[Fixation of the tuberculum in multifragment fractures of the proximal humerus treated with hemiarthroplasty].

Hemiarthroplasty is an effective treatment for multifragmentary fractures of the proximal humerus. Purpose of this study was to compare 2 different methods of tuberosity dislocations,which is one of the primary reasons for successful posttraumatic arthroplasty. Between 2006 and 2008, 29 patients with multifragmentary fractures of the proximal humerus underwent hemiarthroplasty of the shoulder. Mean gae was 69y., while mean postoperative follow up was 27 months. We evaluated two different techiques of tuberosity fixation after anatomic reattachment on humeri: (A) intertuberosity suture stabilization around the prothesis, and their suture to the humeri and (B) direct intertuberosity suture and their suture to the humeri Postoperartive Constant score averaged 71 points. Reason for failure of the operative treatment was primary due to the postoperative tuberosity migration It was noted in all patients of group 2 and in 2 patients of group 1. Intertuberosity stabilization using sutures arpund the prothesis and tuberosity fixation to the humeri was proofed to be optimal method, because it decreased strain and mobility of tuberosities, maximize stability of the hemiarthroplasty and facilitate postoperative rehabilitation.

[Intramedullary fixation and proximal femoral fractures: diversity in use through case reports].

Proximal femoral fractures, including intertrochanetric and subtrochanteric with diaphiseal propagation represent a significant challenge in orthopedic surgery, especially in older population. Retrospective analysis of patients, after the application of "Bi Nail (Bioimpianti Inc.) intramedullary nail for fractures and pathological conditions of proximal femur, was done at the Department of Adult Orthopedics, Institute of Orthopedic surgery Banjica, during the three year period. We present patients with complex fractures and pathological conditions (metastasis and pseudoarthrosis) of proximal femur; most of the fractures were result of effects of low energy, and the most common pathological fracture is due to metastasis of breast cancer. The analysis included the technical characteristics and duration of surgery, intraoperative and postoperative complications as well as the coalescence time of fracture healing and postoperative quality of life after rehabilitation. We believe that the described surgical method, although technically demanding, with a variable length duration of surgery and treatment of high risk elderly patients, provides stable fracture fixation with early rehabilitation to improve the quality of life.

Unusual position of bone tunnels in failed ACL reconstruction.

INTRODUCTION: Surgery of ACL deficient knees is very frequent nowadays due to advanced surgical techniques, sophisticated implants and large number of surgeons. Therefore, the number of revisions for various reasons is growing up. There are several well known reasons for failed surgery This paper reported a case of revision surgery in a patient with previously done and failed reconstruction of ACL. CASE OUTLINE: Reviewing the clinical findings and X rays we found out peculiar position of the transplant and tunnels as a cause of the failure. We haven't found such complication reported in literature therefore we decided to report the case. CONCLUSION: Variety of implants and instruments can ease the surgery but basic anatomical knowledge of position and relations of the knee ligaments are essential for good surgical outcome.

Treatment of locked chronic posterior dislocation of the shoulder by reconstruction of the defect in the humeral head with an allograft.

The treatment of a chronic posterior dislocation of the shoulder is often determined by the size of the associated impression fracture of the humeral head. Our hypothesis was that patients with a chronic unreduced posterior dislocation of the shoulder and a defect in the humeral head involving between 25% to 50% of the articular surface, would do better if reconstructed with an allograft from the femoral head rather than treated by a non-anatomical reconstruction. We reviewed ten men and three women with a mean age of 42 years (36 to 51) at a mean follow-up of 54 months (41 to 64) who had this procedure. At follow-up, nine had no pain or restriction of activities of daily living. Their mean Constant-Murley shoulder score was 86.8 (43 to 98). No patient had symptoms of instability of the shoulder. Reconstruction of the defect in the humeral head with an allograft provides good pain relief, stability and function for patients with a locked, chronic posterior dislocation where the defect involves between 25% and 50% of the circumference of the articular surface.

[Treatment of unreduced posterior dislocations of the shoulder].

Unreduced posterior dislocations of the shoulder are rare and difficult to treat. Treatment depends of defect of the humeral head. Since 1997 to 2002 eleven patients were referred to us for treatment unreduced posterior dislocations of shoulder with impressed fracture of the humeral head. Dislocations have lasted between two to eight months. All patients were treated with open reduction. Allograft reconstruction of the defect was used in six and hemiarthroplasty in two cases. As assessed with the scoring system of Constant, patients were rated excellent (9), satisfactory (1), unsatisfactory (1). Allograft reconstruction is the optimal choice for defects involving 20% to 45% of the humeral head. Prosthetic replacement is preferred for larger defects. Reconstruction of the defects involving less than 20% of the humeral head is not necessary. The observation is only ment to serve as a guide during decision making. The surgeon must make his own surgical choice based on the individual patient factors and on the intraoperative findings.

[Treatment of resistant frozen shoulder by manipulation under anesthesia, intermittent interscalene blocks and protocol of kinesitherapy (Banjica)].

Treatment of frozen shoulder resistant to conservative therapy is complex problem. Manipulation under anesthesia is undertaken if at least 3 months of physical therapy fails to improve mobility of the shoulder. Maintaining the increased range of montion after manipulation is not easy to acheive. The main reaxon is the pain, which prohibits optimal physical therapy were treated between 2001 and 2003. The treatment consisted of manipulation in conjunction with intermittent interscalene blocks followed by protocol of kinesitherapy named Banjica. At final follow up, 95% of the elevation and 81% of the external rotation achieved intraoperatively were maintained.