Background

To determine if double needle ultrasound-guided hydrodissolution and aspiration of intratendinous calcification is more effective treatment than blind subacromial corticosteroid injection.

Aim: This retrospective study presents the results of humeral pseudarthrosis management, in our clinic, during the period 1997–2002.

Material: 21 patients with humeral pseudarthrosis were treated during this period. 7 were men, with an average age of 48, 6 (range 22–63) and 14 were women, with an average age of 63, 3 (range 42–80). The initial treatment in 19 cases was conservative and in 2 cases surgical (internal fixation with plate – screws or intramedullary nailing). The average time of the humeral pseudarthrosis management was 5,9 months (4–10 months).3 pseudarthrosis were oligotrophic and 18 atrophic.

Method: All patients underwent an open reduction, internal fixation and bone grafting (autografts and/or allografts).In humeral shaft pseudarthrosis a wide plate was applied, while in superior humeral metaphysis pseudarthrosis, a T-plate. In all cases impaction of the fracture edges was achieved.

Results: The average follow-up was 40,2 months (range 4–68 months).Union was achieved in all cases in an average of 2,8 months (range 2–8 months). Direct postoperative mobilisation and physical therapy was applied in 20 cases and only in 1 case a “Sarmiento” splint was applied for 3 weeks. In 2 cases a postoperative haematoma presented. In 1 case a pre-existed paresis of the radial nerve after the initial treatment of the fracture with internal fixation, came back 3 months after the management of pseudarthrosis and the release of the nerve. All patients’ revealed good functional rehabilitation, about 85–90% compared with the normal arm. Arm shortening in no case was greater than 2 cm.

Conclusion: Open reduction and internal fixation is the treatment of choice in the management of the humeral pseudarthrosis. The impaction of the fracture edges into each other strengthens significantly the stability of the fracture and promotes union.

Aim: The purpose of this study is to determine the outcome in patients with acetabular fractures treated either conservatively or surgically

Method: From 1990–2000, we treated 152 patients with 158 acetabular fractures. 63 patients were treated nonoperatively and 95 operatively. According to Tile classification there were 70 type A, 52 type B, 36 type C fractures. Mean follow up was 90 months (23–151 months). Indications for surgery were fracture displacement of more than 2mm, hip joint instability, intrarticular fragments and ipsilateral femoral fracture. Surgical approaches used included the kocher-Langenbeck and the triradiate approach. Follow up consisted of radiological examination and functional assessment using Merle d’ Aubigne score.

Results: 53 conservatively treated patients followed up. 39 (73.6%) had excellent and good results and 14 (26.4%) fair and poor results due to excessive fracture comminution, severe osteoporosis, or they were too sick to be operated on.

83 operatively treated patients with 85 fractures were followed-up. Anatomic reduction was achieved in 57 fractures, satisfactory in 18 and poor in 10 fractures.

Functional outcome was excellent or good in 60 (72.3%) patients and fair and poor in 23 (27,7%).The complications were 3 wound infections, 4 cases of femoral head osteonecrosis, 3 cases of secondary loss of reduction and 5 cases of significant ectopic ossification.

Conclusion: The outcome of these difficult fractures depends on restoration of hip joint congruity and stability and correlates closely to radiographic result.