[Clinical outcomes of reverse shoulder arthroplasty for the treatment of failed fixation of proximal humeral fracrtures in the elderly patients].

OBJECTIVE: To evaluate the clinical outcomes of reverse total shoulder arthroplasty as a revision procedure for the failed fixation of proximal humeral fractures in the elderly patients. METHODS: A retrospective analysis was performed on 8 patients with failed internal fixation of proximal humeral fractures from May 2014 to March 2020, including 3 males and 5 females, aged from 65 to 75 years old. All 8 patients underwent reverse total shoulder arthroplasty, and the mean time between initial fixation and reverse total shoulder arthroplasty ranged from 8 to 16 months. Range of motion(ROM), University of California at Los Angeles(UCLA) shoulder score, visual analogue scale (VAS), self-rating anxiety scale(SAS), and Constant-Murley score of shoulder function were assessed pre-operatively and at the last follow-up. Complications relating to the surgery were recorded. RESULTS: All 8 patients successfully followed up. The mean follow-up after reverse total shoulder arhroplasty ranged from 16 to 28 months. The range of motion (forward flexion, external rotation, abduction and internal rotation) of the affected shoulder was significantly improved after surgery, and the post-operative VAS, SAS and UCLA scores were also significantly improved. For the Constant-Murley score of shoulder joint function, the total scores and the subscores of pain, daily activities, range of motion and strength test at the last follow-up were all significantly improved. Scapular glenoid notch was observed in patient, which was evaluated as grade 1 on imaging. All the other patients did not develop specific or non-specific complications. CONCLUSION: Reverse total shoulder arhroplasty is an appropriate treatment as a revision surgery for failed fixation of proximal humeral fractures. It has shown satisfactory clinical outcomes, accelerating the rehabilitation of shoulder function and improving the quality of life.

[High strength wire under arthroscopy combined with outside anchor nail in treating Meyers McKeever II, III avulsion fracture of anterior cruciate ligament tibial check point].

OBJECTIVE: To explore clinical effect of high strength wire under arthroscopy combined with outside anchor nail in treating Meyers McKeever II, III anterior cruciate ligament tibial check point. METHODS: From March 2014 to June 2016, 21 patients with Meyers McKeever II, III avulsion fracture of anterior cruciate ligament tibial check point were treated by high strength wire under arthroscopy combined outside anchor nail. There were 13 males and 8 females aged from 18 to 48 years old with an average of (26.40±5.42) years old. There were 9 cases injured on the left side, and 12 cases on the right side. The courses of disease included sports injuries of 12 cases, falling down injuries of 6 cases, and accident injuries of 3 cases. According to Meyers-McKeever classification, 16 patients were type II and 5 patients were type III. All fractures were fresh, closed and simple injury. The time from injury to operation ranged from 2 to 15 days with an average of (6.20±2.63) d. Lysholm score, IKDC score and the changes of knee mobility were observed and compared before operation and 6 months after operation. RESULTS: Twenty-one patients were followed up for 12 to 24 months with an average of (14.30±3.01) months. Operation time ranged from 40 to 65 min with an average of (45.10±4.82) min, Blood loss ranged from 5 to 15 ml with an average of (10.05±2.75) ml. Lysholm score was improved from 50.29±6.67 before operation to 92.48±2.18 at 6 months after operation. IKDC scores was increased from 47.19±4.57 before operation to 90.71±2.22 at 6 months after operation. Knee joint activity was respectively (83.05±5.33)° and (132.05±7.15)° before operation and 6 months after operation. CONCLUSIONS: High strength wire under arthroscopy combined outside anchor nail in treating Meyers McKeever II, III ACL tibial check point has the advantages of less trauma, firm fixation, and satisfactory clinical effect.

[Application of drilling columnar autogenous iliac bone graft and clinical analysis of postoperative complications in the donor bone region].

OBJECTIVE: To investigate the clinical effect of drilling columnar autogenous iliac bone graft and analyze the effect of bone grafting on postoperative complications in donor site. METHODS: From March 2014 to October 2016, 68 patients with autogenous iliac bone graft were retrospectively analyzed, and divided into drilling group and osteotomy group, 34 patients in each group. In drilling group, there were 24 males and 10 females with an average age of (40.06±5.60) years old ranging from 23 to 53 years old;in osteotomy group, there were 26 males and 18 females with an average age of (39.32±6.44) ranging from 22 to 56 years old. The operative time of bone extraction, blood loss in donor area, healing time of donor site and postoperative donor site complications were observed and compared between the two groups. VAS score was used to evaluate the pain of donor site in different periods after operation. RESULTS: All patients were followed up for 12 to 24 months, with an average of 16.9 months in drilling group and 17.1 months in osteotomy groups. The bone healing structure was displayed in the recipient area in two groups, the effect of autogenous iliac bone grafting was good. There was no significant difference in operative time between two groups (P>0.05). There was significant difference between two groups in the amount of donor site bleeding and the time of donor site wound healing(P<0.05). Postoperative complications(iliac depression and numbness) were significantly different between two groups (P<0.05). There was no significant difference in VAS score between two groups at 2 weeks after operation(P>0.05). VAS scores of drilling group at 6 months and 1 year after operation were lower than those of osteotomy group (1.85±0.61 vs 2.97±0.67, P=0.000; 1.15±0.56 vs 2.41±0.61, P=0.000). CONCLUSIONS: When bone graft is no need to have large pieces of special shape or more cortical bone iliac, it is simple to operate and less complications postoperative by drilling type columnar autogenous iliac bone graft. What's more, it has the obvious advantages of promote healing, improve patient quality of life compared with traditional osteotomy.