Purpose The aim of this study was to identify specific complications of locking plate fixation of proximal humerus fractures. Patients and Methods Seventy-threee adult patients with a displaced 3- ...(24%) or 4-part (76%) fracture of the proximal humerus were treated over a period of 2 years under the supervision of a trauma surgeon. Fourty-four patients came back for a clinical and radiographic examinations at least 18 months after the trauma; the others were evaluated at 6 weeks and 3 and 6 months. Results Out of the 73 patients (64.4% females, mean age of 65), 11 patients needed a second surgery and 18 were lost for follow-up after 6 months. Mean final constant score was 62.3 points. The incidence of secondary displacement was 8.2%. Nonunion rate was 5.5%, affecting the constant score ( P = .018). 16.4% of the patients developed a partial necrosis of the humeral head at the latest follow-up, which influenced on the constant score ( P = .029). Quality of the reduction of the greater tuberosity influenced final results ( P = .037). Screw cutout rate was 13.7%, with an influence to the constant score ( P = .001). A too high plate positioning influenced the constant score ( P = .002). Conclusion Locked screw-plates provide more secure fixation of fractures, especially in weak bone. Complications rate remains high. Two complications are to be distinguished: 1) technical complications in plate positioning, length of the screws or secondary screw cutout strongly influence the final clinical result; and 2) specific complications related to this technology such as pseudarthrosis or plate fracture.
Background In a retrospective multicenter study, we evaluated the efficiency and outcomes of the different therapeutic options for infection after reversed shoulder arthroplasty. Methods Thirty-two ...patients were reoperated on for infection after reversed shoulder arthroplasty between 1996 and 2011. The mean age was 71 (55-83) years. The involved implants were primary prostheses in 23 cases and revision prostheses in 9 cases. The average preoperative Constant score was 34 (11-69). Six of these patients needed 2 successive procedures. A total of 38 procedures were performed: débridement (13), 1-stage (5) or 2-stage revision (14), or implant removal (6). At last follow-up (mean, 36 months; range, 12-137 months), every patient had clinical, biologic, and radiographic evaluation. Results Infections were largely caused by coagulase-negative staphylococci (56%) and Propionibacterium acnes (59%). The complication rate was 26%. At last follow-up, 26 patients were free of infection (81%). The final Constant score was 46 (12-75). After débridement with implant retention, the mean Constant score was 51 (29-75), but the healing rate was only 54%. Implant revision (1 or 2 stage) led to better functional results than implant removal (46 vs. 25; P = .001), with similar healing rates (73% and 67%, respectively). Patients with low initial impairment (Constant score > 30) were not significantly improved by surgical treatment. Conclusion Débridement is the less aggressive option but exposes patients to healing failure. It should be proposed as a first treatment attempt. Revision of the implant is technically challenging but preserves shoulder function, with no higher rate of residual infection compared with implant removal.
Eccentric posterior glenoid erosion is a common condition in osteoarthritis. No limits have ever been placed on the degree of eccentric erosion that can be corrected while still maintaining ...sufficient bone stock to implant a glenoid securely. Five cadaveric scapulae were dissected. Posterior glenoid erosion was created to simulate retroversion of 15° or more. A computed tomography (CT) scan confirmed the degree of glenoid retroversion. The glenoid was then reshaped to correct the glenoid retroversion to neutral, and a glenoid component with central and peripheral pegs was inserted. A second CT scan confirmed the correction to neutral and also evaluated the fit of the component into the glenoid. In all 5 experimental cases, at least 1 of the 4 pegs penetrated the glenoid vault. In 1 case, there was a fracture of the anterior rim. Glenoid retroversion of 15° or more cannot be satisfactorily corrected simply by reaming to lower the anterior edge of the glenoid and restore neutral version when using a glenoid component with peripheral pegs.
Summary The specific aims of this experiment were (1) to develop a clinically relevant model of anteroinferior shoulder dislocation in the apprehension position to compare the biomechanics of the ...intact anterior capsuloligamentous structures, and (2) to evaluate the initial strength of an open Bankart and of a coracoid abutment procedure. Fifteen shoulders from deceased donors were used. For the intact shoulders, mean peak load was 486 N, and stiffness was 26,7 N/mm. For the Bankart repair, the mean peak load was 264 N, and mean stiffness was 14.1 N/mm. Transosseous repairs failed by suture pullout through soft tissues. For the coracoid abutment repair, the mean peak load was 607 N and stiffness was 25.57 N/mm. This study reveals that the biomechanical performance of the Bankart and coracoid abutment repairs fails to reproduce the properties of the natural intact state.
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