Surgical repair of acute and chronic pectoralis major tendon rupture: clinical and ultrasound outcomes at a mean follow-up of 5 years.

BACKGROUND: Pectoralis major (PM) tendon rupture is an uncommon injury whose incidence has risen in recent decades mainly as a result of the increasing number of sports-practising individuals. This study evaluates clinical and ultrasound (US) outcomes after surgical repair of acute and chronic PM tendon rupture. MATERIALS AND METHODS: Twelve men with PM tendon rupture (9 right and 3 left shoulders) were enrolled. Mean age was 34.6 years, and mean follow-up was 60 months (range 12-108). Rupture was diagnosed by magnetic resonance imaging. Eight patients underwent direct tendon repair (acute group) and 4 had allograft reconstruction (chronic group). Pain, range of motion, strength recovery and return to sports were assessed. Postoperative X-ray and US scans were obtained in all patients. Final outcomes were graded as excellent, good, fair or poor. Isometric strength in adduction/abduction, flexion, internal rotation (IR) and external rotation was recorded. RESULTS: There were 9 excellent and 3 good outcomes. A comparative strength assessment failed to show significant differences in any plane. Mean strength was not significantly different between affected and unaffected arm. Slight but significantly lower strength in IR with the arm adducted (p = 0.0306) was found in chronic patients. On US, all PM tendons appeared to be anatomically intact and continuous with the humerus. DISCUSSION: Prompt surgical repair ensures satisfactory outcomes in patients with complete PM rupture; however, delayed allograft repair provides good results with only slight strength impairment. Fresh insights are provided on the role of US in evaluating PM anatomy and tendon attachment to bone.

The X-Mas Box Osteosuture: A New Technique for Coracoid Process Fracture.

A fracture of the tip of the coracoid is a rare but challenging fracture. A surgical indication is required in case of a displaced fracture. Screws and suture anchors often do not offer a reliable fixation in the case of very small fragments. We describe our hardwareless technique that consists of an osteosuture with a 90-degree suture threads configuration that we called the x-mas box technique. This procedure is cost-effective and it provides stable fixation and low complications rate.

Bone mineral density and singh index predict bone mechanical properties of human femur.

The aim of our study was to assess the predictive value of the Singh index (SI), which estimates bone architecture, and bone density (BMD) when dealing with the mechanical competence of bone and to analze possible differences in bone properties between gender in humans. The relationship between SI, BMD, and mechanical competence was analyzed in 106 bone cylinders from 37 human femoral heads obtained during hip-joint replacement surgery for low energy fracture or for osteoarthritis. Bones from osteoporotic patients are less dense and more brittle compared with bones from osteoarthritic patients, as expected. Among osteoporotic patients female bones were more brittle than those from males, although BMD was similar. In osteoarthritic patients there were no significant differences among sexes. Bone mechanical competence varies according to BMD and to SI categories. Thus, our study suggests that bone strength is predicted by both BMD and bone architecture.

Informed consent in shoulder surgery.

Informed consent is an essential tool for diagnosis and therapy in medicine, and is of fundamental importance in surgery, where it underpins the operation itself. Its origins can be traced back to US forensic medicine but is now incorporated into the Italian legal system, with different consequences depending on the context in which it is applied. This article describes our experiences in shoulder surgery, with suitable references to legislation and analysis of the literature studies in this area.

Salter-Harris type II proximal humerus injuries: our experience with a new external fixator.

Proximal humeral fractures in the pediatric population are commonly treated conservatively. When there is an indication for surgery, percutaneous pinning is considered to be the elective choice. We report our experience with a new external fixator that reduces the risk of pin migration and permits an early rehabilitation. The range of motion was completely restored in all patients and no pain or discomfort was detected at follow-up. According to the literature, a small varus malunion at the first x-ray control can be tolerated in the pediatric population because of the remodeling ability of the bone. We conclude that this system provides a good stability and healing of Salter-Harris type II proximal humerus injuries.

Sequestrectomy in primary osteomyelitis of the humerus: a new indication for posterior approach.

Surgical treatment for primary osteomyelitis of the humerus is not well standardized; guidelines come from the scientific literature on osteomyelitis of the femur and tibia. Commonly deltopectoral approach is used for the proximal humerus and posterior approach for the distal humerus. Sequestrectomy alone or the use of antibiotic cement (bead pouch technique) is advised in case of chronic osteomyelitis. Berger and Buckwalter described a posterior approach to the proximal part of the humerus for an excisional biopsy of an osteoid-osteoma. We found that this approach is also useful for sequestrectomy in primary osteomyelitis of the humerus. We describe the technique and make a review of the literature.

The 'hit by a stick' disease: an epidemiologic study of the causes of trauma in a non-profit hospital in rural Ethiopia.

Traumatic injuries are one of the leading causes of death and disability worldwide and represent a very important public health problem in countries like Ethiopia, where there are insufficient centres of trauma care and where an interest in prevention has only relatively recently been awakened. The aim of this study was to investigate the causes of trauma at St Luke Catholic Hospital. We conducted a one-year retrospective study on 2969 patients who suffered from trauma. Every traumatized patient was classified by age, sex, cause and site of the trauma. The admission rate and hospital stays were also analysed. The most common causes of injury were: interpersonal conflict (32.2%); falling (15.1%); and road traffic incidents (RTIs; 14%). Men (71.7%) and young adults (37.6%; range 15-29 years) were the most affected, while head and neck were the most affected sites (33%). Half of the 377 admitted patients stay in hospital for more than a week. The 'hit by a stick' disease can be reduced with appropriate public health campaigns on trauma prevention. This is a priority in trauma prevention, especially in the rural areas.

Non-orthopaedic causes of shoulder pain: what the shoulder expert must remember.

Aim of this review is to underline some specific patterns of shoulder pain that are not related to musculoskeletal diseases but are manifestations of gastrointestinal, neurological, cardiological or rheumatological diseases. The most important pathologies (like gallstones, myocardial ischaemia and Parsonage-Turner syndrome...) that can manifest with shoulder pain will be presented by specialty doctors and elements for differential diagnosis will be discussed. Orthopaedic shoulder surgeons should always suspect other causes of pain, different from those related to bone, tendons and joint. If there is something unfair, patients should be referred to family doctor for further investigations in order to exclude major systemic diseases.

Gleno-Humeral arthritis in young patients: clinical and radiographic analysis of humerus resurfacing prosthesis and meniscus interposition.

Recently, interest about glenoid resurfacing with lateral meniscus in osteoarthritis of the shoulder has been increasing. Aim of this study is to evaluate the results of this procedure, from a clinical and a radiographic point of view. Constant score, DASH (Disability of the Arm, Shoulder, and Elbow) questionnaire, some specific questions about satisfaction after surgery, and radiographic exams were performed pre-operatively and post-operatively, at a minimum follow-up of 2 years. Constant score improved from 49.8 to 66.2. 84.4% of the patients were satisfied. Mean Dash was about 24.2 points. Gleno-Humeral measurement on X-Ray shows a good widening of the articular space after surgery (5.92 mm), but a narrowing (2.07 mm), at 2 years of follow-up. We have suspended glenoid resurfacing because narrowing of the articular space at follow-up can be related to meniscal resorption and clinical results are good but comparable with humeral resurfacing alone, as seen in the literature. Long-term follow-up studies are needed.

Importance of neurological evaluation before reverse shoulder arthroplasty in patients with previous poliomyelitis.

We present a case report of a patient, affected by post-polio syndrome and cuff tear arthropathy of his right shoulder, who underwent reverse shoulder arthroplasty. A previous radial deficiency was unmasked in the post-operative follow-up, with passive elbow bending when the forearm was put in an antigravitational position. A precise preoperative neurological evaluation is mandatory in shoulder replacement in order to estimate the functional outcome after surgery.

Correlation between radiographic risk for glenoid component loosening and clinical scores in shoulder arthroplasty.

Glenoid component loosening is the weak point in the failure of total shoulder arthroplasty (TSA). In this study we analyse the radiographic risk factors observed on 86 cemented polyethylene glenoid components and their relationship with clinical signs at a mean follow-up of 5.8 years. Clinical assessment included Simple Shoulder Test (SST) and Constant-Murley score. Radiograms were taken to detect periprosthetic radiolucency, tilt, medial displacement and polyethylene thinning. Pearson's correlation coefficient and Spearman's rank correlation coefficient were calculated for statistical analysis. In 61 patients (71%) lucent lines were less than 2 mm wide (grade 2) and in 6 cases (7%) they were >or=2 mm wide (grade 3 and 4). Thinning of the polyethylene was found in 11 cases (13%), glenoid tilt in 6 cases (7%) and medial migration of the component in 5 cases (6%). Complete glenoid prosthetic loosening was found in 3 cases (3.5%) associated with polyethylene wear and glenoid bone loss. The Constant-Murley score associated with radiolucency grade 3 and 4 was less than 45% (38.39 +/- 8.9) (p < 0.05), while a score less than 56% (30.72 +/- 8.7) was found in patients with glenoid tilt and medial migration (p < 0.01). The mean SST score was 4.8 +/- 2.8 in case of glenoid tilt and migration of the component (p < 0.01). Removal of the glenoid component and conversion to hemiarthroplasty or reverse prostheses is suggested in painful glenoid loosening. An exhaustive analysis of radiograms is essential to detect early and late complications or risk factors of glenoid loosening.

Reverse shoulder prosthesis as revision surgery after fractures of the proximal humerus, treated initially by internal fixation or hemiarthroplasty.

Complex (3-4 fragments) fractures of the proximal humerus often have a bad outcome, whatever treatment is performed. When revision surgery is required, reverse shoulder prosthesis can improve function and reduce pain in these patients. We analysed whether the choice of the first treatment (hemiarthroplasty vs. reduction and fixation) can influence the outcome of revision surgery. Our data demonstrate that results are not significantly dependent on the choice of the first implant, even though there is a tendency for patients with previous hemiarthroplasty to have a worse outcome.

Coracoid transfer in Bristow-Latarjet procedure: does it modify the biceps muscle?

The aim of this study is to evaluate the size and morphologic patterns of the biceps muscle after coracoid transfer performed during the Bristow-Latarjet procedure to treat anterior shoulder instability. We analyzed retrospectively 26 patients, who underwent a Bristow-Latarjet procedure, and 23 volunteers (control group) with no shoulder disease. A US machine (ATL 5000 HDI, probe 4.2 MHz) was used to determine the biceps section area (BA) and biceps echogenicity (BE). The dominant and non-dominant limbs in both groups were compared. The coracoid transfer performed in the Bristow-Latarjet procedure to treat recurrent anterior shoulder instability does not modify the size and morphology of the biceps muscle.