Percutaneous cement augmentation for the treatment of depression fractures of the tibial plateau.

The management of insufficiency fractures of the tibial plateau in osteoporotic patients can be very challenging, since it is difficult to achieve a stable fixation, an essential condition for the patients' early mobilization. We present a minimally invasive technique for the treatment of proximal tibial plateau fractures, "tibiaplasty", using percutaneous polymethylmethacrylate augmentation. Five osteoporotic patients (7 fractures) with a non-traumatic insufficiency tibial plateau fracture were treated with this technique at the authors' institution from 2006 to 2008. The patients' median age was 79 (range 62-88) years. The intervention was performed percutaneously under general or spinal anesthesia; after the intervention, immediate full weight bearing was allowed. The technique was feasible in all patients and no complications related to the intervention were observed. All patients reported a relevant reduction in pain, were able to mobilize with full weight bearing and would undergo the operation again. No secondary loss of reduction or progression of arthrosis was observed in radiological controls; no revision surgery was required. Our initial results indicate that tibiaplasty is a good treatment option for the management of insufficiency in tibial plateau fractures in osteoporotic patients. The technique is minimally invasive, safe and allows immediate mobilization without restrictions. In our group of patients, we found excellent early to mid-term results.

[Correction of rheumatic forefoot. The value of a combined arthrodesis of the first toe and resection of metatarsal heads 2-5]. / Korrektur des rheumatischen Vorfusses. Stellenwert einer Kombination von Grosszehengrundgelenkarthrodese und Metatarsalköpfchenresektion 2-5.

INTRODUCTION: Resection of the metatarsal heads is an established procedure for the therapy of rheumatic forefoot deformations. However, a recurrence of lateral deviation of the lesser toes and painful plantar keratosis remain a challenging problem for the treatment of these patients. The aim of this study was to evaluate our results in cases of rheumatoid forefoot deformities. We performed a resection of the metatarsal heads 2-5 in combination with an arthrodesis of the first toe and resection of keratosis by the plantar approach. MATERIAL AND METHODS: Fifteen patients (20 feet) were followed-up clinically and radiologically using the American Orthopedic Foot and Ankle Society (AOFAS), Miehlke-, and Larsen scores. RESULTS: Average follow-up time was 3.5 years (range: 1.5-7.5 years). An average AOFAS score of 81/90 was found for the hallux and 90/100 for the lesser toes. A total of 18 feet were rated as pain free, while two feet showed some residual pain. Every case showed an harmonic cascade of the resection. All patients stated that the operation had improved their quality of life and that they would consent to undergoing it again. CONCLUSION: Our results after arthrodesis of MP-1 and resection of the metatarsal heads 2-5 using the plantar approach were good compared to the data published in the literature.

Influence of the design of the prosthesis on the outcome after hemiarthroplasty of the shoulder in displaced fractures of the head of the humerus.

We reviewed 39 patients with displaced three- and four-part fractures of the humerus. In 21 patients (group A) we had used an anatomical prosthesis for the humeral head and in 18 (group B) an implant designed for fractures. When followed up at a mean of 29.3 months after surgery the overall Constant score was 51.9 points; in group A it was 51.5 and in group B 52.4 points. The subjective satisfaction of the patients was assessed using a numerical rating scale and was similar in both groups. In group A complete healing of the tuberosities was found in 29% and 50% in group B. Partial integration was seen in 29% of group A and in only one patient in group B, while resorption was noted in 43% of group A and 44% of group B. The functional outcome was significantly better in patients with complete or partial healing of the tuberosities (p=0.022). The specific trauma prosthesis did not lead to better healing of the tuberosities. The difference in clinical outcome obtained by the two designs did not reach statistical significance.

[Migration of shoulder prosthesis as a consequence of hemi- or total arthroplasty]. / Die Dezentrierung des Schultergelenkes als Spätfolge nach hemi- und totalendoprothetischem Gelenkersatz.

BACKGROUND: Migration after shoulder arthroplasty can induce muscular dysbalance and instability of the shoulder joint. The aim of this study was to analyse the frequency, causes and consequences of secondary migration after shoulder arthroplasty. METHODS: 107 shoulder arthroplasties in patients with primary osteoarthritis (OA, n = 83) or avascular necrosis of the humeral head (AVN, n = 24), were followed clinically and radiographically over a period of 1 to 10 years. RESULTS: 17 Patients (16 %) developed secondary migration of the prosthesis. These were determined after a mean period of 33 months after shoulder arthroplasty. Patients with secondary migration of the prosthesis showed a worse function with a mean Constant score (CS) of 52.3 points in comparison to the patient group without migrated shoulder arthroplasties (62 points) (p = 0.038). In patients with total shoulder arthroplasty (TSA, n = 75), migration was observed in 13 % of cases during follow-up. Lucent lines at the glenoid were found in radiographs in 55 % of migrated shoulders and in 52 % of non-migrated shoulders (p = 0.633). The Constant score showed no significant difference between the groups (non-migrated shoulders 63 points, migrated shoulders 61 points, p > 0.5). Migration was seen in 22 % (7/32 patients) after hemiarthroplasty, however, no significant difference could be found between the respective Constant scores for migrated (47.7 points) or non-migrated (55.1 points) shoulders (p = 0.447). In patients with OA there was no significant difference in Constant score between migrated and non-migrated shoulders (p = 0.331), whereas patients with AVN showed significantly worse function after migrated shoulder arthroplasty (p = 0.007). CONCLUSION: Migration after total shoulder arthroplasty leads in the medium term neither to an increased frequency of lucent lines at the glenoid nor to a worsening of the functional score in comparison to non-migrated prosthesis. In patients with AVN, migration is accompanied by a worsening of the functional score and can consequently be regarded as a negative prognostic factor.