Arthroscopic treatment of an anterior glenoid fracture with a cannulated, headless screw and suture anchors: a case report

Recently, anterior glenoid fractures have been treated arthroscopically with either suture anchors or screws. The keys to this arthroscopic procedure are to repair the labrum and to firmly fix the osseous fragment. We used suture anchors to repair the labrum and reduce the osseous fragment, and a cannulated headless screw to fix the osseous fragment. This is the first case report of arthroscopic treatment of an anterior glenoid fracture using suture anchors and a cannulated headless screw.     

Anatomical glenoid reconstruction for recurrent anterior glenohumeral instability with glenoid deficiency using an autogenous tricortical iliac crest bone graft

BACKGROUND: Anterior shoulder instability associated with severe glenoid bone loss is rare, and little has been reported on this problem. Recent biomechanical and anatomical studies have suggested guidelines for bony reconstruction of the glenoid. HYPOTHESIS: Anatomical glenoid reconstruction will restore stability in shoulders with recurrent anterior instability owing to glenoid bone loss. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Eleven cases of traumatic recurrent anterior instability that required bony reconstruction for severe anterior glenoid bone loss were reviewed. In all cases, the length of the anterior glenoid defect exceeded the maximum anteroposterior radius of the glenoid based on preoperative assessment by 3-dimensional CT scan. Surgical reconstruction was performed using an intra-articular tricortical iliac crest bone graft contoured to reestablish the concavity and width of the glenoid. The graft was fixed with cannulated screws in combination with an anterior-inferior capsular repair. RESULTS: At mean follow-up of 33 months, the mean American Shoulder and Elbow Surgeons score was 94, compared with a preoperative score of 65. The University of California, Los Angeles score improved to 33 from 18. The Rowe score improved to 94 from a preoperative score of 28. The mean motion loss compared with the contralateral, normal shoulder was 7 degrees of flexion, 14 degrees of external rotation in abduction, and one spinous process level for internal rotation. All patients returned to preinjury levels of sport, and only 2 complained of mild pain with overhead sports activities. No patients reported any recurrent instability (dislocation or subluxation). The CT scans with 3-dimensional reconstructions obtained 4 to 6 months postoperatively demonstrated union of the bone graft with incorporation along the anterior glenoid rim and preservation of joint space. CONCLUSION: Anatomical reconstruction of the glenoid with autogenous iliac crest bone graft for recurrent glenohumeral instability in the setting of bone deficiency is an effective form of treatment for this problem.     

The surgical outcome of immediate arthroscopic Bankart repair for first time anterior shoulder dislocation in young active patients

This study evaluated the surgical outcomes of young active patients with arthroscopic Bankart repair within 1 month after first-time anterior shoulder dislocation. From July 2002–October 2004, patients presented with first-time traumatic anterior shoulder dislocation and treated with arthroscopic stabilization within 1 month of injury were retrospectively reviewed. Magnetic resonance imaging and computed tomography were performed before the operation in all cases. Cases with contralateral shoulder multidirectional instability or glenoid bone loss of more than 30% on preoperative computed tomography on the injury side were excluded. All patients were treated with arthroscopic Bankart repair, using metallic suture anchors or soft tissue bio-absorbable anchors by a same group of surgeons and followed the same rehabilitation protocol. Recurrence, instability signs, range of motion, WOSI score, Rowe score and complications were assessed. Thirty-eight patients were recruited: the average age was 21 (16–30). All patients had definite trauma history. Radiologically, all patients had Bankart/Hill-Sachs lesion. All the operations were done within 1 month after injury (6–25 days). The average hospital stay was 1.2 days (1–5 days). The average follow-up was 28 months (24–48 months). There were two cases of posttraumatic re-dislocation (5.2%). The average external rotation lag was 5° (0–15) in 90° shoulder abduction when compared with contralateral side. 95% of patients had excellent or good Rowe score. The average WOSI score was 83%. There was one case of transient ulnar nerve palsy and one case of superficial wound infection. This study concluded that immediate arthroscopic Bankart repair with an accelerated rehabilitation program is an effective and safe technique for treating young active patients with first-time traumatic anterior shoulder dislocation. This study complies with the current laws of the Hong Kong Special Administration Region Government.     

Open reconstruction of anterior glenoid rim fractures

The present study evaluates the clinical and radiological results of patients with anterior glenoid rim fractures treated with two different open surgical techniques depending on the size of the bony fragment. In patients with displaced glenoid rim fractures involving less than 25% of the glenoid surface (Type I, II and IIIA fractures) suture anchor repair was performed. Patients with a bony defect involving more than 25% of the glenoid surface (Type IIIB fractures) underwent open reduction and internal fixation using cannulated screws. After a mean follow-up of 22 months, 15 patients (mean age 42.2 years) treated with suture anchor repair achieved an average Constant Score of 85.5 points (range 67.1–100) and an average Rowe Score of 94 points (range 70–100). In six patients the bony fragment was located in an unimproved medial position compared to the preoperative X-ray. In another six patients the fragment was consolidated medially to the level of the glenoid rim, and in three cases an anatomic situation was found. Patients treated with cannulated screws (ten cases, mean age 46.6 years) had a mean follow-up of 30 months and achieved a mean Constant Score of 81.9 points (range 61.7–96.1) and a mean Rowe Score of 90 points (range 70–100). Radiologically, the bony fragment was consolidated in an anatomic position in nine out of ten cases. Three patients suffered from screw impingement and one patient had screw loosening. No recurrent subluxations or dislocations were observed in either group. Three patients in group one and one patient in group two had glenohumeral osteoarthritic changes. In cases of small glenoid-rim fractures (Type I, II and IIIA fractures), suture anchor repair resulted in an excellent clinical outcome; however, the radiological results of chronic Type I fractures revealed in many cases a non-anatomical glenoidal reconstruction. For Type IIIB fractures with significant loss of glenoid concavity, open reduction and internal fixation with cannulated screws gave good clinical and radiological results; however the early complication rate was higher.     

Arthroscopic stabilization in patients with an inverted pear glenoid: results in patients with bone loss of the anterior glenoid

BACKGROUND: Recent literature has demonstrated that the success rates of arthroscopic stabilization of glenohumeral instability deteriorate in patients with an anteroinferior glenoid bone deficiency, also known as the "inverted pear" glenoid. PURPOSE: This study was conducted to assess the outcomes of arthroscopic stabilization for recurrent anterior shoulder instability in patients with a mean anteroinferior glenoid bone deficiency of 25% (range, 20%-30%). STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Twenty-one of 23 patients (91% follow-up) undergoing arthroscopic stabilization surgery and noted to have a bony deficiency of the anteroinferior glenoid of 20% to 30% were reviewed at a mean follow-up of 34 months (range, 26-47). The mean age was 25 years (range, 20-34); 2 patients were female and 19 were male. All patients were treated with a primary anterior arthroscopic stabilization using a mean of 3.2 suture anchors (range, 3-4). Eleven patients had a bony Bankart that was incorporated into the repair; 10 had no bone fragment and were considered attritional bone loss. Outcomes were assessed using the Rowe score, the American Shoulder and Elbow Surgeons (ASES) Score, the Single Assessment Numeric Evaluation (SANE), and the Western Ontario Shoulder Instability (WOSI) Index. Findings of recurrent instability and dislocation events were documented. RESULTS: Two patients (9.5%) experienced symptoms of recurrent subluxation, and 1 (4.8%) sustained a recurrent dislocation that required revision open surgery. The mean postoperative outcomes scores were as follows: SANE = 88.1 (range, 65-100; standard deviation [SD] 9.0); Rowe = 85.2 (range, 55-100; SD 14.1); ASES Score = 93.1 (range, 78-100; SD 5.3); and WOSI Index = 398 (82% of normal; range, 30-1175; SD 264). No patient with a bony fragment experienced a recurrent subluxation or dislocation, and mean outcomes scores for patients with a bony fragment were better than those with no bony fragment (P = .08). No patient required medical discharge from the military for his or her shoulder condition. CONCLUSIONS: Arthroscopic stabilization for recurrent instability, even in the presence of a significant bony defect of the glenoid, can yield a stable shoulder; however, outcomes are not as predictable especially in attritional bone loss cases. Longer-term follow-up is needed to see if these results hold up over time.     

Long-term results of arthroscopic Bankart repair with a bioabsorbable tack

BACKGROUND: Short-term to midterm data are available on arthroscopic shoulder stabilization using bioabsorbable tacks or suture anchors. It remains unknown whether these techniques can equal the success of open Bankart repair in the long term. PURPOSE: To assess the long-term outcome of arthroscopic Bankart repair using bioabsorbable tacks in patients with traumatic anterior shoulder instability with a minimum follow-up of 7 years. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Treatment outcomes were determined prospectively according to the Rowe score and retrospectively according to the Constant and American Shoulder and Elbow Surgeons scores. Included in this study were 18 consecutive patients with a mean age of 26.8 years (range, 16-62 years) who underwent arthroscopic Bankart repair using bioabsorbable tacks for traumatic anterior shoulder instability. The study group consisted of 14 male and 4 female patients. The mean follow-up was 8.7 years (range, 7.0-9.8 years). RESULTS: One patient had recurrent dislocations requiring further surgery, for an overall failure rate of 5.6%. An additional patient had 1 traumatic subluxation episode within the first postoperative year that did not recur. According to the Rowe score, which increased to 90.3 (17.8) from 32.8 (8.3) points preoperatively, 15 patients (83.3%) achieved a good or excellent result. The mean Constant score was 91.3 (SD, 6.9) points, and the mean American Shoulder and Elbow Surgeons score was 92.1 (SD, 6.9) points postoperatively. A return to the preinjury level of sports competition was reported by 64% of patients. No signs of synovitis occurred in any patient postoperatively. CONCLUSION: Arthroscopic Bankart repair for the treatment of recurrent traumatic anterior shoulder instability repair using bioabsorbable tacks offers reliable results with respect to failure rate, range of motion, and shoulder function during a minimum follow-up of 7.0 years. In contrast to previous reports on arthroscopic Bankart repair, results did not deteriorate during follow-up.     

关节镜下经髌内侧入路空心钉固定治疗前交叉韧带胫骨止点撕脱骨折

目的:探讨关节镜下经髌内侧入路空心钉固定治疗前交叉韧带胫骨止点撕脱骨折的临床疗效。方法:回顾性分析2008年10月至2011年9月的32例前交叉韧带胫骨止点撕脱骨折患者的病例资料,全部患者采用关节镜下经髌内侧入路导入空心钉进行骨折内固定,采用膝关节功能评分及影像学检查评估术后疗效。结果:术后膝关节侧位片螺钉与胫骨平台夹角平均为(48°±7.3°),随访8~32个月,平均18个月,骨折愈合平均时间为(6.5±0.6)周,术后8周Lysholm膝关节功能评分达到(90.5±1.7)分,随访终末期Lysholm评分达到(94.6±1.5)分。结论:采用关节镜下经髌内侧入路导入空心钉治疗前交叉韧带胫骨止点撕脱骨折,取得了良好的临床效果。     

Arthroscopic fixation of osteochondritis dissecans of the knee: clinical, magnetic resonance imaging, and arthroscopic follow-up

BACKGROUND: Optimal treatment of osteochondritis dissecans of the knee is still controversial. PURPOSE: To review a group of patients with osteochondritis dissecans of the knee who were treated with arthroscopic compressive screw fixation and who were evaluated with magnetic resonance imaging studies and a second-look arthroscopic procedure at follow-up. STUDY DESIGN: Case series; level of evidence, 4. METHODS: A total of 14 patients (15 knees) with osteochondritis dissecans of the knee were treated with arthroscopic titanium Herbert screw fixation of the osteochondral fragment. A second-look arthroscopic procedure was performed to remove hardware and to evaluate fragment stability. At final follow-up, magnetic resonance imaging studies were used to evaluate potential healing of the subchondral bone. Outcomes were clinically evaluated at a mean follow-up of 50 months (range, 25-104 months) by the Lysholm score and by the International Knee Documentation Committee score. RESULTS: At second-look arthroscopy, 14 of 15 knees showed evidence of a stable fragment with an intact smooth surface. According to magnetic resonance imaging parameters, 14 knees showed evidence of a healing process of the osteochondral fragment. The average Lysholm score improved 18 points from a mean of 79 preoperatively to 97 postoperatively, and according to the International Knee Documentation Committee score, 13 of 15 knees showed a normal result. CONCLUSION: This study suggests that magnetic resonance imaging parameters of a healed osteochondral fragment and patients with satisfactory functional results correspond with arthroscopic evidence of fragment stability. According to this study, arthroscopic fixation with compressive screws is an effective method of repair for osteochondritis dissecans of the knee.     

关节镜下盂唇修补合并改良Remplissage术治疗伴Hill-Sachs损伤肩关节前方不稳的临床对照研究

目的:研究盂唇修补合并改良Remplissage手术治疗伴肱骨头中小型Hill-Sachs骨性缺损的创伤性复发性肩关节前方不稳的疗效。方法:选取2006年至2010年经影像学检查确诊为伴肱骨头中小型Hill-Sachs损伤的创伤性复发性肩关节前方不稳患者共42例行回顾性随访研究。所有患者均由同一名医生施行关节镜下前方稳定术。根据是否加用改良Remplissage术式分为A、B两组。A组26例,在2006年至2009年行关节镜下单纯盂唇修补术。B组16例,在2009年至2010年行关节镜下盂唇修补术加改良Remplissage术,采用双线锚钉将后方关节囊(非冈下肌腱)填充于肱骨头缺损处。两组患者术后采用相同方法进行康复训练。采用牛津肩关节不稳评分(OSIS)和ROWE评分进行疗效评估、对比术前和术后3个月、6个月、9个月及12个月时肩关节活动度。结果:所有患者均获得随访,A组随访平均(28.0±5.6)个月(20～38个月);术前、术后OSIS评分分别为(37.0±4.2)分(27～43分)和(18.0±3.3)分(12～25分),ROWE评分分别为(20.2±12.2)分(5～40分)和(83.8±7.3)分(70～95分);术后再脱位患者1例,由再次创伤造成,半脱位患者5例。B组随访平均(19.6±3.8)个月(14～27个月);术前、术后OSIS评分分别为(37.9±4.9)分(29～44分)和(13.4±2.1)分(12～20分),ROWE评分分别为(18.4±8.3)分(5～30分)和(95.3±5.3)分(80～100分);术后无再脱位患者。对两组患者术后肩关节活动度分别测量的结果显示,两组患者术后中立位外旋活动度恢复趋势无明显差异。Kaplan-Meier生存分析显示,两组患者术后不稳复发率差异有统计学意义(P=0.043)。结论:关节镜下盂唇修补合并改良Remplissage手术是治疗伴肱骨头中小型Hill-Sachs损伤的创伤性复发性肩关节前方不稳的有效方法,可显著提高肩关节稳定性,并对术后肩关节活动度无明显影响。     

Surgical treatment of significant glenoid bone defects and associated humeral avulsions of glenohumeral ligament (HAGL) lesions in anterior shoulder instability

Purpose

Combined occurrence of humeral avulsion of glenohumeral ligament (HAGL) lesion and a significant glenoid bone defect is an unusual and previously undescribed association in traumatic anterior shoulder instability. The purpose of this study was (1) to report a retrospective case series of seven anterior bony instability patients who were diagnosed with this unusual association and (2) to evaluate the results of a modified Latarjet procedure and simultaneous HAGL repair using a new subscapularis-sparing approach.

Methods

A retrospective review of the records of 64 anterior shoulder instability patients who underwent bony stabilization surgery was performed, and patients who underwent a combined reconstruction for significant glenohumeral bone defects (glenoid loss >20 %) and an associated HAGL lesion were identified. Pre- and postoperative follow-up clinical parameters and functional scores were documented (Oxford shoulder instability score [OSIS], Western Ontario shoulder instability index [WOSI]), Rowe score). Radiological assessment included measurement of the glenoid bone defect (CT scan) and evaluation of soft tissue lesions (MR arthrogram).

Results

Radiological and arthroscopic evaluation confirmed the combined lesion complex in 7 (11 %) patients. Follow-up evaluation (mean 20.6 months) suggested an excellent outcome (Rowe score: median 95, range 95–100); a statistically significant improvement was seen in the follow-up OSIS (median 12, range 12–14, p = 0.018) and WOSI score (median 28, range 17–102, p = 0.018) as compared to the preoperative score (median OSIS 50, range 32–53; median WOSI 1,084, range 919–1,195). Clinical tests for subscapularis function revealed a functional subscapularis muscle; no significant differences were detected in pre- versus postoperative internal rotation strength and in the operated versus normal contralateral shoulder (ns). The dual-window subscapularis–sparing approach provided adequate exposure for combined reconstruction of the humeral and glenoid lesions, and no complications were encountered.

Conclusions

Significant glenoid defects are associated with HAGL lesions in approximately 1/10th of patients with bony instability. Combined reconstruction of these lesions via a subscapularis-sparing approach results in an excellent outcome and significant improvement in functional scores at a medium-term follow-up.

Level of evidence

Therapeutic study, Level IV.     

Arthroscopic reduction and internal fixation of acetabular fractures

Arthroscopic reduction and screw fixation of acetabular fractures have not been reported. In this case report, arthroscopic treatment for acetabular fracture is reported for two patients. A 49-year-old man diagnosed with acetabular posterior wall fracture was treated by arthroscopic reduction and fixation using two screws. A 20-year-old woman who diagnosed with anterior column fracture was fixed using a screw using the arthroscopic technique prior to open reduction and internal fixation in the iliac bone fracture. Arthroscopic reduction and fixation in some case of acetabular fracture could be good indication with additional advantages of joint debridement and loose body removal. Level of evidence V.     

经踝后内侧入路结合无头加压空心钉内固定治疗距骨后突内侧结节骨折

目的评估经踝后内侧入路结合无头加压空心钉内固定治疗距骨后突内侧结节骨折的疗效。方法 2012年1月—2015年12月上海市黄浦区中心医院骨科共收治5例距骨后突内侧结节骨折患者,其中男性3例,女性2例;年龄27~62岁,平均46.2岁。单纯距骨后突内侧结节骨折1例,合并距下关节脱位者4例。所有患者入院后常规行X线摄片及三维CT检查以明确受伤情况,待软组织条件允许后,于伤后1周左右(第4~10天)行经踝后内侧入路切开复位螺钉内固定治疗。术后患者定期复查X线片,并采用美国足踝外科协会(AOFAS)踝与后足评分系统评估功能恢复情况。结果所有患者术后均获随访,平均随访12.3个月(8~14个月)。5例均无伤口感染、神经损伤等并发症发生。术后AOFAS踝与后足评分平均为84分(57~94分)。1例于术后1年继发创伤性关节炎。结论经踝后内侧入路结合无头加压空心钉治疗距骨后突内侧结节骨折安全可靠,术中可清晰暴露,复位固定良好,避免了内踝截骨。     

Arthroscopic lavage reduced the recurrence rate following primary anterior shoulder dislocation A randomised multicentre study with 1-year follow-up

Young individuals have a high recurrence rate following non-operative treatment of traumatic primary anterior shoulder dislocation. The present multicentre study was undertaken to find out whether the results could be improved by using arthroscopic lavage as treatment. Sixty patients aged 16-30 years, with traumatic primary anterior shoulder dislocation were randomised into two groups. One group was treated with arthroscopic lavage within 10 days, while the other group was treated non-operatively. Rehabilitation was otherwise identical. At 1-year follow-up, 4 of 30 patients (13%) in the lavage group had had redislocation compared with 13 of 30 (43%) in the group treated non-operatively (P = 0.01).The difference in recurrence rate was more pronounced in younger patients. The functional outcome according to the Rowe shoulder score was better in the lavage group (P = 0.003), as was the anterior stability according to the apprehension test (P = 0.008). We conclude that arthroscopic lavage reduced the recurrence rate and produced a better functional outcome at 1-year follow-up than the non-operative treatment in young individuals.     

Operative stabilization of posterior shoulder instability

BACKGROUND: Symptomatic, traumatic posterior shoulder instability is often the result of a posteriorly directed blow to an adducted, internally rotated, and forward-flexed upper extremity. Operative repair has been shown to provide favorable results. Current arthroscopic techniques with suture anchors and the ability to plicate the capsule using a nonabsorbable suture may provide favorable outcomes with reduced morbidity. PURPOSE: To evaluate the results of operative shoulder stabilization in patients with traumatic posterior shoulder instability. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A consecutive series of patients who underwent arthroscopic or open posterior stabilization for traumatic posterior shoulder instability were evaluated using subjective assessments, physical examinations, the Single Assessment Numeric Evaluation, Rowe score, Simple Shoulder Test, and the Western Ontario Shoulder Instability Index.Results: Between May 1996 and February 2002, 31 shoulders (30 patients) underwent posterior stabilization (19 arthroscopically, 12 open). There were 29 men and 1 woman (mean age, 23 years). Preoperatively, all patients had a distinct traumatic cause for the instability. On physical examination, all patients had posterior apprehension and increased (2+, 3+) posterior load-shift testing. Preoperative radiographs and/or magnetic resonance imaging revealed posterior rim calcification or reverse Bankart lesions in 29 cases (94%). At arthroscopy, posterior labral injuries, reverse Bankart lesions, or humeral head defects were identified. Follow-up averaged 40 months, and the mean duration between injury and surgery was 21 months. The mean Single Assessment Numeric Evaluation, Rowe score, Simple Shoulder Test, and Western Ontario Shoulder Instability Index scores, respectively, for the entire group were 89, 87, 11, and 346; for the open group, they were 81, 80, 10.5, and 594; for the arthroscopic group, they were 92, 92, 11.4, and 190. The Western Ontario Shoulder Instability Index (P < .03) and Rowe score (P < .04) outcomes scores for the arthroscopic group were statistically better than those of the open group. Twenty-nine of 31 shoulders were rated as excellent or good. CONCLUSION: In the case of traumatic posterior shoulder subluxation, posterior lesions of the labrum ("reverse Bankart"), articular edge, and capsule are observed. Surgical treatment addressing these lesions led to satisfactory results for both the open and arthroscopic treated groups. In this study, an arthroscopic technique utilizing suture anchor repair with capsular placation provided the most favorable outcomes.     

A new “double-pulley” dual-row technique for arthroscopic fixation of bony Bankart lesion

The double-row technique is a new concept for arthroscopic treatment of bony Bankart lesion in shoulder instability. It presents a new and reproducible technique for arthroscopic fixation of bony Bankart fragments with suture anchors. This technique creates double-mattress sutures which compress the fragment against its bone bed and restores better bony anatomy of the anterior glenoid rim with stable and non-tilting fixation that may improve healing.     

髋臼骨折的内固定治疗

目的　总结髋臼骨折内固定治疗的临床实用价值。方法　对 30例由不同原因引起的不同类型髋臼骨折,在硬膜外麻醉或全麻下行手术切开复位, 9例先用钢板固定前柱,再以长拉力螺钉固定后柱, 2例单纯用加压螺钉固定, 5例用高分子可吸收螺钉固定,其余全部采用髋臼钢板的内固定。结果　按髋臼骨折切开复位标准,达到解剖复位 22例,满意 8例;按美国矫形外科研究院标准:优 15例,良 10例,可 3例,差 2例,优良率 83 3%。结论　髋臼骨折进行手术切开复位,钢板、加压螺丝钉,可吸收螺钉内固定治疗实用可行,疗效满意。     

Open screw fixation of large anterior glenoid rim fractures: mid- and long-term results in 29 patients

The aim of this retrospective study was to analyse the clinical, functional and radiographic outcomes of patients sustaining traumatic anterior dislocations of the shoulder in combination with large anterior glenoid rim fractures, treated by open reduction and internal screw fixation (ORIF). Twenty-nine patients with a mean follow-up of 6.5 years (2.5–12 years) were evaluated clinically using the Constant and DASH scores, radiographs in two planes and isokinetic muscle strength measurement (Biodex 3 PRO). Mean age was 41.6 years (17–68 years). There was no case of postoperative re-dislocation. Eight out of 29 patients (27.5%) underwent revision surgery to remove the screws. The mean age- and gender-adjusted Constant score was 93.3% (range 64–102%), and the mean DASH score was 10.1 points (range 0–71 points). On radiological examination, 6 patients had signs of osteoarthritis: Samilson type I (n = 3) and II (n = 3). Significant differences for maximal strength in external rotation and muscular endurance compared to the unaffected side were found (P < 0.035). Twenty-seven patients (93%) were satisfied or very satisfied with the result after surgery. ORIF seems to be a good treatment option in cases of large glenoid rim fractures to avoid re-dislocation in the mid-term. Prospective randomised studies are necessary to compare these findings with those after non-operative or arthroscopic treatment of these injuries. P. Raiss and F. Baumann contributed equally to the present study.     

Bony Bankart is a positive predictive factor after primary shoulder dislocation

It would be a great advantage if it were possible to categorise the patients with first time dislocations to an initial treatment with the most beneficial outcome. MRI could be a useful method for finding lesions after shoulder dislocation. Fifty-eight patients with traumatic anterior shoulder dislocation were treated by closed reduction and were examined by MRI after a maximum of 2 weeks. The hemarthrosis or effusion present in the joint after the primary dislocation could be used as a contrast for arthrography to identify the lesions present on MRI. At follow-up more than 8 years later, the MRI findings were compared to the shoulder function, shoulder stability, Rowe score and Western Ontario Shoulder Instability Index (WOSI). Besides the age of the patient being above 30, the MRI findings analysed showed that an isolated fracture of the major tubercle, as well as a bony Bankart lesion are prognostic factors for a good functional result and a stable shoulder after a primary dislocation. The glenoid rim fracture was only detected on plain radiographs in 6 out of 10 findings on MRI. MRI findings of a gleniod rim fracture, equal to a bony Bankart lesion, were found to be a prognostic factor for stability and a good functional outcome.     

C臂引导下骶骨钉固定骨盆骨折后环不稳的临床疗效

目的回顾性研究经皮骶骨钉内固定治疗骨盆骨折后环不稳的临床疗效。方法对42例C型骨盆骨折患者使用前环钢板内固定和后环骶骨钉内固定治疗的临床资料进行回顾性分析,应用Tornetta复位情况评价表评估复位情况,应用Majeed骨盆骨折评分系统评价疗效。结果 42例均获随访,随访时间为4～34个月,平均随访15个月。闭合复位骶骨钉内固定骨盆骨折后环不稳术后疗效满意。结论掌握C臂引导下骶骨置钉技巧,应用骶骨钉固定骨盆骨折后环不稳,手术效果良好,手术操作简单,适于在基层医院广泛开展。     

Open Bankart repair versus arthroscopic repair with transglenoid sutures or bioabsorbable tacks for Recurrent Anterior instability of the shoulder: a meta-analysis

BACKGROUND: In published comparative studies, it remains unknown if arthroscopic techniques for performing Bankart repair for anterior shoulder instability equal the success of open repair. HYPOTHESIS: The current literature supports a lower rate of recurrent instability after open Bankart repair compared to arthroscopic repair with bioabsorbable tacks or transglenoid sutures. STUDY DESIGN: Meta-analysis. METHODS: A Medline search identified all randomized controlled trials or cohort studies that directly compared open repair to arthroscopic techniques of Bankart repair for traumatic, unilateral, recurrent anterior instability. Data collected from each study included patient demographics, surgical technique, rehabilitation, outcome, and complications. RESULTS: Six studies met all inclusion criteria. There were 172 patients in the arthroscopic group (90 patients with transglenoid sutures, 77 patients with arthroscopic tacks, and 5 patients with suture anchors) and 156 patients in the open group. The groups were similar in demographic characteristics. When comparing the arthroscopic to the open group, there was a significantly higher rate of recurrent dislocation (12.6% vs 3.4%; P = .01) and total recurrence (recurrent dislocation or subluxation) (20.3% vs 10.3%; P = .01). In addition, there was a higher proportion of patients with an excellent or good postoperative Rowe score in the open group (88%) than in the arthroscopic group (71%) (P = .01). CONCLUSIONS: Arthroscopic Bankart repair using transglenoid sutures or bioabsorbable tacks results in a higher rate of recurrence of instability compared to open techniques. Studies comparing open repair to newer arthroscopic techniques using suture anchor fixation and capsular plication are necessary.