Hemiarthroplasty for the treatment of complex proximal humeral fractures: does a trabecular metal prosthesis make a difference? A prospective, comparative study with a minimum 3-year follow-up.

BACKGROUND: Proper positioning and healing of the greater tuberosity are key for functional shoulder recovery after hemiarthroplasty for complex proximal humeral fractures. The purpose of this study was to compare the outcomes after hemiarthroplasty between a trabecular metal prosthesis and a conventional prosthesis in the treatment of complex proximal humeral fractures. METHODS: A prospective, comparative study was performed. We compared a trabecular metal shoulder prosthesis for the treatment of complex proximal humeral fractures in a cohort of 35 consecutive patients (TM group) with a conventional prosthesis in a cohort of 38 consecutive patients (conventional group). All the patients, with a mean age of 63.9 years, were prospectively followed-up for a mean time of 4.6 years (range, 3-6 years) after surgery. RESULTS: At the last follow-up, radiographic complication rates related to the greater tuberosity were lower in the TM group (6.1%) than in the conventional group (25.7%) (P = .028). The mean functional shoulder scores, as well as mean active forward elevation and external rotation, were better in the TM group than in the conventional group. CONCLUSIONS: Radiographic complication rates related to the greater tuberosity were significantly lower in the TM group than in the conventional group. The functional shoulder scores and active forward elevation and external rotation were all better in the TM group than in the conventional group. These findings could imply better healing potential of the greater tuberosity after hemiarthroplasty with a trabecular metal prosthesis to treat complex proximal humeral fractures.

Image of the month: Mycotic aortic arch pseudoaneurysm due to Salmonella enterica.

A 61-year-old man with hypertension and psoriasis, which was treated with adalimumab, was admitted after a 1-month history of fever following a dental implantation. Computed tomography of the chest revealed a pseudoaneurysm in the aortic arch, and blood culture grew Salmonella enterica A diagnosis of mycotic pseudoaneurysm of the aortic arch due to Salmonella was made, and he was treated with cefoperazone-sulbactam. During his hospital stay, he developed hoarseness followed by haemoptysis, and underwent thoracic endovascular aortic repair followed by emergency open surgical repair. However, he died 5 weeks after the surgery due to acute upper gastrointestinal bleeding, which was confirmed as an aortoesophageal fistula by oesophagogastroscopy.

Description and biological notes of the larva of Cionus olivieri Rosenschoeld, 1838 (Coleoptera, Curculionidae), with a comparison with other species of the tribe Cionini.

The mature larva of Cionus olivieri Rosenschoeld, 1838 is described and illustrated in detail for the first time. It is compared with those known from the same genus and other genera in the tribe Cionini and with those of the hypothesized sister tribe Mecinini in the Curculioninae. The larvae of Cionus have three distinctive diagnostic features: the reduced number of setae on the epicranium (only two or three des and one or two fs) and on the epipharyngeal lining (only two als, two ams, and no mes); i.e., distinctly fewer than the most frequent number of setae in weevils, and mandibles dentate or angulate internally near the base. If considered together with Stereonychus Suffrian, 1854, the other genus of Cionini with larvae studied in detail, it is preliminarily suggested that mature larvae of this tribe might be characterized by six main diagnostic features: (1) labial palpi one-segmented, (2) labral rods absent, (3) pedal areas swollen to form large lobes or prolegs, (4) mandible with sharp apical teeth, (5) reduced number of fs on frons, only one or two fs, and (6) reduced number of epipharyngeal setae (two or three als and two or three ams, but no mes). It was noticed that C. helleri Reitter, 1904 from Japan, a very distinct species in the genus for some characters of the adult, also possesses distinctive characters in the larva which are uncommon among known cionines. New biological data on C. olivieri with the discovery of its host plant, Verbascum songaricum (Scrophulariaceae), in central Asia are also reported.