[Functional results after shoulder hemiarthroplasty for proximal humerus fracture: experience in our center]. / Resultados funcionales tras hemiartroplastía de hombro por fractura de húmero proximal: experiencia en nuestro centro.

INTRODUCTION: shoulder hemiarthroplasty is being relegated as a treatment for non-osteosynthetic proximal humerus fractures. Our objective is to analyze the functional results of patients treated with hemiarthroplasty for this reason in our hospital. MATERIAL AND METHODS: cross-sectional descriptive study that includes patients operated between February 2016 and November 2021; 24 patients, with an average follow-up of 44.6 months. Active joint balance, the Constant-Murley test, the DASH questionnaire and current pain (VAS) were collected. The radiographic parameters analyzed were the number of fracture fragments and the consolidation of the tuberosities. RESULTS: a mean of 71.65 ± 13.75 was obtained in the Constant-Murley and 18.14% ± 13.92 in the DASH. For shoulder flexion, the mean was 108.75° ± 41.26; 104.5° ± 43.68 for abduction and 33° ± 14.73 for external rotation. About internal rotation, 60% of the patients reached the scapular plane. Average VAS was 1.25 ± 1.74. Consolidated tuberosities in 90.5%. There were no significant differences comparing the Constant-Murley test, DASH or rotations between both, over and under 65 years old group of patients. Those over 65 years of age obtained a mean flexion of 125.91° ± 26.82 whereas those under 87.78° ± 26.82 (p = 0.038). The mean abduction in those over 65 was 125.45 ± 28.94 vs 78.89 ± 46.29 in the young group (p = 0.012). CONCLUSION: hemiarthroplasty provides quality of life with acceptable functionality and good pain control, therefore it should continue to be an alternative to consider in selected patients.

INTRODUCCIÓN: la hemiartroplastía de hombro está siendo relegada como tratamiento de fracturas de húmero proximal no osteosintetizables. Nuestro objetivo es analizar los resultados funcionales de los pacientes tratados con hemiartroplastía por este motivo en nuestro centro. MATERIAL Y MÉTODOS: estudio descriptivo transversal que incluye a los pacientes intervenidos entre Febrero de 2016 y Noviembre de 2021; 24 pacientes, con un seguimiento medio de 44.6 meses. Fueron recogidos el balance articular activo, el test de Constant-Murley, el cuestionario DASH y el dolor actual (EVA). Como parámetros radiográficos se analizó el número de fragmentos de fractura y la consolidación de las tuberosidades. RESULTADOS: se obtuvo una media de 71.65 ± 13.75 en el Constant-Murley y de 18.14% ± 13.92 en el DASH. Para flexión de hombro la media fue de 108.75° ± 41.26; 104.5° ± 43.68 para abducción y 33° ± 14.73 para rotación externa. En rotación interna 60% llegaba hasta plano interescapular. EVA medio de 1.25 ± 1.74. Tuberosidades consolidadas en 90.5%. No hubo diferencias significativas entre el Constant-Murley, DASH ni rotaciones de pacientes mayores y menores de 65 años. Los mayores de 65 años obtuvieron flexión media de 125.91° ± 26.82 y los menores de 87.78° ± 26.82 (p = 0.038). La abducción media en mayores de 65 fue de 125.45 ± 28.94 versus 78.89 ± 46.29 en el grupo joven (p = 0.012). CONCLUSIÓN: la hemiartroplastía otorga calidad de vida con aceptable funcionalidad y buen control del dolor, por lo que debe continuar siendo una alternativa a tener en cuenta en pacientes seleccionados.

Treatment of Massive Irreparable Rotator Cuff Tears: A Cost-effectiveness Analysis.

Massive irreparable rotator cuff tears cause significant shoulder pain and dysfunction. Physical therapy (PT), arthroscopic debridement with biceps tenotomy (AD-BT), and hemiarthroplasty (HA) are treatments shown to reduce pain and improve quality of life. Reverse total shoulder arthroplasty (RTSA) is a newer surgical treatment option that may offer improved function. A cost-effectiveness analysis of these interventions has never been performed, and no head-to-head comparative effectiveness trials currently exist. A Markov decision analytic model was used to compare RTSA, HA, AD-BT, and PT as treatments for elderly patients with massive irreparable rotator cuff tears. Probabilities for complications, perioperative death, conversion procedures, and reoperations were derived from the literature, and costs were determined by average Medicare reimbursement rates from 2011. Reverse total shoulder arthroplasty yielded the most quality-adjusted life years (QALY) with 7.69, but greater benefits came at higher costs compared with other treatments. Sensitivity analyses showed that PT was the most cost-effective intervention at a health utility of 0.75 or greater (QALY 7.35). The health utility of RTSA was 0.72 or less (QALY 7.48) or RTSA probability of no complications was 0.83 or less (QALY 7.48 at cost of $23,830). Reverse total shoulder arthroplasty yielded benefits at a cost considered good value for money compared with other treatments. Reverse total shoulder arthroplasty is the preferred and most cost-effective treatment option for elderly patients with massive irreparable rotator cuff tears. For patients seeking pain relief without functional gains, AD-BT can be considered a cost-effective and cheaper alternative. The cost-effectiveness analysis approach can help guide clinical practice as well as the policies of health care systems and insurers. [Orthopedics. 2017; 40(1):e65-e76.].

Hip fracture evaluation with alternatives of total hip arthroplasty versus hemiarthroplasty (HEALTH): protocol for a multicentre randomised trial.

INTRODUCTION: Hip fractures are a leading cause of mortality and disability worldwide, and the number of hip fractures is expected to rise to over 6 million per year by 2050. The optimal approach for the surgical management of displaced femoral neck fractures remains unknown. Current evidence suggests the use of arthroplasty; however, there is lack of evidence regarding whether patients with displaced femoral neck fractures experience better outcomes with total hip arthroplasty (THA) or hemiarthroplasty (HA). The HEALTH trial compares outcomes following THA versus HA in patients 50 years of age or older with displaced femoral neck fractures. METHODS AND ANALYSIS: HEALTH is a multicentre, randomised controlled trial where 1434 patients, 50 years of age or older, with displaced femoral neck fractures from international sites are randomised to receive either THA or HA. Exclusion criteria include associated major injuries of the lower extremity, hip infection(s) and a history of frank dementia. The primary outcome is unplanned secondary procedures and the secondary outcomes include functional outcomes, patient quality of life, mortality and hip-related complications-both within 2 years of the initial surgery. We are using minimisation to ensure balance between intervention groups for the following factors: age, prefracture living, prefracture functional status, American Society for Anesthesiologists (ASA) Class and centre number. Data analysts and the HEALTH Steering Committee are blinded to the surgical allocation throughout the trial. Outcome analysis will be performed using a χ(2) test (or Fisher's exact test) and Cox proportional hazards modelling estimate. All results will be presented with 95% CIs. ETHICS AND DISSEMINATION: The HEALTH trial has received local and McMaster University Research Ethics Board (REB) approval (REB#: 06-151). RESULTS: Outcomes from the primary manuscript will be disseminated through publications in academic journals and presentations at relevant orthopaedic conferences. We will communicate trial results to all participating sites. Participating sites will communicate results with patients who have indicated an interest in knowing the results. TRIAL REGISTRATION NUMBER: The HEALTH trial is registered with clinicaltrials.gov (NCT00556842).

Simultaneous bilateral femoral neck fracture and end-stage renal disease in a 76-year-old woman: a case report.

Hip fracture is a common occurrence in the elderly. Due to the growing demand for the specific care of these patients, we established the Orthogeriatric Unit (OGU) at San Gerardo University Hospital (Italy) in 2007. However, simultaneous bilateral femoral neck fractures among the geriatric population (those aged ≥65 years) are rarely reported in the literature. Reporting the rare case of a frail 76-year-old woman admitted with bilateral hip fracture and end-stage renal disease, we explain the important role played by the OGU and its flexible multidisciplinary approach for providing comprehensive care to patients with multimorbidity and clinical complexity. The team of geriatricians, orthopedic surgeons, anesthesiologists, and, in this case, a nephrologist, helped in the careful planning and timing of the single-step surgical repair, decided the appropriate type of anesthesia, and optimized outcomes. After a prompt evaluation of the patient, the OGU approach can achieve clinical stabilization prior to intervention. Along with a strict follow-up in the postoperative phase, this could result in a significant reduction of complications and mortality rates and an early start to a tailored rehabilitation process. We strongly suggest employing facilities with multidisciplinary teams for cases involving complex patients at short-term high risk for poor clinical outcomes. Indeed, the usual single-specialist model of care is gradually being abandoned worldwide.