Displaced three and four part proximal humeral fractures: prospective controlled randomized open-label two-arm study comparing intramedullary nailing and locking plate.

PURPOSE: The aim of this study was (1) to compare clinical and radiological outcomes of 3- and 4-part proximal humeral fractures using either IMN or LP (2) and to report complications related to each technique. METHODS: A prospective controlled randomized open-label two-arm study was performed. Ninety-nine consecutive adult patients with a 3- and 4-part displaced acute proximal humeral fractures were randomized to be treated with IMN (n = 49) or LP (n = 50). Constant, ASES and SST scores were recorded by the surgeon. Range of motion was evaluated. A visual analog scale (VAS) was used to assess shoulder pain. Complications and revision surgeries were reported. RESULTS: Eighty-five patients were analyzed, nine were lost, and five died during the follow-up period. The mean age was 73.7 years (± 13.3,, and the mean follow-up was 66 months (± 13.5). At last follow-up, VAS was lower in the IMN group (0.9 (± 1.1) vs. 1.9 (± 1.7), p = 0.001). The median Constant score was significantly higher in the IMN group (81.6 (± 10.9) points) vs. in the LP group (75.6 (± 19.5) points) (p = 0.043), and ASES score was also significantly higher in the IMN group (86.3 (± 9.5) vs. 75.2 (± 19.6), p = 0.001). There was no difference in the range of motion or SST scores between the two groups. Complications were seen higher in the LP group (9 (21%) vs. 22 (52%), p = 0.003). Revision surgery was higher in the LP group (37% vs. 21%). CONCLUSION: Satisfactory results were accomplished in both groups according to the reported clinical outcomes. Complication and revision rates were higher in LP group.

Viscosupplementation in symptomatic severe hip osteoarthritis: a review of the literature and report on 60 patients.

Osteoarthritis of the hip is a frequent joint disorder in adults aged 50 years and older. The management focuses on pain reduction, by means of non-steroidal anti-inflammatory drugs and analgesics, physical therapy and weight reduction. When these treatments fail, total hip replacement can be considered. Viscosupplementation is a local therapeutic approach with the objective to decrease pain and to improve joint mobility. The treatment consists of injecting hyaluronic acid or hyaluronate derivatives intra-articularly. Although this approach is frequently used in young sportive adults to avoid knee surgery, its use in the severe osteoarthritic hip is less well documented. Moreover the injection of the hip joint is more difficult than injection of the knee joint, and on another hand the general condition of the patients is often already compromised. In this article we present a literature review on the subject and report the results in 60 patients who received intraarticular viscosupplementation of the hip with the objective to delay total hip replacement surgery.