Gerhard Oberleitner

Displaced fractures of the greater tuberosity: a comparison of operative and nonoperative treatment.

BACKGROUND Displaced two-part fractures of the greater tuberosity requiring surgical intervention are rare and the literature gives only few data of functional results after operative treatment. The purpose of this study was to analyze functional and radiographic long-term results in patients who had undergone surgical treatment of displaced greater tuberosity fractures and to compare those results with the results of patients who had been treated nonoperatively. MATERIAL From a prospectively gathered database, we retrospectively analyzed functional and radiographic results of 52 patients with operative treatment of displaced greater tuberosity fractures at an average time of 5.5 years (range, 2-11 years) after trauma. Those results were compared with the functional and radiographic outcome of nine patients with equal injuries, who had been treated nonoperatively. Functional results were defined by three supplementary shoulder scores: the Vienna Shoulder Score (VSS), the Constant Score (CS), and the University of California, Los Angeles (UCLA)-Score. Radiographic results were assessed based on accurate radiographs in two planes (anteroposterior and axillary). Patients underwent either open reduction and internal fixation (n = 30) or closed reduction and percutaneous internal fixation (n = 22). RESULTS Thirty-four patients (65%) achieved good functional results (CS >80 points, VSS <8 points, UCLA >28 points) and eight patients (15%) had excellent results with a maximum of points on two of three shoulder scores. Ten patients (20%) experienced satisfactory results with two-thirds points on two of three shoulder scores. All fractures healed without any signs of nonunion or relevant loss of reduction. In nine patients (17%) we had a minimal loss of reduction (<5 mm) to superior, but there was no significant influence on shoulder function. In comparison of the operative techniques, patients with open reduction and internal fixation had slightly better functional results than did those with closed reduction and percutaneous internal fixation, but this was statistically not significant (p > 0.05). In comparison of the results of the surgical study group and the nonoperative control group, patients with reduction and fixation of greater tuberosity fractures had significantly better results on shoulder function than did those with conservative treatment (p < 0.05). CONCLUSION Surgical treatment of displaced greater tuberosity fractures revealed good functional and radiographic results. Reduction and fixation of those fractures is recommended because patients with nonoperative treatment showed significantly worse results. Similar results can be achieved for open reduction and internal fixation, or closed reduction and percutaneous fixation.

Surgical treatment of dens fractures in elderly patients.

BACKGROUND A dens fracture is the most common cervical fracture in elderly patients. The purposes of this study were to analyze the functional and radiographic results after surgical treatment of dens fractures in patients over sixty-five years of age and to compare the two methods that were used for operative treatment. METHODS We reviewed the cases of fifty-six patients, with an average age of 71.4 years at the time of surgery, who had undergone surgical treatment of a dens fracture from 1988 to 2002. Thirty-seven fractures were stabilized with anterior screw fixation, and nineteen fractures had posterior cervical arthrodesis. RESULTS Forty-five patients returned to their preinjury activity level and were satisfied with their treatment. Thirty-five patients had a full range of neck movement, and forty-seven patients were free of pain. Technical failures occurred in eight patients. The thirty-seven patients treated with anterior screw fixation had a good clinical outcome, with fracture-healing in thirty-three patients (89%) and technical failure in five patients (14%). All nineteen patients treated with posterior cervical arthrodesis had fracture union, with technical failure in three patients, but the functional results were worse than those after anterior screw fixation. With the inclusion of the six patients who had been excluded from the clinical and radiographic review, the overall morbidity rate was 16% (ten of sixty-two patients) and the overall mortality rate was 6% (four of sixty-two patients). CONCLUSIONS A satisfactory outcome can be achieved with surgical treatment of a dens fracture in geriatric patients. It appears that anterior screw fixation may maintain better mobility of the cervical spine, but it appears to be associated with a higher rate of fracture nonunion and a greater potential for reoperation.

Posterior Atlanto-Axial Arthrodesis for Fixation of Odontoid Nonunions

Study Design. A retrospective case series. Objective. To determine the clinical and radiographic long-term results after posterior atlanto-axial arthrodesis of odontoid nonunions. Summary of Background Data. Nonunion of odontoid fractures is a relatively common and dreaded complication after surgical and nonoperative treatment of these injuries. Although there might be a significant rate, which require surgical stabilization due to atlanto-axial instability, only few publications have covered this issue and presented reliable long-term results. Methods. We retrospectively analyzed the clinical and radiographic records of 9 (4 women and 5 men) patients with an average age of 68 (42–78) years at the time of injury who had undergone posterior atlanto-axial arthrodesis for surgical treatment of odontoid nonunions between 1988 and 2004. For posterior atlanto-axial arthrodesis, we performed either C1–C2 transarticular screw fixation, or posterior wiring and bone grafting, or a combination of these 2 techniques. Results. Eight patients achieved a satisfactory clinical outcome and returned to their preinjury activity level. The Smiley-Webster scale showed an overall functional outcome score of 2.2, which was 0.9 points superior to the outcome score before surgery. Neurologic deficits after operative treatment of the odontoid nonunion were evaluated in 2 patients. In all the other patients with primary neurologic deficits or delayed neurologic sequelae we saw a full recovery. Solid bony fusion of the cervical arthrodesis was achieved in all of the patients. Failures of reduction or fixation were noted in 2 patients, but no reoperations were necessary. Conclusion. In summary, we had a satisfactory outcome after surgical treatment of odontoid nonunions in patients with atlanto-axial instability and severe motion pain at the cervical spine. With a bony union rate of 100% and a noticeable improvement of clinical results and neurologic function, posterior atlanto-axial arthrodesis seems to be an appropriate option for nonunited odontoid fractures that require surgical stabilization.

Is suprascapular neuropathy common in high-performance beach volleyball players? A retrospective analysis

SummaryBackgroundPain in the shoulder is a common problem in overhead sports and at times goes along with atrophy of the supra- and infraspinatus muscles. A neuropathy of the suprascapular nerve is one possible reason. The aim of the study was to examine the suprascapular nerve in Austrian high-performance beach volleyball players.MethodsIn this cross-sectional study, 18 high-performance beach volleyball players were included. An electrophysiological examination was performed consecutively. Nerve conduction studies of the suprascapular nerve were performed bilaterally. Needle electromyography was done for the infraspinatus muscle of the dominant arm. Additionally, pain and muscle atrophy were evaluated.ResultsNo acute or chronic neurogenic changes in the infraspinatus muscle were seen in any player, although atrophy of the suprascapularis innervated muscles was present in five players.ConclusionsA lesion of the suprascapular nerve could not be shown in any of the players. Therefore, a biomechanical cause has to be considered for the clinical symptoms in the present study population.ZusammenfassungGrundlagenSchulterbeschwerden treten häufig bei Überkopfsportlern auf und gehen oftmals mit einer Atrophie des M. supra- und infraspinatus einher. Eine mögliche Ursache für diese Beschwerden stellt eine Neuropathie des N. suprascapularis dar. Ziel dieser Studie war die Untersuchung des N. suprascapularis bei Österreichischen Elite-Beach-Volleyballspielern.MethodikIn diese Beobachtungsstudie wurden 18 Elite-Beach-Volleyballspieler eingeschlossen. Eine elektrophysiologische Untersuchung erfolgte konsekutiv. Eine Nervenleitgeschwindigkeitsmessung vom N. suprascapularis wurde beidseits mittels Oberflächenelektroden durchgeführt. Weiters erfolgte eine Untersuchung des M. infraspinatus vom dominanten Arm mittels Nadelelektromyographie. Zusätzlich wurde Schmerz und Muskelatrophie erhoben.ErgebnisseEs konnten keine akuten oder chronischen Veränderungen im M. infraspinatus gefunden werden, obwohl sich bei 5 Spielern eine Atrophie der vom N. suprascapularis innervierten Muskulatur zeigte.SchlussfolgerungenEs konnte keine Läsion des N. suprascapularis gefunden werden. Die Beschwerden in unserer Studienpopulation könnten durch biomechanische Gründe ausgelöst worden sein.