RESUMO
Background: To investigate the functional outcomes of reverse shoulder arthroplasty (RSA) in acute complex proximal humerus fractures (PHF) in patients with an anatomic greater tuberosity union in comparison to patients with a displaced or resorbed tuberosity. Method: It is a retrospective study with prospective data collection including 32 consecutive PHF with a minimum two-year follow-up treated with RSA. A radiological study and a CT scan were performed specifically for the study. Two shoulder surgeons and a musculoskeletal radiologist assessed the position and union of the greater tuberosity. The functional outcomes were assessed with the Constant-Murley, DASH, ASES and ADLER scores. Results: The mean overall CS was 59.55. In 17 cases, the greater tuberosity healed in an anatomical position. In 15 cases, it was non-anatomical. In 53% of patients, greater tuberosity union was obtained. The CS was 62.76 in the anatomic union group and 55.9 in the non-anatomic union group. No significant differences were observed. No differences were observed in the ASES, DASH and ADLER scores. Conclusion: After RSA for PHF, anatomic greater tuberosity healing was obtained in 53% of patients. The influence of the position and union of the greater tuberosity on the functional results could not be evidenced.
RESUMO
Se describe la clínica de dos pacientes con patologías no traumáticas de la articulación sacroilíaca a los que se les practicó con éxito una artrodesis siguiendo esta técnica. Una paciente, afecta de secuelas de poliomielitis presentaba una disyunción articular secundaria a sobrecarga mecánica; la otra, un proceso degenerativo de la articulación sacroilíaca. En ambos casos la fusión se mantiene estable a los 3 años de seguimiento. La técnica utilizada presenta la ventaja de que los tornillos en el ilíaco y en el pedículo de S-1 son fáciles de colocar obteniendo una fijación muy estable y un montaje de perfil bajo. Además, el tiempo operatorio es corto y la pérdida sanguínea mínima. Este método de artrodesis sacroilíaca puede ser una opción atractiva que debe considerarse cuando se indica una artrodesis y existe una anormalidad no-traumática de la articulación sacroilíaca
A previously described method by Belanger for posterior fusion of the sacroiliac joint utilizing pedicular instrumentation is presented, suitable for cases with chronic pain. Two patients with nontraumatic disorders of the sacroiliac joint who have undergone successful arthrodesis by this technique are presented. One patient, with poliomyelitis sequels, had sacroiliac disruption secondary to mechanical overloading; the other, had degeneration of the sacroiliac joint. In both cases their fusion remained stable after 3 years follow-up. The advantage of this technique, using iliac and S1 pedicular screws, is that the screws are relatively easy and rapid to insert. As they are connected to the rod a very stable fixation is achieve and this allows for a low-profil construct. This technique has reduced intra-operative blood loss and operative time. This method of sacroiliac arthrodesis may be an attractive option for surgeons who are familiar with pedicle screws instrumentation techniques. It should be considered when contemplating sacroiliac arthrodesis in the rare instance of nontraumatic sacroiliac abnormality