Reverse shoulder replacement versus hemiarthroplasty for proximal humeral fracture in elderly patients: a systematic review.

This systematic review of the literature aims to analyse current knowledge to inform choice between hemiarthroplasty (HA) and reverse total shoulder arthroplasty (rTSA) for managing proximal humerus fractures (PHF) in elderly patients; the aim is to understand if rTSA can be considered the gold standard for treating PHF in the elderly when surgical fixation or conservative treatment is not viable options. Studies reporting outcomes and complications of PHF treated with shoulder arthroplasty in the elderly were included. Studies were in English and published after 2008. Evidence levels I, II, III and IV were included. According to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a comprehensive literature search was conducted using Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and PubMed search engines, as well as the Cochrane Central Register of Controlled Trials. General data collected were study design, number of patients treated with HA and rTSA, age of patients (mean, mean and SD, mean and range), length of follow-up, type of implant, and clinical outcomes. rTSA can be regarded as the gold standard for surgical management of displaced 3 and 4-part fractures in the elderly. However, the literature offers mostly low-quality studies, thereby requiring further work to achieve a full understanding of this important topic.

Outcome of a metaphyseal reverse total shoulder replacement in rheumatoid arthritis.

AIM: To assess the clinical and radiological results of a metaphyseal reverse total shoulder arthroplasty (rTSA) without diaphyseal stem, in rheumatoid arthritis (RA) patients. METHODS: Forty-five shoulders in 36 consecutive RA patients (2005-2015) underwent rTSA with a bone impaction technique. Patients were assessed clinically and radiographically preoperatively, at 3 weeks, 3 months, 6 months, 12 months post-operatively, and yearly thereafter, using constant score (CS), pain score, subjective shoulder value (SSV) and patient satisfaction score. RESULTS: Forty-four shoulders with mean follow-up of 67 months (range 24 m-146 m (12y)) were available for follow-up. Mean age at surgery was 68.7 years (range 39-86). CS improved from 17.5 ± 10.5(SD) (age/sex adjusted 23.9 ± 14.5(SD)) preoperatively to 60.9 ± 17.4 (SD) (age/sex adjusted 86.5 ± 24.5 (SD)) at last follow-up (P < 0.001). Pain score and SSV also significantly improved (p < 0.001). Mean range of movement improved to 140°active forward flexion, 134°active abduction, 47°active external rotation (AER) and 70°active internal rotation (AIR). The results were maintained over time. Combined early and late complication rate was 15.6%, which is lower than described in the literature for RA. No lucencies, loosening, subsidence or stress shielding were evident radiographically. CONCLUSION: Metaphyseal rTSA without a diaphyseal stem is successful and safe in RA patients. Patients achieve good function and have high satisfaction rates. LEVEL OF EVIDENCE: Case series: Level IV.

Factores clínicos que afectan a la calidad de vida percibida en la reconstrucción artroscópica de las luxaciones acromioclaviculares / Clinical factors that affect perceived quality of life in arthroscopic reconstruction for acromioclavicular joint dislocation

Objetivo. Analizar los resultados de la reparación artroscópica de la luxación acromioclavicular en términos de calidad de vida percibida. Material y método. Estudio prospectivo de pacientes con luxación acromioclavicular grados iii-vde Rockwood, tratados artroscópicamente con un seguimiento medio de 25,4 meses. Se registraron los datos demográficos de la serie y se realizaron evaluaciones antes de la cirugía, a los 3 meses y a los 2 años con los cuestionarios validados Short Form-36 Health Survey (SF-36), escala visual analógica (EVA), The Disabilities of the Arm, Shoulder and Hand (DASH), Constant-Murley Shoulder Outcome Score (Constant) y Walch-Duplay Score (WD). Resultados. Se analizaron 20 pacientes, 17 hombres y 3 mujeres, con una edad media de 36,1 años. Según la clasificación de Rockwood, 3 pacientes fueron grado iii, 3 grado iv y 14 grado v. Se objetivó mejoría tanto funcional como clínica en todos los test clínicos analizados (SF-36, EVA y DASH) tanto a los 3 meses como a los 2 años (p<0,001). El valor final del test de Constant fue de 95,3±2,4 y el WD medio fue de 1,8±0,62. No se encontró que la calidad de vida percibida se viera afectada por ninguna variable a estudio, excepto por la evolución del DASH. Conclusiones. La calidad de vida percibida (valorada mediante el SF-36) en pacientes intervenidos artroscópicamente de luxación acromioclavicular grados iii-v no se ve influida por el sexo, la edad, el grado, el desplazamiento, la lateralidad, la evolución de la EVA, la puntuación del Constant ni por el WD. Sí se correlaciona con la evolución en el DASH (AU)

Objective. To analyse the results of arthroscopic repair of acromioclavicular dislocation in terms of health-related quality of life. Material and method. Prospective study of patients with acromioclavicular dislocation Rockwood grade iii-v, treated arthroscopically with a mean follow up of 25.4 months. The demographics of the series were recorded and evaluations were performed preoperatively, at 3 months and 2 years with validated questionnaires as Short Form-36 Health Survey (SF-36), visual analogue scale (VAS), The Disabilities of the Arm, Shoulder and Hand (DASH), Constant-Murley Shoulder Outcome Score (Constant) and Walch-Duplay Score (WD). Results. Twenty patients, 17 men and 3 women with a mean age of 36.1 years, were analysed. According to the classification of Rockwood, 3 patients were grade iii, 3 grade iv and 14 grade v. Functional and clinical improvement was detected in all clinical tests (SF-36, VAS and DASH) at 3 months and 2 years follow up (P<.001). The final Constant score was 95.3±2.4 and the WD was 1.8±0.62. It was not found that the health-related quality of life was affected by any variable studied except the evolution of DASH. Conclusions. The health-related quality of life (assessed by SF-36) in patients undergoing arthroscopic repair of acromioclavicular joint dislocation grades iii-v was not influenced by gender, age, grade, displacement, handedness, evolution of the VAS, scoring of the Constant or by the WD. However, it is correlated with the evolution in the DASH score (AU)

Clinical factors that affect perceived quality of life in arthroscopic reconstruction for acromioclavicular joint dislocation. / Factores clínicos que afectan a la calidad de vida percibida en la reconstrucción artroscópica de las luxaciones acromioclaviculares.

OBJECTIVE: To analyse the results of arthroscopic repair of acromioclavicular dislocation in terms of health-related quality of life. MATERIAL AND METHOD: Prospective study of patients with acromioclavicular dislocation Rockwood grade iii-v, treated arthroscopically with a mean follow up of 25.4 months. The demographics of the series were recorded and evaluations were performed preoperatively, at 3 months and 2 years with validated questionnaires as Short Form-36 Health Survey (SF-36), visual analogue scale (VAS), The Disabilities of the Arm, Shoulder and Hand (DASH), Constant-Murley Shoulder Outcome Score (Constant) and Walch-Duplay Score (WD). RESULTS: Twenty patients, 17 men and 3 women with a mean age of 36.1 years, were analysed. According to the classification of Rockwood, 3 patients were grade iii, 3 grade iv and 14 grade v. Functional and clinical improvement was detected in all clinical tests (SF-36, VAS and DASH) at 3 months and 2 years follow up (P<.001). The final Constant score was 95.3±2.4 and the WD was 1.8±0.62. It was not found that the health-related quality of life was affected by any variable studied except the evolution of DASH. CONCLUSIONS: The health-related quality of life (assessed by SF-36) in patients undergoing arthroscopic repair of acromioclavicular joint dislocation grades iii-v was not influenced by gender, age, grade, displacement, handedness, evolution of the VAS, scoring of the Constant or by the WD. However, it is correlated with the evolution in the DASH score.

Artroplastia de revisión de prótesis de superficie de hombro hacia prótesis invertida no cementada con vástago corto / Revision shoulder arthroplasty from resurfacing to non-cemented short-stem reverse prosthesis

Objetivo. Valorar los parámetros perioperatorios y los resultados clínicos y radiológicos de la cirugía de revisión de las prótesis de superficie de hombro recambiadas hacia prótesis invertida no cementada con vástago corto. Material y métodos. Entre 2005 y 2012, se realizaron 23 revisiones de prótesis de superficie de hombro a prótesis invertidas. La edad media fue 70,3 años ± 11,95. Un 82,6% (19/23) de los recambios se realizaron por rotura secundaria del manguito rotador; 13,04% (3/23) por aflojamiento aséptico del componente glenoideo más insuficiencia del manguito y 4,35% (1/23) por fractura periprotésica. Se documentaron: necesidad de ventanas humerales y aloinjerto estructural, duración del procedimiento, pérdidas hemáticas, transfusiones y fracturas intraoperatorias. Seguimiento mínimo de 25 meses. Resultados. En ninguno de los casos se necesitó realizar una ventana humeral para la extracción del implante de superficie, así como tampoco aloinjerto estructural. En 8,69% (2/23) de los casos se requirió aloinjerto para reconstrucción glenoidea. La duración del procedimiento fue 113,35 ± 21,30 min. Las pérdidas hemáticas intraoperatorias fueron 374 ± 245,09 mls. Se requirió hemotransfusión en un caso. Se produjo una fractura intraoperatoria. El Constant mejoró de 17,32 a 59,78 (ajustado por sexo y edad, 84). La satisfacción general aumentó de 1,37 a 8,04. El recorrido articular aumentó 79,57° en elevación anterior; 72,88° en abducción; 38,06° en rotación interna; y 13,57° en rotación externa. No hubo evidencia de radiolucencias, hundimientos, ni resorción ósea. Conclusión. La artroplastia de revisión de las prótesis de superficie de hombro recambiadas hacia prótesis invertida no cementada con vástago corto ofrece buenos resultados clínicos y radiológicos, representando una técnica con complejidades intraoperatorias mínimas. Nivel de evidencia IV, serie de casos (AU)

Objective. To assess the surgical parameters and the clinical and radiological outcomes of revisions of resurfacing shoulder arthroplasty to non-cemented short-stem reverse total shoulder arthroplasty. Material and methods. A total of 23 revisions from resurfacing shoulder arthroplasty to reverse total shoulder arthroplasty were performed. The mean age was 70.3 ± 11.95 years. The patients included 82.6% (19/23) revised for cuff failure; 13.04% (3/23) cuff failure and aseptic loosening, and 4.35% (1/23) peri-prosthetic fracture. The need for humeral osteotomy or structural allograft, operation length, blood loss, blood transfusions and intraoperative fractures were recorded. Minimum follow-up 25 months. Results. No humeral osteotomy or humeral structural allograft was required, and 2/23 (8.69%) required allograft for glenoid reconstruction. The mean operation time was 113.35 ± 21.30 minutes. Intra-operative blood loss was 374 ± 245.09 mls. Blood transfusion was required in one case. Intra-operative fracture occurred in 1 case. The Constant score improved from 17.32 to 59.78 (age/sex adjusted, 84). Overall satisfaction improved from 1.37 to 8.04. The range of motion increased 79.57° in forward elevation; 72.88° in abduction; 38.06° in internal rotation; and 13.57° in external rotation. There was no evidence of radiolucency, subsidence, or bone resorption. Conclusion. Revisions of resurfacing implants to non-cemented short-stem reverse prosthesis show good clinical and radiological outcomes, with minimal intra-operative complexities. Level of evidence IV, case series (AU)

Revision shoulder arthroplasty from resurfacing to non-cemented short-stem reverse prosthesis. / Artroplastia de revisión de prótesis de superficie de hombro hacia prótesis invertida no cementada con vástago corto.

OBJECTIVE: To assess the surgical parameters and the clinical and radiological outcomes of revisions of resurfacing shoulder arthroplasty to non-cemented short-stem reverse total shoulder arthroplasty. MATERIAL AND METHODS: A total of 23 revisions from resurfacing shoulder arthroplasty to reverse total shoulder arthroplasty were performed. The mean age was 70.3±11.95 years. The patients included 82.6% (19/23) revised for cuff failure; 13.04% (3/23) cuff failure and aseptic loosening, and 4.35% (1/23) peri-prosthetic fracture. The need for humeral osteotomy or structural allograft, operation length, blood loss, blood transfusions and intraoperative fractures were recorded. Minimum follow-up 25 months. RESULTS: No humeral osteotomy or humeral structural allograft was required, and 2/23 (8.69%) required allograft for glenoid reconstruction. The mean operation time was 113.35±21.30minutes. Intra-operative blood loss was 374±245.09 mls. Blood transfusion was required in one case. Intra-operative fracture occurred in 1 case. The Constant score improved from 17.32 to 59.78 (age/sex adjusted, 84). Overall satisfaction improved from 1.37 to 8.04. The range of motion increased 79.57° in forward elevation; 72.88° in abduction; 38.06° in internal rotation; and 13.57° in external rotation. There was no evidence of radiolucency, subsidence, or bone resorption. CONCLUSION: Revisions of resurfacing implants to non-cemented short-stem reverse prosthesis show good clinical and radiological outcomes, with minimal intra-operative complexities. LEVEL OF EVIDENCE: IV, case series.

Artroplastia de la articulación interfalángica proximal: comparación entre el abordaje palmar y dorsal / Proximal interphalangeal joint replacement: a comparison between the volar and dorsal approach

Introducción. La artropatía de las articulaciones interfalángicas proximales (AIP) cursa con síntomas muy restrictivos, siendo algunos casos tributarios de artroplastia. En la mayoría de las series de artroplastias de las AIP la técnica utilizada es a través de un abordaje dorsal. El papel del abordaje palmar en la artroplastia de las AIP todavía no se ha valorado suficientemente. Objetivo. Revisar retrospectivamente los pacientes intervenidos de artroplastia de la AIP, y determinar si las realizadas por vía palmar consiguen un rango de extensión mayor que las realizadas por vía dorsal. Pacientes y métodos. Entre 2005-2010 se realizaron 22 artroplastias de AIP. La media de seguimiento fue de 29 meses. El implante que se utilizó en todos los pacientes fue el implante de silicona de AIP modelo Avanta® (Avanta Orthopaedics, San Diego, California, EE. UU.). Se realizó un abordaje dorsal en 14 articulaciones y un abordaje palmar en 8. La valoración clínica preoperatoria incluyó la escala visual analógica (EVA) y el arco de movimiento. El arco de movimiento preoperatorio medio era de -15°/60° en ambos grupos. En la última visita del seguimiento, la EVA y el rango de movimiento se registraron y se compararon con los valores preoperatorios. Resultados. El arco medio de flexo-extensión postoperatorio del grupo del abordaje dorsal era de -15°/60°, y el del abordaje palmar de -2°/62°. Conclusión. En nuestra serie hemos observado que las artroplastias de AIP realizadas por vía palmar consiguen un rango de extensión mayor que aquellas realizadas por vía dorsal. El abordaje palmar ofrece las ventajas de mantener la integridad del mecanismo extensor (AU)

Introduction. Arthropathy of the proximal interphalangeal (PIP) joint symptoms is very restrictive, and in some cases arthroplasty is required. In most of the reported series of PIP silicone arthroplasty, the technique described is the dorsal approach. As far as we know, the role of the volar approach in PIP arthroplasty has still not been adequately assessed. Objectives. To retrospectively review the patients who had PIP joint arthroplasty, and to study the clinical and radiographic outcomes in relation to the approach: volar or dorsal. Methods. A total of 22 PIP joint replacements were performed between 2005 and 2010. The mean age was 56 years and the mean follow-up period was 29 months. The implant used in all patients was the Avanta® PIP Soft-Skeletal Implant (Avanta Orthopaedics, San Diego, USA). The dorsal approach was performed in 14 joints, and a volar approach in 8 joints. The preoperative clinical evaluation included a visual analogue scale (VAS) and the range of motion (ROM). The preoperative ROM mean was -15°/60° in both groups. The VAS and the ROM in the last follow-up visit were recorded and compared with preoperative values. Results. The postoperative ROM of the dorsal approach group had a mean of -15°/60°, and that of the volar approach was -2°/62°. Conclusion. It was found that the volar approach in this series offers the advantages of maintaining the integrity of the extensor mechanism, resulting in a complete restoration of the extension in the range of motion (AU)

Fractura-avulsión bilateral simultánea de la tuberosidad tibial anterior / Simultaneous anterior tibial tubercle avulsion fracture

La fractura-avulsión de la tuberosidad tibial anterior (FATTA) es una lesión infrecuente, siendo la variante bilateral simultánea realmente excepcional. Presentamos el caso de un adolescente masculino de 13 años que presentó una FATTA bilateral simultánea en el contexto de aterrizaje tras un salto, realizándose tratamiento mediante reducción abierta y fijación interna con tornillos canulados. A los 15 meses de seguimiento tras la intervención, el paciente no refería dolor y el balance articular era de 0-130° (AU)

Avulsion fracture of the anterior tibial tuberosity (AFATT) is a very rare injury, and the simultaneous bilateral variant is exceptional. We report the case of a 13-year-old male teenager who had a simultaneous bilateral AFATT in the context of landing from a jump, in whom open reduction and internal fixation (ORIF) with cannulated screws was performed. At 15 months follow-up after surgery, the patient was not complaining of any pain and the range of motion was 0-130º (AU)

[Proximal interphalangeal joint replacement: A comparison between the volar and dorsal approach]. / Artroplastia de la articulación interfalángica proximal: comparación entre el abordaje palmar y dorsal.

INTRODUCTION: Arthropathy of the proximal interphalangeal (PIP) joint symptoms is very restrictive, and in some cases arthroplasty is required. In most of the reported series of PIP silicone arthroplasty, the technique described is the dorsal approach. As far as we know, the role of the volar approach in PIP arthroplasty has still not been adequately assessed. OBJECTIVES: To retrospectively review the patients who had PIP joint arthroplasty, and to study the clinical and radiographic outcomes in relation to the approach: volar or dorsal. METHODS: A total of 22 PIP joint replacements were performed between 2005 and 2010. The mean age was 56 years and the mean follow-up period was 29 months. The implant used in all patients was the Avanta® PIP Soft-Skeletal Implant (Avanta Orthopaedics, San Diego, USA). The dorsal approach was performed in 14 joints, and a volar approach in 8 joints. The preoperative clinical evaluation included a visual analogue scale (VAS) and the range of motion (ROM). The preoperative ROM mean was -15°/60° in both groups. The VAS and the ROM in the last follow-up visit were recorded and compared with preoperative values. RESULTS: The postoperative ROM of the dorsal approach group had a mean of -15°/60°, and that of the volar approach was -2°/62°. CONCLUSION: It was found that the volar approach in this series offers the advantages of maintaining the integrity of the extensor mechanism, resulting in a complete restoration of the extension in the range of motion.

Injerto óseo vascularizado y fijación con mini-acutrak (R) en las pseudoartrosis de escafoides con necrosis del polo proximal / Vascularised bone graft with mini-acutrak (R) fixation in scaphoid pseudoarthrosis with proximal pole necrosis

Objetivo. Evaluar los resultados del injerto óseo vascularizado (IOV) de la arteria 1, 2 suprarretinacular intercompartimental (1,2 SRIC) junto con la fijación, en pseudoartrosis de escafoides y necrosis del polo proximal. Material y método. Realizamos un estudio retrospectivo, entre enero de 2006 y diciembre de 2009. Se trata de 10 pacientes con pseudoartrosis de escafoides con necrosis del polo proximal. Todos eran varones con edad media de 27 años (rango: 18-46). El seguimiento medio fue de 18 meses (rango: 12-43). La evaluación clínica incluye el dolor según la escala visual analógica (EVA), el balance articular y la fuerza de prensión. La evaluación radiológica incluye radiografías, TC y RNM. Se midió el ángulo escafolunar y la altura carpiana de acuerdo con el índice de Nattrass et al. La escala utilizada fue la Mayo Wrist Score. Resultados. La consolidación tuvo lugar en todos en un tiempo medio de 15 semanas (rango: 6-25 semanas). La media de EVA preoperatoria fue de 4,5 (2-8) y postoperatoria de 1 (0-2). El índice de la altura carpiana de Nattrass preoperatorio fue de 1,50 y postoperatorio de 1,58. El ángulo escafolunar medio preoperatorio fue de 52° y postoperatorio de 49°. Los valores preoperatorios de la Mayo Wrist Score fueron de 53 y los valores postoperatorios de 92. Conclusiones. La técnica que combina el IOV y la fijación con un tornillo mini-acutrak®, presenta buenos resultados, en el tratamiento de las pseudoartrosis de escafoides con necrosis del polo proximal. Preferimos el uso de la arteria 1,2 SRIC. En el caso de que esta arteria este ausente se pueden utilizar otros pedículos vasculares (AU)

Objectives. We studied the use of vascularized bone graft (VBG) in combination with a fixation with screw in patients with scaphoid nonunion and avascular proximal poles. Materials and methods. Between January 2006 and December 2009, we treated 10 patients with scaphoid nonunion with avascular proximal poles. There were 10 males with nonunion. Their average age was 27years (range: 18-46years). The average follow-up was 18 months (range: 12-43 months). The clinical valuation was the scale of pain (VAS), the range of motion and grip strength. The radiological valuation included radiographies, CT and MRI. We studied the scapholunate angle, the Carpal Height Index by Nattrass et al. and the Mayo Wrist Score. Results. The mean preoperative VAS was 4.5 (2-8) and postoperative VAS 1 (0-2). All patients achieved union in an average time of 15weeks (range: 6-25weeks). X-rays and CT showed a complete osseous union in all patients. Carpal Height Index was a mean of 1.50 preoperative and 1.58 postoperative. The scapholunate angle was a mean of 52° preoperative and 49° postoperative. Mayo Wrist Score was 53 preoperative and 92 postoperative. Conclusions. We have found that the technique which combines VBG with mini acutrak® screw, is successful in treating scaphoid nonunions with avascular poles. We prefer to use the vessel 1, 2 ICSRA. If this vessel is occasionally absent, other pedicles may be used (AU)