Successful surgical treatment of a four part fracture dislocations of the proximal humerus and coracoid avulsion.

racture-dislocation of the proximal humerus (usually occurring after violent trauma) may be more frequently associated with a poor long-term results because the destruction of the hinged periosteum is associated with an high-risk of avascular necrosis of the head of the humerus (1, 2). Concomitant coracoid fracture with anterior shoulder dislocation in such case is something extremely rarely reported (8). Herein, we describe a challenging case of a 44 years old man with 4-parts fracture of the right proximal humerus, dislocation of the glenohumeral joint associated with coracoid avulsion. Considering the severe functional damage on the right shoulder, the patient was immediately treated with open reduction internal fixation (ORIF) at the level of the proximal humerus and with the concomitant placement of one screw at the level of coracoid avulsion. At a 15 months follow up we observed an excellent clinical and radiographic results. We take the opportunity of this unusual case for briefly discuss on such clinical condition and surgical options. (www.actabiomedica.it).

Acute posterior shoulder dislocation with reverse hill-sachs lesion of the epiphyseal humeral head.

Posterior dislocation of the shoulder is an unfrequent event that often occurs as a consequence of a direct trauma or epileptic crisis. Frequently the posterior dislocations are misunderstood, so they become chronic lesions. We reported a case of an acute posterior left shoulder dislocation with lesser tuberosity fracture and reverse Hill-Sachs lesions which involved more than 25% of the articular surface of the humeral head, in a 57-old-year man with right hemiparesis. We performed a synthesis of the lesser tuberosity with a screw, and we restored the shape of the humeral head with allograft. We achieved a good result that allows the patient to be able to do his previous activities of daily living.

Mini-open blind procedure versus limited open technique for carpal tunnel release: a 30-month follow-up study.

PURPOSE: To evaluate prospectively the safety and effectiveness of a mini-open blind technique for carpal tunnel release (group A) when compared with a limited open technique (group B). METHODS: From November 1999 to May 2001 (mean follow-up period, 30 mo) we performed 222 carpal tunnel release procedures on 185 consecutive patients. All patients were affected by mild to moderate median nerve compression. Patients in group A (82 patients, 99 procedures) had a short transverse incision at the wrist (length, 2 cm). We used a manual surgical instrument that helps in blindly dividing the flexor retinaculum because it has an integrated light source. The light makes it possible to locate precisely the tool blade by transillumination. Patients in group B (103 patients, 123 procedures) had a limited longitudinal incision (length, 3-4 cm). The preoperative and postoperative patient statuses were evaluated with an Italian modified version of the Boston Carpal Tunnel questionnaire with a mean of 30 months' follow-up after surgery (range, 24-39 mo). RESULTS: Group A patients showed better results than group B patients in all of the sections of the Italian modified version of the Boston Carpal Tunnel questionnaire at a mean follow-up period of 19 months, whereas after a mean of 30 months of follow-up evaluation the differences between groups A and B tended to decrease. Disease recurred in 7 group B patients, whereas only 1 patient in group A experienced symptom recurrence at the latest office evaluation. CONCLUSIONS: The blind mini-invasive technique has been shown to be as safe as traditional techniques but the recovery period is significantly shortened. With the technique we described a low recurrence rate was observed. All patients in group A reported great reduction in preoperative pain and numbness.