Results of decompression and rotator cuff repair in patients 65 years old and older: 6- to 14-year follow-up.

At an average of 9.2 years after surgery, 47 patients with 51 shoulders who had undergone rotator cuff repair and subacromial decompression through an open Rockwood 2-stage acromioplasty-type approach were reviewed. All patients were 65 years or older at the time of their initial index procedure. Results were rated by patient satisfaction, the Constant's score, American Shoulder and Elbow Surgeons (ASES) Evaluation, and Neer rating. Subjectively, the patients were highly satisfied, with a 94.1 overall satisfaction rate. Objectively, the average Constant's score was 82 when normalized to the opposite shoulder and age. According to the Neer rating scale, there were 20 (39%) excellent, 26 (51%) satisfactory, and 5 (10%) unsatisfactory results. When assessing the ASES Evaluation, the patients who had undergone an extensile deltotrapezial takedown had increased strength in their lateral deltoid as compared with a cohort of individuals who had undergone the VY exposure. There was no statistically significant difference in subjective or objective results. For the most part, open rotator cuff repair and subacromial decompression in older patients has a high level of success with respect to pain relief, independent living, and when desired, reasonable sports participation.

Tibial shaft fractures treated with functional braces. Experience with 780 fractures.

We have reviewed our recent results with functional bracing of tibial shaft fractures in adults in order to define its role in management. We also analysed several parameters of these fractures to discover those which influence healing. A total of 780 tibial fractures treated in prefabricated functional braces were followed to union; shortening of less than 10 mm and angulation of less than 5 degrees in any plane were our parameters for successful treatment. The average time before applying a brace was 3.8 weeks for closed fractures and 5.2 weeks for open ones. Closed fractures healed in an average of 17.4 weeks and open fractures in an average of 21.7 weeks, 90% of them with 10 mm of shortening or less. Varus angulation and posterior angulation were the most common deformities encountered at union. There were 20 nonunions (2.5%) and 46 braces were discontinued during treatment. We found no association between fracture healing and the patient's age, the mechanism of injury or the fracture location. The degree of soft tissue injury appeared to have most influence on the speed of fracture healing. Fracture comminution and initial displacement, the condition of the fibula and the time from injury to bracing also appeared to affect the speed of union.