Jan-Magnus Björkenheim

Internal fixation of proximal humeral fractures with a locking compression plate: a retrospective evaluation of 72 patients followed for a minimum of 1 year.

Background Proximal humeral fractures, particularly in osteoporotic patients, remain an unsolved problem as regards the durability of the osteosynthesis. The AO/ASIF group has developed a new technique which aims to preserve the biological integrity of the humeral head and secures the reduction using multiple locking screws with angular stability (Philos), thus allowing an early mobilization. Patients and outcome We retrospectively reviewed the complications and functional outcome after a minimum follow-up of 1 year in 72 patients treated with this new method. 2 fractures failed to unite, and 3 patients developed an avascular necrosis of the humeral head. In addition, 2 implant failures were observed due to a technical error. According to the Constant score, the functional outcome was acceptable even in elderly patients. Interpretation The Philos method appears to be safe and can be recommended for the treatment of proximal humeral fractures in patients with poor bone quality.

Operative Treatment of Severe Proximal Humeral Fractures

Results after the operative treatment of 41 severe proximal fractures of the humerus are reported. The fractures were classified according to Neer (1970a). The aim of treatment was accurate reduction and stable fixation of the fracture with screws or with screws and a plate. When scored according to Neers (1970a) functional assessment, results in the 31 patients re-examined more than 1 year postoperatively were excellent or satisfactory in 23 patients. Results were excellent or satisfactory in 14/15 patients with type III fractures, in 7/11 with IV, and 2/4 with type VI. In the only re-examined patient with a type V fracture the result was unsatisfactory. The most common technical error was a too high positioning of the AO plate and persistent varus deformation of the head of the humerus. High positioning of the plate caused post-operative restriction in the movements of the glenohumeral joint because the implant impinged under the acromion during abduction. No aseptic necrosis of the humeral head was observed. Of the patients of working age all but one returned to their preoperative occupations within a mean of 3.5 months after surgery.

Sling Compared with Plate Osteosynthesis for Treatment of Displaced Midshaft Clavicular Fractures A Randomized Clinical Trial

BACKGROUND Few randomized controlled trials have compared operative with nonoperative treatment of clavicular fractures. METHODS Patients with displaced midshaft clavicular fractures were randomized either to nonoperative treatment with a sling or to operative treatment with a stainless steel 3.5-mm reconstruction plate. Outcome measures were the Constant shoulder score, DASH (Disabilities of the Arm, Shoulder and Hand) score, pain, fracture-healing, and complications. The null hypothesis was that the Constant and DASH scores would not differ between the groups at the one-year follow-up evaluation. RESULTS In accordance with the power analysis, we included sixty patients in the study; thirty-two were randomized to the nonoperative group and twenty-eight to the operative group. We found no difference in the Constant score (p = 0.75), the DASH score (p = 0.89), or pain (p = 0.98) between the groups at the one-year follow-up evaluation. All fractures in the operative group healed, but six nonunions (24%) occurred in the nonoperative group. CONCLUSIONS One year after a displaced midshaft clavicular fracture, nonoperative treatment resulted in a higher nonunion rate but similar function and disability compared with operative treatment.

Structure and function of the rabbit's supraspinatus muscle after resection of its tendon

The tendinous part of the supraspinatus muscle was removed in 12 rabbits in order to simulate a major rotator cuff tear. Changes in the contractile response and the development of atrophy of the supraspinatus muscle were significant. These changes may indicate that the modest results obtained in reconstruction of major rotator cuff tears may be due to muscular insufficiency.

Injuries in competitive junior ice-hockey: 1437 players followed for one season

During one season we followed 1437 ice-hockey players, 9-18 years of age, participating in a junior league. We found 128 injuries (9 percent) that caused the player to miss at least one training session or game. One third of the injuries were a result of foul play. The most common types of injury were contusions, sprains, and lacerations. However, fissures and fractures were surprisingly frequent, reflecting foul play with the stick and improper use of the protective equipment. Thanks to the mandatory use of a completely-covering face protector, there were few maxillofacial injuries. The highest yearly incidence of injuries was found in the older players. Prevention of ice hockey injuries is multifactorial, including stricter rule enforcement, improved protective equipment, and better understanding of the forces involved.

Surgical treatment of acromioclavicular dislocation: A review of 39 patients

Results after the operative treatment of 39 total (Type III) acromioclavicular (AC) dislocations are reported. The operation consisted of suture of the acromioclavicular and coracoclavicular ligaments and transfixion of the AC joint with an AO/ASIF malleolar screw passed through the acromion into the lateral end of the clavicle. The screw was removed at an average of six weeks after the operation. In 36 patients re-examined after a mean of 4 years, the overall results were good in 92 per cent of cases. The range of flexion and abduction was excellent (over 170 degrees) in 90 per cent. Stress radiographs revealed persisting subluxation of the AC joint in 6 patients and persisting dislocation in 1. Signs of osteoarthrosis were seen in 4 patients and signs of osteolysis in 12. Radiological signs of osteolysis correlated well with incongruity of the AC joint but not with the clinical function. Radiological signs of osteoarthrosis in the AC joint, however, correlated with a poor clinical result: all patients with a fair or poor clinical result had signs of osteoarthrosis in the AC joint. Except for one, all patients returned to their preoperative occupations within an average of two months.

Recurrent anterior dislocation of the shoulder: Results of Eden-Hybbinette and Putti-Platt operations

The results of surgery in 74 cases of recurrent anterior dislocation of the shoulder are reported. The procedures used were Eden-Hybbinette (E-H) in 48 cases and Putti-Platt (P-P) in 26 cases. The recurrence rate in the 62 shoulder joints re-examined some 4 years postoperatively was 3/41 in E-H cases and 3/21 in P-P cases. The clinical results were excellent in 46 cases, satisfactory in 11, unsatisfactory in four and poor in one case without notable difference between the methods. A restriction of the outward rotation of more than 10 degrees could be observed in half the cases regardless of method. Radiographically, the Bankart lesion of the glenoid rim could be observed in two-thirds of the cases and osteoarthrosis of the glenohumeral joint was evident in one tenth. The transplanted bone block used in the E-H reconstruction was still in position in the majority but some degree of resorption could usually be observed. These observations did not correlate with the clinical results.

Surgical treatment of Rockwood grade-V acromioclavicular joint dislocations 50 patients followed for 15-22 years

Background and purpose Long-term outcome after surgery for grade-V acromioclavicular joint dislocation has not been reported. We performed a retrospective analysis of functional and radiographic outcome 15–22 years after surgery. Patients and methods We examined 50 patients who were treated at our hospital between April 1985 and December 1993. Various methods of stabilization were used: K-wires (n = 36), 4.5-mm screw (n = 12), or biodegradable screw (n = 2). Osteosynthesis material was removed after 6–8 weeks. Mean follow-up time was 18 (15–22) years. Outcomes were assessed with the Constant shoulder (CS) score, Disabilities of the Arm, Shoulder, and Hand (DASH) score, the simple shoulder test (SST), the Copeland shoulder impingement test, the cross-arm test, pain, stability of the AC joint, and complications. From radiographs, we evaluated AC and glenohumeral (GH) arthrosis, osteolysis of the lateral clavicle, and alignment of the clavicle with the acromion. Results Mean values were 90 (75–100) in CS score, 5.1 (0–41) in DASH score, and 11 (2–12) in SST. There was no statistically significant difference in CS score between the injured shoulder and the uninjured shoulder. The AC joint was clinically stable in 42 patients. In 38 patients, the clavicle alignment with the acromion was normal in radiographs. Lateral clavicle osteolysis (10 patients) appeared to be associated with permanent AC joint dislocation. Interpretation Surgery with a temporary fixation for acute grade-V AC joint dislocation leads to successful long-term functional results. Only minor disability occurred in some patients.

The intraarticular pressure during shoulder arthrography: a diagnostic aid in rotator cuff tear

The intraarticular pressure was determined in 24 shoulders during glenohumeral joint arthrography. As the contrast volume increased, the pressure stayed low in the shoulders with a tear of the rotator cuff and rose along a characteristic biphasic curve in intact shoulders. Simultaneous monitoring of the intraarticular pressure can improve the diagnostic value of arthrography.