Open surgical treatment of recurrent anterior instability of the shoulder

Recurrent anterior gleonohumeral instability is the most frequent joint instability of the body. Because of the complex stability mechanisms and diverse instability patterns of the glenohumeral joint, most cases present with more than one anatomic cause. Thus, the treatment of recurrent anterior instability of the shoulder should be designed to treat these pathologies. Although arthroscopic repair has outweighed the use of open surgical methods especially for the first dislocations, recurrent dislocations still require open repair techniques to overcome capsular laxity accompanying a Bankart lesion.     

Anatomy, biomechanics, and pathophysiology of instability of the glenohumeral joint

The stability of the shoulder is dependent on both static and dynamic anatomic restraints. In most cases, there must be insufficiency of more than one restraint for the shoulder joint to become instable. Although the role of these restraints is largely known in maintaining shoulder stability, our information on their interactions is insufficient. This article reviews the anatomy and biomechanics of the shoulder and conditions causing instability of the glenohumeral joint.     

Proximal humeral fractures with minimal displacement treated conservatively

We reviewed 27 patients with a minimally displaced proximal humeral fracture treated conservatively after a mean follow-up of 25 (12–34) months. All fractures had united. Patients were evaluated using the Constant-Murley scoring system, and isokinetic muscle strength was tested using a Cybex dynamometer. Finally, all shoulders were examined ultrasonographically. The mean Constant score for all patients were 81 (54–100). Twenty-three patients had no or only mild pain, while three had moderate and one severe pain necessitating regular use of oral analgesics. Twenty patients were able to perform all activities of daily living, but seven had mild trouble in overhead activities and weight carrying. Only in one patient, the abduction peak torque equalled the one of the opposite shoulder. In all other patients, the peak torque was lower than, and in 14 patients below, 50%. In nine patients, rotator cuff tears were seen at ultrasonography.

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Résumé Nous avons examiné 27 malades avec une fracture humérale proximale peu déplacée traitée dune manière conservatrice après un suivi moyen de 25 (12–34) mois. Toutes les fractures avaient consolidé. Les malades ont été évalués avec le score de Murley Constant et la force musculaire isokinetique a été testée par un dynamomètre Cybex. Toutes les épaules ont été examinées par échographie. Le score de Constant moyen pour tous les malades était de 81 (54–100). Vingt-trois malades navaient aucune douleur ou des douleurs très discrètes, trois avaient des douleurs modérées et une patiente avait des douleurs sévères nécessitant lusage régulier danalgésiques oraux. Vingt malades étaient capables dexécuter toutes les activités de la vie quotidienne mais sept avaient des difficultés pour les activités en hauteur et pour le port de charges. Chez seulement un patient la force dabduction maximum était égale à celle de lépaule opposée, pour tous les autres malades elle était inférieure et chez 14 dentre eux elle était même à moins de la moitié. Chez neuf patients une déchirure de la coiffe des rotateurs était visible à léchographie.

     

The relationship between accessory navicular and medial longitudinal arch: evaluation with a plantar pressure distribution measurement system

This study included 92 patients with an accessory navicular (AN) noted on an anteroposterior roentgenography. This group was selected from 860 patients admitted to the authors' gait analysis laboratory. The medial longitudinal arch was evaluated by using an "arch index" calculated from the pressure picture obtained from a pressure distribution measurement system. The average arch index was 0.15 and there was no significant correlation between AN types and arch index. The study concluded that the presence and type of AN are not correlated with the height of the medial longitudinal arch of the foot and that AN is not associated with pes planus.     

Center-of-pressure displacement during postural changes in relation to pressure ulcers in spinal cord-injured patients

OBJECTIVE: To evaluate the center-of-pressure displacement in spinal cord-injured patients, to investigate dynamic sitting stability and its relationship with pressure ulcers. DESIGN: Sixteen spinal cord-injured patients and 18 healthy volunteers were included in the study. For the assessment of dynamic sitting stability, center-of-pressure displacement during maximum unsupported forward, backward, and right- and left-sided trunk leaning were measured with a seat sensor system, which was placed between the subject's buttocks and chair. RESULTS: Center-of-pressure displacements in all directions in spinal-injured patients were smaller than healthy volunteers (P < 0.05). Center-of-pressure displacements for high- and low-thoracic spinal cord-injured patients were not significantly different. History of previous pressure ulcer was not different between high- and low-thoracic spinal cord-injured patients (chi = 0.90, P = 0.62). Mean center-of-pressure displacement during forward and backward leaning were smaller in patients with pressure ulcer history (P = 0.04 and 0.03, respectively). CONCLUSIONS: The results of this study suggest that impaired dynamic sitting stability is associated with pressure ulcer development.     

Screening for developmental dysplasia of the hip: Results of a 7-year follow-up study

BACKGROUND: Screening for developmental dysplasia of the hip (DDH) is widely recommended for all infants to prevent disability from late diagnosis of dislocation of the hip. The present study evaluates the results of screening for developmental dislocation of hip in a clinic in Turkey over the course of 7 years. METHODS: Hospital records of 5798 infants who were examined regularly until walking age at Gazi University well child clinics between January 1995 and December 2001 were reviewed. Infants with known risk factors for DDH such as breech presentation, family history of DDH or swaddling, and of infants with physical examination findings suggestive of DDH, were referred to orthopedic surgeons for diagnosis. Based on this final diagnosis, sensitivity, specificity, positive and negative predictive values of risk factors and physical examination findings were calculated. RESULTS: Of the 5798 infants, risk factors were detected in the medical history of 111 infants, and in 14 infants a musculoskeletal deformity was detected. In 606 infants the physical examination findings were suggestive of DDH. Ten patients were subsequently diagnosed with DDH. The sensitivity, specificity, positive predictive value and negative predictive values of having a risk factor for DDH in history were 10.0%, 98.1%, 0.9%, 99.8%, and having abnormal hip examination findings were 100.0%, 88.9%, 1.6% and 100.0%, respectively. CONCLUSIONS: A careful history and physical examination is the cornerstone of DDH screening. Serial hip examinations performed during health examination visits provide an opportunity to identify DDH cases. The sensitivity of risk factors in history and physical examination findings together is high enough to be accepted as a screening tool.     

Arthroscopic repair of type II superior labrum anterior posterior (SLAP) lesions in patients over the age of 45 years: a prospective study

Background  

Superior labrum anterior posterior (SLAP) lesions are a well-defined cause of shoulder pain and disability and may occur in conjunction with rotator cuff tears. This study was designed to prospectively evaluate the minimum 2 year results of arthroscopic repair of type II SLAP lesions in patients over the age of 45 years with and without rotator cuff tears.     

Results of triple arthrodesis: effect of primary etiology

BACKGROUND: Severe disability originating from feet generally requires surgery. In addition to a number of other techniques, triple arthrodesis is still used to treat deformity and instability unresponsive to conservative measures. The aim of this study was to evaluate the results of the triple arthrodesis operation in two groups of patients with different primary etiologies and to identify the possible factors affecting the results. METHODS: During a 4-year period, triple arthrodesis was performed on 25 feet in 20 patients (average age 24.9 years). These patients were divided into two groups according to the primary etiology of the disability: neurogenic and nonneurogenic. Patients were evaluated with pre-and postoperative clinical examinations, American Orthopedic Foot and Ankle Society (AOFAS) Hindfoot and Ankle Scale, radiography, pedobarography, and a general health questionnaire (Short Form 36, SF-36). The need for orthotics and the effect of previous treatments on the end results were also evaluated. RESULTS: The preoperative average AOFAS score improved from 24 to 71 postoperatively. Preoperative AOFAS values of neurogenic cases were significantly lower than those of nonneurogenic cases. Postoperative AOFAS values were found to be lower in neurogenic cases (64.0 vs. 77.6). Marked improvement was observed for all angular measurements. No relation was found between the AOFAS, changes in angular measurements, and pre-and postoperative plantar pressure analysis results. SF-36 results improved postoperatively in both groups. Triple arthrodesis decreased the use of orthotics postoperatively in both groups. Previous treatments were not found to affect the end results in this series. CONCLUSIONS: Triple arthrodesis operation is a surgical option with limited alternatives in patients with disabilities originating from feet. Both neurogenic and nonneurogenic patient groups improved significantly, and we were unable to show any significant differences in the results of these two groups.