Johan Walters

Gluteus minimus: observations on its insertion

In 17 adult and 3 full term fetuses the hip joints were dissected to expose the insertion of gluteus minimus. An attachment of the deep surface of the tendon as it passes over the hip joint capsule was found in every case. Histological examination of this insertion confirmed the presence of short intramuscular tendons firmly anchoring the tendon to the capsule. It is suggested that this attachment retracts the capsule during hip joint motion, thereby preventing capsular entrapment.

Atlas of Amputations and Limb Deficiencies. Surgical, Prosthetic, and Rehabilitation Principles

Section II addresses the upper limb and commences with an exposé of motion and function of the upper limb, followed by a well-illustrated documentation of available prosthetic fitting. Thereafter deficiencies at all levels, starting with fingertip injuries and progressing up the arm to shoulder girdle ablation, are systematically described. The surgical techniques and prosthetic applications are detailed. Practical issues relating to prosthetic choice and patient training are useful inclusions in this text. A chapter on adaptations of prostheses for sporting activities (and potentially to any area of activity) illustrates the inventive ingenuity demonstrated in this field.

Arthrodesis of the Shoulder With Subacromial Plating

Shoulder arthrodesis has evolved such that a combined intra-articular and extra-articular technique utilizing a plate and compression screws are the standard of care. The current method of plate fixation to the spine of the scapula passing over the lateral edge of the acromion to the humeral shaft is associated with a high incidence of pressure symptoms. Our aim was to evaluate a new technique for shoulder arthrodesis. A 56-year-old woman who had undergone numerous previous shoulder operations including a failed shoulder arthrodesis was treated by rearthrodesis using an angular-stable plate placed in the supraspinatus fossa and passed below the acromion to achieve scapula-humeral fusion. Radiographic evaluation of union as well as a clinical assessment regarding plate prominence and pain was documented 4 years postoperative. The technique resulted in a stable fixation and union was achieved. This procedure avoids the complication of pressure symptoms related to the plate and hence removal of the plate was not necessary.

Reliability of shoulder symptom recall after 1 year in a retrospective application of the Oxford Shoulder Score

Background The accuracy of retrospective recall of shoulder symptoms has not been well documented. This prospective study assesses the ability of patients to recall their preoperative shoulder function one year after a surgical intervention, using the Oxford Shoulder Score (OSS). Methods 35 patients completed an OSS before undergoing shoulder surgery. One year later, patients were asked to recall their symptoms prior to their surgery. The recalled OSS of the patients as a group was compared to their preoperative score. The recall bias of each test pair was assessed with a Bland – Altman plot. Results On recall after a mean of 12.6 months, the mean OSS from the index assessment increased from 36.25 to 38.25 points. The mean difference of 2 points for the patients as a group was not significant (p = 0.14). The statistical limits of agreement of the Bland – Altman plot were set at +/-2 SD = 14.079 points. The plotted points showed fair correlation between each individual test pair. Conclusion The recall of symptoms of a large group of patients at 1 year after the index intervention appears to have a moderate correlation with the preoperative scoring. Although statistically acceptable, this limit of agreement is much larger than the 4.5-point difference, established to be clinically relevant in prior studies. The variation seen within the scores at the individual level suggests that these data cannot be used as a retrospective tool.