The Bankart repair versus the Putti-Platt procedure: a randomized study with WOSI score at 10-year follow-up in 62 patients.

BACKGROUND AND PURPOSE: This randomized study compared clinical results after surgery for posttraumatic shoulder instability with either an anatomical repair or an older, less anatomical but commonly used method. The less anatomical procedure has been considered quicker and less demanding, but it has been questioned regarding the clinical result. We therefore wanted to compare the clinical outcome of the two different procedures. Our hypothesis was that the anatomical repair would give less residual impairment postoperatively. METHODS: Patients with anterior posttraumatic shoulder instability were consecutively randomized on the day before surgery to either a Bankart repair using Mitek GI/GII anchors combined with capsular imbrication (B) (n = 33) or a Putti-Platt procedure (P) (n = 33). Follow-up was performed by examination at 2 years and using a self-evaluation score at 10 years. RESULTS: At the 2-year follow-up, we found no difference in muscle strength between patients treated with the two surgical methods and there were no statistically significant differences in the Rowe scores (mean 90 units for both groups). Compared to preoperatively, the decrease in external rotation 2 years after surgery was 10 degrees in the P group and 3 degrees in the B group (p = 0.03). 10 years after surgery, 62 of 66 patients replied to a questionnaire sent by mail. It included a self-evaluating quality of life score for shoulder instability (WOSI) for evaluation of their shoulder function. In the P group 15 patients and in the B group 19 patients reported they had experienced either a redislocation or a subluxation with a new feeling of shoulder instability. Mean WOSI score was similar in the P and B groups: 80% and 83%, respectively. The WOSI score was 87% for patients with stable shoulders (n = 28) and 77% for those with unstable shoulders (n= 34) (p = 0.005). INTERPRETATION: With assessment of pain and general shoulder function, only a small difference was found between the two methods. The WOSI scores for stable shoulders indicated that some shoulders still had impaired function even though the shoulders had become stable.

Medium-term results after primary hemiarthroplasty for comminute proximal humerus fractures: a study of 46 patients followed up for an average of 4.4 years.

This study investigated 82 patients who underwent primary hemiarthroplasty for a severely displaced proximal humerus fracture at Danderyd Hospital between 1989 and 2002. According to the Neer classification system, fractures were 2-part in 2, 3-part in 20, and 4-part in 60. The prostheses used were 12 Neer-II, 39 Global, and 31 Bigliani-Flatow. Follow-up time averaged 4.4 years (range, 1-14 years). Twenty-two patients died, 9 were contacted by phone, and 5 were lost to follow-up. Forty-six patients underwent clinical examination, including the Constant score (CS) and radiographic examination. Mean CS for all patients was 42 of 100 points (range, 11-83 points). Radiologic evaluation revealed that 24 prostheses had migrated superiorly; this finding decreased the CS significantly. Ectopic bone developed in 25 patients, 16 had glenoid erosion, and 5 had displaced tuberosities; no correlation was found with the CS. Hemiarthroplasty usually prevented shoulder pain, but most patients had moderate function and poor strength. The reduced function appeared to be related to a lack of rotator cuff integrity.