[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.

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 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.