Proximal humeral internal locking plate combined with a custom neutral-position shoulder and elbow sling for proximal humerus fractures: A randomized study.

OBJECTIVES: The aim of this study was to investigate the effectiveness of the proximal humeral internal locking system (PHILOS) plate combined with a custom neutral-position shoulder and elbow sling for proximal humerus fractures. METHODS: A total of 112 patients with proximal humerus fractures were assigned randomly into 2 groups. Group A (n = 56) was treated by open reduction and internal fixation (ORIF) with a PHILOS plate; group B (n = 56) was treated by ORIF with a PHILOS plate in combination with the use of a custom neutral-position shoulder and elbow sling for 30 days after surgery. The incidence of internal fixation failure, the Constant-Murley shoulder assessment, and Visual Analogue Scale (VAS) score were recorded and analyzed. RESULTS: Patients included were followed up for an average of 15 months (range, 6-24 months). No significant differences were observed in mean VAS scores and mean Constant-Murley shoulder assessment scores at 1-day preoperative and postoperative day 3 between groups A and B. However, mean VAS scores and mean Constant-Murley shoulder assessment in group B were significantly improved when compared with group A at postoperative day 30 and the final follow-up. No cases of postoperative infection, loss of reduction, PHILOS break, or vascular nerve injury occurred in either group. CONCLUSIONS: Proximal humerus fractures treated with the combination of the PHILOS and custom neutral-position shoulder and elbow sling for 30 days after operation was associated with a lower incidence of internal fixation failure. There was no increase in adverse events compared with open reduction and internal fixation with a PHILOS plate alone.

[The clinical comparison of double knee osteoarthritis patients undergoing unicompartmental knee arthroplasty and total knee arthroplasty].

OBJECTIVE: To study the differences in clinical outcome of double knee osteoarthritis patients undergoing unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). METHODS: From May 2009 to May 2012, 30 patients (60 knees) with isolated compartmental osteoarthritis of knees were enrolled. Each patient accepted UKA on one knee, TKA on the other. There were 9 male and 21 female patients, aged from 60 to 79 years, average 69 years. Patients evaluation focused on the hospital for special surgery(HSS) knee score, blood loss, hemoglobin 48 h after the operation, the time of knee being able to flex to 90° and patients' sensation after operation. Collection the UKA side and TKA side data and compare two groups of data. RESULTS: All patients were followed up for 13 to 35 months, average 20.5 months. There were no component loosening and revision. HSS knee score improved significantly in both two groups: UKA group was promoted from 61 ± 3 to 87 ± 3 (t = 11.21, P < 0.001) and TKA group from 59 ± 5 to 86 ± 3 (t = 17.64, P < 0.001). Compared with the TKA group, the UKA group had less blood loss (t = 11.56, P < 0.001), and a decrease of hemoglobin 48 h after the operation (t = 12.38, P < 0.001). The dates of knees being able to flex ≥ 90° after operation were less (t = 4.03, P < 0.05) in the UKA group. As to therapeutic effects, 70% patients found that UKA was better than TKA; 16.7% patients had opposite opinion; and 13.3% patients found no differences between their two knees. CONCLUSIONS: UKA for the treatment of isolated compartmental osteoarthritis of knee shows as well as TKA, and it has less trauma, less blood loss, more rapid postoperative recovery than TKA.

[Clinical application of Wallis interspinous dynamic stabilization in treating adjacent segment degeneration (ASD) after lumbar spinal fusion].

OBJECTIVE: To evaluate therapeutic effects of Wallis interspinous dynamic stabilization in treating ASD after lumbar spinal fusion. METHODS: Totally 40 patients (included 16 males and 24 females, aged 25 to 60 years old) with degenerative disc disease were treated with posterior interbody fusion. Among them, 20 cases (treatment group) were treated with posterior interbody fusion combined with Wallis interspinous dynamic stabilization, while other 20 cases (control group) only treated with posterior interbody fusion. JOA score and VAS score were compared after inserted Wallis interspinous dynamic stabilization at 1 month and 3 years, and changes of intervertebral disc height of adjacent segment and cross-sectional area of the canal were tested and compared. RESULTS: All patients were followed up from 3 to 5 years with an average of 3.6 years. All injuries were healed at stage I and the pain were released after treatment. There were no significant meaning in JOA score and VAS score at 1 month after treatment between two groups (P>0.05), while had meaning at 3 years (P<0.05). There were no statistical significane in intervertebral disc height of adjacent segment and cross-sectional area of the canal at 1 month after treatment (P>0.05), while had statistical meaning at 3 years (P<0.05). CONCLUSION: There is no difference in immediate effects between two groups. Both of them can obtain good results for effective decompression. Medial-term effectiveness of treatment group is obviously better than control group, which depends on Wallis interspinous dynamic stabilization to plays good biology effects and effective accelerate adjacent degeneration caused by lumbar fusion.