Alexandre Galland

Three- and four-part displaced proximal humeral fractures in patients older than 70 years: reverse shoulder arthroplasty or nonsurgical treatment?

BACKGROUND The objective of our study was to evaluate the results of surgical treatment by reverse shoulder arthroplasty (RSA) compared with nonsurgical treatment after 2 years of follow-up in patients aged 70 years or older with displaced 3-part or 4-part proximal humeral fractures. METHODS Two groups were formed: the RSA group (n = 28) and the nonsurgical group (n = 32). Minimum follow-up was 2 years. We included patients with 3-part or 4-part fractures according to the Neer classification. Main outcome measures were the Constant-Murley score, the 11-item version of the Disabilities of the Arm, Shoulder and Hand score, and the Subjective Shoulder Value score. An autonomy score, a cognitive assessment score, and a pain score were also measured. RESULTS Clinical features in the 2 groups were not significantly different. The Constant-Murley mean score was significantly higher for the RSA group (82.1% vs. 76.8%; P = .03). Amplitudes were all higher in favor of the RSA group (P < .02). There was no significant difference in mean score on the 11-item version of the Disabilities of the Arm, Shoulder and Hand score, the preoperative and postoperative Subjective Shoulder Value score, the autonomy score, the cognitive assessment score, or the pain score in both groups at the last follow-up. The complication rate was higher for the RSA group. CONCLUSIONS These results suggest that RSA treatment of proximal humeral fractures with 3-part or 4-part displaced fragments in elderly patients provides better functional outcomes than does nonsurgical treatment. However, the observed clinical difference was relatively small. This solution must be proposed only to patients who have a significant functional demand.

A Bullet in the Supraspinatus Compartment Successfully Removed by Arthroscopy: Case Report and Review of the Literature

Arthroscopic removal of bullet from intra-articular compartment has been described for several joints. Only few reports dealing with this condition in the shoulder have been reported especially for the glenohumeral and the subacromial compartments. We report the story of a fifty-seven-year-old man presenting a bullet in the supraspinatus compartment of his left shoulder successfully removed by arthroscopy.

Biomechanical testing of the primary stability of macro and micro-roughnesses acetabular cups: a numerical and an experimental study

Long-term stability of acetabular implants depends on their primary stability which follows implantation (Adler et al. 1992; Kwong et al. 1994; Markel et al. 2001; Olory et al. 2004; Ries and Harbaugh 1997). The primary stability has to be optimal to avoid micromotion, which, if important, can prevent bony creation and consequently secondary stability (Pilliar et al. 1986). This rigid initial fixation of the implant can be obtained by using screws, a threaded ring or impaction, which may be the best option to achieve firm fixation. In the literature, several mechanical testing and numerical studies have been developed (Adler et al. 1992; Markel et al. 2001; Olory et al. 2004; Bellini et al. 2007; Zhang et al. 2010). Acute study of the primary stability of press-fit acetabular cups remains an important issue because of its complexity and its dependency on various parameters. The aim of this study was to evaluate the influence of three surface roughnesses of acetabular cups on their primary stability. We developed an experimental study that aspires to have a reproducible progression, starting on an artificial material (sawbone), followed by bovine bone. Related to a numerical analysis on the sawbone, the study tried to assess the influence of macro-roughness and diameters’ differences on the cups’ primary stability.