Percutaneous pinning of three- or four-part fractures of the proximal humerus in elderly patients in poor general condition: MIROS® versus traditional pinning.

PURPOSE: Elderly subjects often have fractures of the proximal humerus, which may be difficult to manage in patients in poor general condition. The MIROS is a new percutaneous pinning device allowing correction of angular displacement and stable fixation of fracture fragments. We evaluated the results of percutaneous fixation of three- or four-part fractures of the proximal humerus of patients in the American Society of Anesthesiologists physical status three or four treated either with MIROS or traditional percutaneous pinning (TPP). METHODS: A total of 31 patients treated with MIROS and 27 undergoing TPP were enrolled in the study. Pre-operatively anteroposterior and transthoracic or axillary radiographs were obtained in all cases and computed tomography scans in patients with the most complex fractures. Follow-up evaluations were carried out at three, six, 12 and 16 weeks, and six months, one year and two years postoperatively, using the Constant Score (CS) and subjective shoulder value (SSV) methods. RESULTS: Of the 58 patients, 52 could be evaluated at all follow-ups. In both three- or four-part fractures there were significantly higher CS and SSV scores in the MIROS compared to the TPP group at all the late follow-ups. Lower rates of deep infection, pin tract infection and pin mobilisation were found in the MIROS group (p < 0.001). In both groups there was a significant association between the final result (CS) and either the type of fracture or complications (p < 0.001). CONCLUSIONS: The MIROS resulted in better clinical results and less complications than TPP in elderly patients. This method, however, may not be indicated for younger patients in good general condition.

Long head of the biceps tendon rupture in professional wrestlers: treatment with a mini-open tenodesis.

BACKGROUND: The aim of this study is to assess the validity of a mini-open tenodesis of the long head of the biceps tendon (LHBT) performed on 5 professional wrestlers injured while fighting. METHODS: Five professional wrestlers with an acute rupture of the LHBT were treated with a mini-open tenodesis procedure without arthroscopic assistance. This technique is performed with 2 miniscule incisions of the skin. The tendon is prepared with biological fibrin glue and with a No. 2 Fiberwire; after that, the tendon is sutured to the bicipital groove with a suture anchor. At the follow-up exam (average 7.6 years; range, 2-13), clinical assessments were obtained with the Constant score (CS) and Mayo Elbow Performance Score (MEPS). Forearm flexion strength was measured with a dynamometer, and a magnetic resonance image was also obtained. RESULTS: At the follow-up, the average age of the patients was 32.6 years (range, 28-40). The average CS of the involved shoulder was 95 points (range, 92-98), compared to 97 points (range, 94-98) of the contralateral side (P = .37). The MEPS was 99.76 for the elbow of the involved side and 99.84 for the contralateral one (P = .34). No significant difference was noted for the forearm flexion strength (P = .31). DISCUSSION: In this study, patients were all high-demand wrestlers and biceps tenodesis was mandatory. Mini-opening without arthroscopic assistance tenodesis of the long head of the bicep tendon to the bicipital groove has been used for these professional wrestlers. Functional and cosmetic results of this technique have been excellent, and it allowed athletes to return shortly to their sport activity.

Health-related quality of life and subjective outcome after shoulder replacement for proximal humeral fractures.

Shoulder replacement has increased exponentially in recent decades, and previous studies have documented the effectiveness of this procedure. Pain relief, physical functional level, and health-related quality of life, however, were often not assessed. To our knowledge, no published articles have assessed quality of life in shoulder replacement for fracture. The main purpose of this study was to assess the patient-relevant outcomes in patients who underwent shoulder replacement for proximal humeral fractures. Standardized quality of life and shoulder-specific, self-administered questionnaires were used. On the Medical Outcomes Study Short Form 36 Health Survey, as expected, we observed a lower score in the domain compared with healthy Italian subjects. A surprising finding was that in the General Health and Role-Emotional domains, our sample had a better picture than the healthy one, probably because patients had experienced severe trauma and major surgery previously. These data represent the first step toward the definition of outcome for this procedure. This study does not address the necessity of therapy, but if this were included in future publications, it might provide useful data for therapeutic recommendations.