Abstract: PURPOSE: To review outcomes of arthroscopic repair of rotator cuff tears using
absorbable anchors with a single-row technique. METHODS: 66 patients underwent
arthroscopic repair for rotator cuff tears using absorbable anchors with a
single-row technique. 51 of them aged 37 to 73 (mean, 57) years had been followed
up for a mean of 29 (range, 20-37) months. The extent of the tear was classified
as large, medium or small. Functional outcome was assessed using the Constant
score. Constant scores and re-tear rates in 3 patient groups (classified by
patient age and tear size) were compared. RESULTS: Among the 66 patients, there
were 24 large, 29 medium and 13 small cuff tears, and a total of 48, 37, and 18
anchors were used, respectively. Among the 51 patients, the median Constant score
improved significantly after arthroscopy (30 vs. 73, p<0.0001). Six shoulders had
complete re-tears; their median Constant score was 48 and their adjusted Constant
score was 65%. Complete re-tears occurred more often in patients aged >60 years
than in those aged 50 to 59 years and <50 years (4/15 vs. 1/22 vs. 1/14), and
more often in patients with large tears than in those with medium and small tears
(4/24 vs. 2/29 vs. 0/13). CONCLUSION: Arthroscopic repair of rotator cuff tears
using absorbable anchors with a single-row technique is reliable in patients aged
<60 years with small or medium tears.
Abstract: Twenty-four proximal humeral fractures were treated by surgical internal fixation with a locked antegrade intramedullary nail. The purpose of this paper was to assess the clinical outcomes of proximal epiphyseal and diaphyseal humeral fractures treated with an antegrade humeral nail implanted after an interval rotator split. We treated six proximal epiphyseal fractures and seven bifocal fractures of the epiphysis and shaft and eleven diaphyseal fractures. The mean follow-up was 23 months (range 12 to 34 months). Twenty patients were available for follow-up. All but two fractures progressed to healing. The Mean Constant score was 80%, Relative Constant score was 95.5%. We divided the clinical outcomes by fracture pattern to define the best surgical indication. There were good clinical outcomes in all three groups, but the clinical score was highest in the shaft fracture group. An intramedullary antegrade nail inserted through the interval rotator without penetrating the rotator cuff had a good clinical outcome and with certain fracture types can be an effective and satisfactory device.
Abstract: Prosthetic treatment of complex fractures of humeral proximal meta-epiphysis is a very complex surgery that often does not lead to satisfactory results. Indeed, although in the last 35 years since Neer's studies some progress has been made in the knowledge of the anatomy of humeral meta-epiphysis proximal portion, surgical technique and prosthetic design, in the literature we find non-homogeneous experiences regarding the clinical-functional results. At the same time, such experiences agree as far as pain relief is concerned. We report our experience in the treatment of complex fractures of humeral proximal epiphysis with SMR (Lima Lto, San Daniele, Italy) prosthetic system, using our surgical technique of anatomical reconstruction, starting from the medial neck. The case histories, 35 patients, 30 women and 5 men, aged between 56 and 79, were reported in the observation period between April 2000 and February 2005. In 20 cases the right shoulder was treated and in 15 the left one. At the follow-up the patients were assessed clinically by the average Constant Score and also by X-rays and CT scan in order to measure the prosthesis height, its off-set and retroversion.
Abstract: Surgical treatment of malunions of 3- or 4-part fractures of proximal humerus is very difficult and still represents a challenge. Several indications have been proposed: arthrodesis, osteotomies, and shoulder arthroplasty. These techniques and the results of osteotomies reported in literature are incomplete, sometimes confusing and controversial. The authors recognize the necessity of a new systematic approach. They propose a new surgical osteotomic technique with angular variability, according to the type of malunion. From 2000 to 2003, 13 patients (9 men and 4 women), aged 42 to 71 years (average, 56.5 years), were treated. Malunions were categorized according to the presence of osseous abnormalities, including malposition of the greater or lesser tuberosity, incongruity of the articular surface, and malalignment of the articular segment. The original fracture had been treated conservatively in 10 patients, whereas 3 of them had been operated on by open reduction and internal fixation. The authors analyze the technique and the results of the biplane and triplane osteotomies performed in 8 and 5 patients, respectively. The functional results were evaluated with the Constant score preoperatively and postoperatively. At a mean follow-up of 4.5 years (range, 3-6 years), the results were excellent in 8 cases and fair in 5. The mean active anterior elevation was 156 degrees. There were no bad results. All patients were satisfied or very satisfied both with function and pain. The success of the technique also depends on the careful selection of patients, the detailed preoperative planning and the precise and Constant rehabilitative program according to the Lyonnaise protocol.
Abstract: The treatment of third proximal humerus complex fractures represents a challenge and osteosynthesis techniques are still controversial. The Authors report a new device that has been planned and used to treat this type of fracture, suitable for both young and elderly patients. The device consists of a perforated prismatic-triangular titanium cage (PTTC), available in different sizes so that it can be inserted in the bone cavity as a bridge. Thus, it supports the cephalic cap and, resting on the metaepiphyseal walls, allows greater and lesser tuberosities to be restored using osteosutures or minimal osteosynthesis devices. Furthermore, bone chips or bone substitutes can be inserted as filling in the perforated parts. From June 2005 to February 2006 we used this osteosynthesis surgical technique to treat 10 patients, 4 females and 6 males, all affected by proximal humerus complex fractures. No specific complications during and after surgery were noticed. The reported results are still to be considered as preliminary, but they are very encouraging. In all the cases the effective internal stabilisation allowed anatomical reduction of fragments, their stable fixation, reconstruction close to standard anatomy and early rehabilitation.
Abstract: Purpose of this study is to analyze the results of a consecutive series of 139 patients affected with anterior-inferior shoulder instability and treated by arthroscopic capsuloplasty using the Thal method with absorbable and non-absorbable Mitek knotless anchors. Much attention was paid to the preoperative and intraoperative selection of patients, excluding from the arthroscopic procedure those with bony Bankart lesions measuring more than 25%, with an inverted-pear glenoid, with engaged Hill-Sachs lesions and patients with HAGL lesions. Pre- and postoperative clinical evaluation was carried out using the Rowe scale. Scores rose from 45-55 to 96 postoperatively. Intra-articular mobilization of the anchors did not occur and peri-metallic lysis was not manifested. Areas of bone resorption were observed in 7 cases (7/38, 18.4%) with the presence of peri-insertional geodes with biological anchors, but this had no effect on the clinical results.
Abstract: Between 1996 and 2003 a total of 19 humeral head osteotomies were performed to treat post-traumatic malunion of the proximal humerus. Mean age was 46 years, ranging from 17 to 71 years. The period of time between traumas and surgeries ranged from 6 to 22 months. Osteotomy procedure was as follows: one after two-part fracture of the greater tuberosity, three after two-part fracture of the surgical neck, five after three-part fracture of the greater tuberosity, eight after four-part fracture, two after complex head splitting fracture, one after two-part fracture with anterior dislocation. Three different types of osteotomies were performed: osteotomy of the humeral neck for varus deformity, isolated osteotomy of the greater tuberosity, and a new osteotomy technique (two-plane and three-plane osteotomy) for three- and four-fragment fracture sequelae. At the time of follow-up evaluation, all 19 patients were questioned regarding pain and function. Excellent results in 14 patients and satisfactory results in 5 were obtained. None of the patients required revision surgery. Findings were recorded using the Constant rating scale. All patients had had significant pain relief after shoulder osteotomy. Range of motion was increased in all patients treated by osteotomy. The success of osteotomy in these cases was based on: patient selection, extensive preoperative evaluation, surgical technique and postoperative rehabilitation.
