Placement of the glenoid baseplate is of paramount importance for the outcome of anatomical and reverse total shoulder arthroplasty. However, the database around glenoid size is poor, particularly regarding small scapulae, for example, in women and smaller individuals, and is derived from different methodological approaches. In this multimodality cadaver study, we systematically examined the glenoid using morphological and 3D-CT measurements. METHODS: Measurements of the glenoid and drill hole tunnel length for superior baseplate screw placement were recorded to define size of the glenoid and the distance to the scapular notch on cadaveric specimens. Glenoid angles were determined on both, 3D-CT-scans of the thoraxes using the Friedman method and on subsequently isolated scapulae from 18 male and female donors (average 84 years, range 60-98 years). RESULTS: Mean glenoid height was 36.6 mm ± 3.6, and width 27.8 mm ± 3.1 with a significant sex dimorphism (p ≤ 0.001): in males, glenoid height 39.5 mm ± 3.5, and width 30.3 mm ± 3.3, and in females, glenoid height 34.8 mm ± 2.2, and width 26.2 mm ± 1.6. The average distance from the superior screw entry to its exit in the scapular notch measured by calliper was 27.2 mm ± 6.0 with a sex difference: in males, 29.4 mm ± 5.7, and in females, 25.8 mm ± 5.9 mm with a minimum recorded distance of 15 mm. Measured by CT, the mean inclination angle for male and female donors combined was 13.0° ± 7.0, and the ante-/retroversion angle -1.0° ± 4.0°. CONCLUSION: This study is one of the first to combine dissection, including drill holes, with anatomical measurements and radiological data. In some women and smaller individuals, smaller baseplates should be selected. The published safe zone of 20 mm is generally feasible for superior screw placement, however, in small patients this distance may be substantially shorter than expected and start as of 13 and 15 mm, respectively. No correlation between glenoid height or width with the length of our drilling canal towards the scapular notch was found. Preoperative CT-based treatment planning to determine version and inclination angles is recommended.

Management of non-union of humeral fractures with the Stryker T2 compression nail.

INTRODUCTION: Fractures of the humeral shaft are relatively common injuries and the majority achieve union uneventfully; however, non-union rates of up to 13% are reported when managed either conservatively or operatively. Despite the many surgical techniques described for the management of non-unions, including plate fixation, intramedullary nailing or external fixation, some cases remain resistant to treatment with ongoing problems achieving union. METHOD: We describe a technique using the Stryker T2 humeral nail which incorporates a compression system allowing closure of the non-union fracture gap. Twelve patients underwent compression nailing for established humeral fracture non-union. All achieved radiological union at an average of 4.5 months (range 3-12 months). RESULTS: All patients reported a return to their normal pre-injury level of activities. CONCLUSION: We conclude that this technique of intramedullary nailing with a novel compression technique is effective in the treatment of humeral shaft fracture non-union.

Distal biceps tendon rupture: a new repair technique in 14 patients using the biotenodesis screw.

BACKGROUND: Distal biceps tendon ruptures are uncommon injuries. Operative treatment has been shown to improve functional outcomes. A variety of surgical repair techniques have been described for distal biceps ruptures. PURPOSE: The authors present their experience with a new technique to anatomically repair distal biceps tendon ruptures through a single-incision approach that they believe is a safe and reliable method of achieving repair. STUDY DESIGN: Case series; Level of evidence, 4. MATERIALS AND METHODS: Fourteen patients with 14 biceps tendon ruptures underwent a repair with a bioabsorbable Biotenodesis screw. All 14 patients underwent clinical assessment using the Mayo Elbow Performance Score, measurement of range of motion, and flexion strength testing. Mean follow-up was 29.1 months. RESULTS: Three patients had a good result and 11 patients had an excellent result. The mean elbow flexion arc was 141.4 degrees (range, 125 degrees -155 degrees ; standard deviation, 7.19 degrees ) with no flexion contractures in the operated side compared with the unaffected elbow. All patients achieved an equal range of pronation/supination to the unaffected side. The mean flexion strength in the injured arm was 25.7 kg, compared with 26.9 kg in the uninjured side. No complications were noted about the elbow. CONCLUSION: The authors believe this new technique gives a good functional outcome with reproducible results.

Carpal tunnel syndrome caused by an intraosseous ganglion of the capitate.

Intraosseous ganglions often arise in the foot and ankle but are less common within the carpal bones. We present a case of an intraosseous ganglion of the capitate bone associated with compression of the median nerve that was seen on plain radiographs and magnetic resonance images.