Dynamic posterior stabilization of shoulder hemiarthroplasty in long-standing neglected posterior dislocation of the glenohumeral joint

Posterior dislocations of the shoulder are rare. They account for less than 3% of all shoulder dislocations. The treatment of neglected bilateral posterior dislocation of the shoulder is controversial. We present a novel operative technique to stabilize a shoulder hemiarthroplasty that we used in the treatment of a chronic posterior dislocation of a shoulder with an acute four-part fracture of the proximal humerus.     

Platform systems in shoulder arthroplasty

A platform system for shoulder arthroplasty can include a convertible modular humeral stem and/or a metal-backed glenoid component to facilitate straightforward conversion from either a hemiarthroplasty or anatomic total shoulder arthroplasty to a subsequent anatomic total shoulder arthroplasty, or more frequently, reverse total shoulder arthroplasty without any revision to the stem and/or glenoid baseplate. Recent studies have demonstrated a decreased rate of intraoperative humeral fracture, complications, and blood loss when a platform system is used and the humeral stem is not exchanged during revision arthroplasty. Future studies with larger patient cohorts are necessary to truly evaluate the potential value and limitations of this technology.     

Proximal femoral nail shows better concordance of gait analysis between operated and uninjured limbs compared to hemiarthroplasty in intertrochanteric femoral fractures

PurposeThe purpose of this study was to compare the results of pedobarographic gait analysis between the patients treated by proximal femoral nail or bipolar partial hemiarthroplasty due to intertrochanteric fractures.MethodsThirty-seven patients with a minimum 1-year follow-up who had been operated for intertrochanteric fractures were evaluated clinically, radiologically and with pedobarographic gait analysis. Proximal femoral nail had been performed to 21 patients (group A), whilst 16 patients had been operated by partial bipolar hemiarthroplasty (group B). Pedobarographic analysis was performed by measuring plantar pressure, force and contact area values in both static and dynamic manner. Pedobarographic results of operated limb were compared among groups. Same data's also were compared between operated and uninjured limbs in each group to determine any asymmetry on weight-bearing.ResultsAverage follow-up period in group A and group B was 36 (12–56) and 30 (12–48) months, respectively. There were no statistically significant differences among groups in terms of age, gender, body mass index, type and side of fracture, follow-up period, leg length discrepancy and postoperative hip scores. When the pedobarographic results of operated limb were compared, group B showed much more plantar force and pressure values than group A, on both static and dynamic evaluations. If the evaluation was taken into consideration to comparison of pedobarographic results between operated and uninjured limbs in each group, we found asymmetry in static load bearing, caused by higher load on uninjured limb in both groups. However, there was no statistically significant asymmetry between operated and uninjured limbs in respect to dynamic pedobarographic parameters for patients in group A. On the contrary, operated limbs in group B exposed much more plantar force and pressure values than uninjured limbs, which indicated asymmetric weight-bearing on dynamic evaluation.ConclusionsAssessment of pedobarographic parameters can be another way of measuring the results of treatment in intertrochanteric fractures. Uninjured limbs of patients expose much more loading than operated limbs in postoperative static evaluation for both treatment options. However in dynamic evaluation, there is a better concordance of gait analysis between both limbs in patients operated by proximal femoral nail.     

What would you do? Challenges in shoulder surgery

The treatment of glenohumeral joint disorders presents a challenge to the orthopedic provider. The adept shoulder surgeon must be facile with the management of both primary and complex shoulder pathologies. The cases presented are represented for their complexity and to present management principles that are fundamental to appropriate treatment of both simple and complex glenohumeral diseases. Furthermore, these cases are presented in the light of complex decision making regarding arthroplasty and the older active patient.     

人工肱骨头置换治疗肱骨近端四部分骨折

目的探讨人工肱骨头置换治疗肱骨近端四部分骨折的临床疗效。方法对46例肱骨近端四部分骨折患者采用人工肱骨头置换治疗,术后三角巾固定3~6(4.2±1.5)周。结果患者住院时间5~16(9.6±2.7)d。患者均获随访,时间12~27(15±3.6)个月。末次随访时优14例,良28例,可3例,差1例,优良率91.3%。随访期间无血管神经损伤、术后感染、脱位、松动等并发症。结论人工肱骨头置换是治疗肱骨近端四部分骨折的有效方法 ,可以显著缩短康复的时间,减少患者痛苦,改善关节功能。成功与否取决于患者和假体的正确选择、大结节的重建、后倾角的大小、肩袖的修补、精细的手术操作和完善的功能锻炼。     

Hemiarthroplasty vs primary total hip arthroplasty for displaced fractures of the femoral neck in the elderly: a meta-analysis

Current updated meta-analysis was designed to compare clinical effects of hemiarthroplasty (HA) vs primary total hip arthroplasty (THA) for displaced femoral neck fractures in elderly patients. Five randomized and 4 quasi-randomized controlled trials with a total 1208 patients were included for final analysis. It showed that mortality and postoperative infection between HA and THA had no statistical differences, that long-term reoperation rate of HA was higher than that of THA, that medium-term dislocation rate of HA was lower than that of THA, and that pain rates of HA in short-term and long-term were both higher than THA. Summarily, treatment of THA for elderly displaced femoral neck fracture could provide better results of reduced reoperation rate and pain relief; however, HA yielded a lower incidence of postoperative dislocation.