Stemless reverse shoulder arthroplasty: clinical and radiologic outcomes with minimum 2 years' follow-up.

BACKGROUND: Recently, a stemless reverse shoulder arthroplasty (RSA) design was developed to preserve bone stock. Clinical and radiologic studies of this design in larger cohorts with >100 patients are not frequent. The purpose of this study was to present the clinical and radiologic results of a newly developed stemless RSA implant. The hypothesis was that this design would provide similar clinical and radiologic results to other stemless implants, as well as stemmed implants. METHODS: Between September 2015 and December 2019, all patients who underwent primary RSA with a stemless Easytech prosthesis were considered eligible for inclusion in this prospective multicenter study. The minimum follow-up period was 2 years. Clinical outcomes consisted of the Constant score, adjusted Constant score, QuickDASH (short version of Disabilities of the Arm, Shoulder and Hand questionnaire) score, Subjective Shoulder Value, and American Shoulder and Elbow Surgeons shoulder score. Radiographic parameters included radiolucency, loosening, scapular notching, and specific geometric parameters. RESULTS: Stemless RSA was performed in 115 patients (61 women and 54 men) at 6 different clinical centers. The average age at the time of surgery was 68.7 years. The average Constant score was 32.5 preoperatively and showed significant improvement to 61.8 at latest follow-up (P < .001). The Subjective Shoulder Value also demonstrated significant improvement postoperatively (from 27.0 to 77.5, P < .001). Scapular notching was observed in 28 patients (24.3%); humeral loosening, 5 (4.3%); and glenoid loosening, 4 (3.5%). The total complication rate was 17.4%. Eight patients (4 women and 4 men) underwent implant revision. CONCLUSION: The clinical outcomes of the examined stemless RSA seem to be comparable to those of other humeral designs; however, the complication and revision rates are higher than those of historical controls. Surgeons should proceed with caution when using this implant until longer-term follow-up data are available.

Short term results of anatomic stemless shoulder replacement with peripheral neck fixation.

Background: Most of the current stemless implants are using a central neck fixation design. Easytech Stemless replacements (FX Solutions®, Viriat, France) were developed promoting the idea of peripheral fixation of the stemless implant. The aim of this study was to analyze clinical and radiological results of this stemless TSA implanted for osteoarthritis (OA). Methods: A retrospective study of patients who received TSA with the Easytech® Anatomical Shoulder System (FX Solutions®, Viriat, France) for OA was completed at five clinical sites. Preoperative and minimum 2 year follow-up Constant Scores and X-rays were evaluated. Two independent orthopedic surgeons analyzed X-rays to assess anatomy reconstruction and component migration. Revisions and serious adverse effects were reviewed. Results: 129 patients were analyzed with an average follow-up of 37.47 months (24-54). Seven patients had a revision surgery and one of these resulted in the removal of the Anchor Base. The postoperative Constant Scores showed significant improvement with a mean raw Constant Score of 73.78 (38.0-100.0, mean increase 40.96, P < .0001) and mean adjusted Constant Score of 99.14 (42.20-133.30, mean increase 55.68, P < .0001). Radiographic review demonstrated that no modification of the center of rotation (COR) at minimum 24 months was greater than 3 mm and in comparison to preoperative radiographs, restoration of COR was lateralized in 25% of the cases, medialized in 61.5% and 13.5% had no change in COR. The mean value of the cervico-diaphyseal angle was 130.2° (114; 149) at 3 weeks and 129.9° (113.5; 144.0) at 2 years, demonstrating no significant difference (P = .16). 36 patients (35%) had calcar remodeling. Univariate and multivariate logistic regression found no significant factor, which was associated with the variation of the cervico-diaphyseal angle over time, center of rotation, calcar remodeling, or final Constant Score. The Walch B2 and C glenoid subset of patients (n = 13) had overall survival rate of 90.9% [95% CI 75.4-100.0] vs. 98.0% [95% CI 95.3-100.0] in other glenoid types (P < .01). Walch B2/C patients were 4.44 [95% CI 1.13, 17.6] times more likely to have a Constant Score <85 (P = .03). Conclusions: The peripheral fixation of the Easytech® Anatomical Shoulder System for OA provides excellent clinical results and imaging stability at minimum two year follow-up. Elderly age, gender and BMI do not affect the stability.

Mid-Term to Long-Term Follow-Up of Stemless Anatomic Total Shoulder Arthroplasty.

Background: The purpose was to report mid-term to long-term clinical outcomes in a multicentre series of patients who received stemless total shoulder arthroplasty (TSA). The hypothesis was that stemless TSA would be a safe and effective treatment with satisfactory clinical outcomes. Methods: Authors retrospectively reviewed records of 62 stemless TSAs implanted between March 2013 and December 2014. Six were excluded because they had fractures or muscular impairment, which left 56: primary osteoarthritis (n = 49), rheumatoid arthritis (n = 4), avascular necrosis (n = 1), or glenoid dysplasia (n = 2). Outcomes were absolute Constant Score (CS), age-/sex-adjusted CS, and the American Shoulder and Elbow Surgeons (ASES) score. Proportions of patients that achieved substantial clinical benefits for absolute CS and ASES scores were determined. Results: Of the 56 patients, 8 (14%) died (unrelated to TSA), 5 (9%) were lost to follow-up, and 2 (4%) refused participation. One patient was reoperated for infection with implant removal (excluded from analysis), and one for periprosthetic fracture without implant removal. At 7.6 ± 0.5 years (range 6.8-9.3), the remaining 40 patients, aged 71.0 ± 8.5 years, achieved net improvements of 40.7 ± 15.8 (CS), 62%±23% (age-/sex-adjusted CS), and 59.7 ± 16.4 (ASES). Of patients with complete absolute CS (n = 37) and ASES score (n = 28), respectively, 33 (89%) and 27 (96%) achieved substantial clinical benefits. Conclusions: Stemless TSA yields improvements in functional outcomes at mid-term to long-term that exceed the substantial clinical benefits of the absolute CS and ASES score at a mean follow-up of 7.6 years. Although the findings of this study revealed low complications and revision rates, more studies are needed to confirm long-term benefits of stemless TSA. Level of evidence: IV, case series.

Is surgery needed for displaced olecranon fractures in patients aged 75 years or over?

BACKGROUND: For displaced olecranon fractures, surgery is the standard of care in young adults but remains controversial in patients aged 75 years or over. The objective of this study was to assess the functional and radiological outcomes and to describe the complications of surgical treatment in this older population. HYPOTHESIS: Surgery is the optimal treatment for displaced olecranon fractures in patients aged 75 years or over. MATERIALS AND METHODS: We retrospectively reviewed the files of patients who were 75 years of age or older when they underwent surgery for displaced olecranon fractures at our centre between January 2013 and December 2017. Functional and radiological outcomes were assessed at radiological fracture healing or at last follow-up. RESULTS: We included 29 patients with 30 fractures. Mean age was 82 years (range, 75-93 years). All 30 fractures were Mayo II or III, A or B. Tension-band wiring was used for 21 fractures, locked-plate fixation for 7 fractures, and double-plate fixation for 2 fractures. The mean Mayo Elbow Performance Score was 82.5 (range, 45-100). Complications occurred for 11 (37%) fractures, and the material was removed for 11 (37%) fractures. DISCUSSION: The complications resulted from a mismatch between fracture type, bone quality, and the internal fixation material. Compared to tension-band wiring, plate fixation was associated with more complications, many of which required removal of the material. Tension-band wiring was not sufficient for proximal fractures and type III B fractures, for which lacing is an alternative. Conservative functional treatment remains a wise option for type II olecranon fractures in these elderly patients. Surgery is required, however, in patients with type III fractures (fracture-dislocations). LEVEL OF EVIDENCE: IV, retrospective, single-centre, observational cohort study.

Tuberosity healing in reverse shoulder arthroplasty in traumatology: Use of an offset modular system with bone graft.

INTRODUCTION: Reverse shoulder arthroplasty (RSA) has become a common treatment in displaced proximal humeral fracture (PHF) in elderly patients due to inconstant results with osteosynthesis or hemiarthroplasty. RSA allows a good anterior elevation but rotational results are more random and depend on tuberosity healing. HYPOTHESIS: Use of an offset modular system (OMS) on the prothesis improve tuberosity healing and functional results. MATERIAL AND METHODS: This retrospective cohort analysed radiological and clinical outcomes at least one year after the use of RSA Humelock II Reversed (Fx Solutions) after a displaced PHF Neer 3 or 4 in patients over 70 years. The first criterion was tuberosity healing with or without the use of the OMS device on radiographs. The second criterion was a clinical analysis of active range of motion (ROM), anterior elevation (AAE), external and internal rotations (ER, IR), Constant, DASH, SSV, VAS scores according to tuberosity healing. We also analysed radiological and clinical complications. RESULTS: We analysed from November 2013 to May 2018 thirty-four RSA. Mean age was 78±5,7 years, mean follow up was 18±7,2 months and the mean tuberosity healing rate was 79%. Mean ROM were: 117±24 (AAE), 18̊±18 (ER) and L2 (IR). On the first analysis, healing tuberosity with cage was present on 24 (92%) patients versus 3 (37,5%) without (p<0,005). The second analysis showed a non-significant improvement on ER, IR, Constant, DASH and SSV. Complications found were three removal of prothesis after infection, one axillary nerve lesion, one ulnar paraesthesia and one humeral loosening. CONCLUSION: The use of the OMS cage allows a better consolidation of tuberosities in a significant way but no significant clinical effects was highlighted due to a small patient number in the study. LEVEL OF EVIDENCE: level III, retrospective cohort.

Case Report of an Injectional Anthrax in France, 2012.

(1) Background: Bacillus anthracis is a spore-forming, Gram-positive bacterium causing anthrax, a zoonosis affecting mainly livestock. When occasionally infecting humans, B. anthracis provokes three different clinical forms: cutaneous, digestive and inhalational anthrax. More recently, an injectional anthrax form has been described in intravenous drug users. (2) Case presentation: We report here the clinical and microbiological features, as well as the strain phylogenetic analysis, of the only injectional anthrax case observed in France so far. A 27-year-old patient presented a massive dermohypodermatitis with an extensive edema of the right arm, and the development of drug-resistant shocks. After three weeks in an intensive care unit, the patient recovered, but the microbiological identification of B. anthracis was achieved after a long delay. (3) Conclusions: Anthrax diagnostic may be difficult clinically and microbiologically. The phylogenetic analysis of the Bacillus anthracis strain PF1 confirmed its relatedness to the injectional anthrax European outbreak group-II.

[The role of short Telegraph nail in the treatment of fractures of the upper end of the humerus: about 19 cases]. / La place du clou Telegraph court dans le traitement des fractures de l'extrémité supérieure de l'humérus: à propos de 19 cas.

The fracture of the upper end of the humerus is the third most frequent fracture in the elderly and its distribution is bimodal, preferentially affecting osteoporotic elderly patients after low energy trauma or, more rarely, young subjects as a consequence of severe kinetic mechanism The treatment of complex fractures of the proximal humerus is the subject of much controversy. Telegraph nail is a highly effective therapeutic approach for displaced fractures of the upper end of the humerus. Surgical procedure is easy but with a learning curve; it allows to start rehabilitation protocol immediately after surgery. It is an antegrade nailing material, 15 cm long, with full proximal and distal locking. Proximal locking is secured by 4 cancellous screws, long thread, stable in the nail ensuring perfect solidity of the assembly while the distal locking screw is secured to deltoid tuberosity in the avascular zone and where there is no neural pathway. This study reports 19 case of patients with fractures of the humerus treated with short Telegraph nail between 2013 and 2015. It aims to investigate radio-clinical results and to assess the impact of this technique on shoulder function. Telegraph nail that has been used for more than 12 years or so met and continues to meet with strong success. It allows to trat very effectively simple fractures type 2 and 3, but also 4-fragment valgus impacted fractures Osteosynthesis by Telegraph nail is an efficient, rapid and reproducible surgical treatment option of the fractures of the upper end of the humerus even in case of complex fractures and allows for a more rapid return of shoulder mobility.

Surgical management of acute quadriceps tendon rupture (a case report with literature review).

Quadriceps tendon rupture is uncommon and often overlooked in emergency. Tearing affects weakening tendon by systemic diseases or some medications. The mechanism is generally indirect. Inability to actively extend the knee associated to a supra-patellar defect evoke easily the diagnosis without other investigations. Surgical repair is realized in emergency to completely restore the extension. We report a case of a patient who has sustained of complete quadriceps tendon tear after a long period of tendon weakening by statin therapy, hypertension and diabetes. The repair has consisted on end-to-end Krackow sutures associated with bone suture to the proximal pole of the patella. Surgeons and emergency physicians must think to this form of extensor apparatus rupture, because early diagnosis leads to early treatment and to best outcomes.

Surgical management of acute distal biceps tendon rupture associated with contralateral radial palsy.

Acute distal biceps tendon rupture constitute a rare lesion of biceps injuries, typically, easy to diagnosis after lifting a heavy object. Treatment is controversial, nonoperative for sedentary and elderly patients; surgical for young and active individuals. Many operative techniques are described, they all aim to restore an excellent strength of flexion and supination. We opted for one-incision method and fixation using trans-osseous anchoring for our patient, because we are convinced that is a simpler and safer technique. Postoperative rehabilitation, after a period of elbow immobilization, must be operated for returning to full activity. Biceps tendon repair has permitted to our patient who suffer from right upper limb handicap due to radial nerve palsy, recuperating the lost strength and force in his dominant limb and maintaining some quality of life.

Knee megaprosthesis: a salvage solution for severe open and complex distal femoral fracture associated with an ipsilateral brachial plexus injury (a case report with literature review).

Complex distal femoral fractures in the young patient often occur as a result of high velocity trauma. Timely recognition and treatment is everything in such a situation, and it needs a robust staged management pathway to optimize the chance of limb preservation. We report a case of a motorcyclist admitted to the department of orthopedics at Chambery hospital, France, with a complex comminuted and open distal femoral fracture of the left leg, associated with a brachial plexus injury to the ipsilateral upper limb. On arrival to the emergency department, damage control stabilization and surgery was commenced, debridement of contaminated non-viable tissue, abundant antiseptic lavage and application of external fixation coupled with the use of antibiotic spacer. Following normalization of inflammatory markers and ensuring no clinical signs of infection, subsequent management consisted of joint reconstruction to achieve a functional knee. The external fixator and femoral spacer was removed and a modular megaprosthesis was implanted with a lateral gastrocnemius flap to cover the exposed knee joint and reinforce the extensor apparatus. Nerve graft to the left brachial plexus injury was performed at University Hospital of Grenoble. Our patient entered an intensive rehabilitation program and at 1 year follow-up achieved good knee function and sensation to the left upper limb.