Functional outcome after proximal humeral fractures treated with hemiarthroplasty.

OBJECTIVE: To evaluate functional outcome after hemiarthroplasty for displaced proximal humeral fractures and to review whether prosthesis type, intraoperative technique or previous ipsilateral shoulder surgery could affect the outcome. METHODS: We reviewed the medical records and radiographs of patients who had undergone hemiarthroplasty for proximal humeral fractures between 1992 and 2000. We identified 45 patients, 39 with acute fractures and 6 with fracture-related complications. One surgeon performed 17 surgeries (38%), and the rest were carried out by 11 other orthopedic surgeons. Using the American Shoulder and Elbow Surgeons Evaluation Form and the Western Ontario Rotator Cuff Index, we evaluated patients who had been followed for at least 2 years for residual shoulder pain, range of motion, strength, stability and function. The senior authors reviewed the radiographs. RESULTS: The mean age of the patients at presentation was 70 (range 46-95) years. The mean active forward elevation was 87 degrees, abduction 63 degrees and external rotation 22 degrees; the mean internal rotation was to the L2 vertebra. Of the patients, 15% reported severe pain, and 25% were unable to sleep on the affected side. Patients with previous surgeries and those with intraoperative cuff tears were found to have more postoperative pain. CONCLUSION: We conclude that soft tissue status and operative technique play an important role in late postoperative pain and range of motion. Hemiarthroplasty after failed open reduction and internal fixation is associated with inferior results. We were unable to show a difference in long-term outcome related to the prosthesis type.

Ulnar styloid triquetral impaction.

BACKGROUND: Ulnar styloid triquetral impaction (USTI), one of many causes of ulnar sided wrist pain, is a pathological entity with clear clinical and radiographic features, distinct and different from the impaction of the ulnar head against the lunate or ulno-carpal impaction (UCI). Pain is ulnar and point-tenderness is present precisely over the ulnar styloid as opposed to the proximal lunate in UCI. The provocative maneouvre of dorsiflexion in pronation followed by supination is markedly different from the ulnar deviation grind test maneouvres used to diagnose UCI. Multiple anatomical and pathological features interplay to produce a situation in which the distance between the tip of the ulnar styloid and the triquetrum is reduced resulting in USTI. The concept of ulnar styloid variance is introduced and anatomical variations of ulnar styloid length are demonstrated. METHODS: The clinical and radiographic features of 56 patients diagnosed with USTI were analysed. One thousand standardised film-file wrist radiographs were measured to determine the average length of the ulnar styloid in the population as well as the average projection of the styloid above the radius (ulnar styloid variance). RESULTS: An aetiological classification system for USTI was developed based on the clinical and radiographic features of the aforementioned patients and radiographs. CONCLUSIONS: The causes of this syndrome are often complex and classification of the aetiological features is clinically useful. It is important for physicians and surgeons to recognise the clinical and radiographic features of this syndrome in order to properly manage the symptoms and prevent an iatrogenic production of USTI.

Combined anterior cruciate ligament reconstruction and unicompartmental knee arthroplasty: surgical technique.

Anterior cruciate ligament (ACL) reconstruction can be safely combined with medial unicompartmental knee arthroplasty from a technical point of view. The procedure has been performed in younger patients with the goal of preserving bone in case of need for future revision. The short-term results are encouraging although longer-term data are necessary to thoroughly evaluate the role of this procedure in patients with medial compartment osteoarthritis and ACL deficiency.

The effect of the wafer procedure on pressure in the distal radioulnar joint.

PURPOSE: To investigate the effect of the wafer procedure on pressure within the distal radioulnar joint. METHODS: The effect of increasing transverse distal ulnar head resection with preservation of the ulnar styloid was evaluated in 4 fresh frozen cadaver arms. Specimens were tested in neutral rotation. A standard transaxial load was applied from the radius to the ulna and the distal radioulnar joint intra-articular pressure was evaluated. RESULTS: Increasing amounts of distal ulnar resection led to a linear increase in pressure in the distal radioulnar articulation. CONCLUSION: The wafer procedure leads to an increase in pressure in the distal radioulnar joint that may lead to the early onset of osteoarthritis.