A series of 116 patients surgically treated, with exclusion of arthroplasty, between December 1996 and December 2002 for a fracture of the proximal humerus, was retrospectively reviewed. Only 44 patients (45 shoulders) were available for clinical and radiological follow-up, 21 were deceased, 36 refused to participate and 14 could not be traced.

The mean age was 60 y (15–93 y), the mean follow up was 44 months (15–78 m.); 28 were women, 16 men.

The fractures were classified according the Neer-classification but also according the different types of surgery they underwent: percutaneous or retrograde pinning without opening the fracture site, osteosynthesis with plate and screws, osteosynthesis with screws alone, bone-graft and osteosutures or a combination of two or more methods.

Two-part fractures (10 out of 13 fractures), but also 9 of the 15 three-part fractures, were treated by pinning, whereas the remaining 2 and 3-part, the isolated fractures of tuberculi and two 4-part fractures needed open surgery and fixation. A plate was used in only 3 cases, screws alone in 6 cases, a cortical bone-graft with osteosutures in 4 cases and a combination of open fixation in 8 cases. Whenever possible a minimal invasive technique was thus preferred.

16 patients (35,7%) had complications: 6 were minor (pin migration, slight secondary displacement or impingement as a consequence of protruding hardware), but one non-union, 4 CRPS and 5 avascular necrosis occurred. Only one of the latter underwent shoulder-arthroplasty at time of review. Major complications occurred mainly in the more complex fracture types (3 or 4 part fractures)

Mean values of Constant score, ASES-score, Neerscore, UCLA score and Simple Shoulder test were not statistically different, neither between fracture types nor between surgical techniques. Using a correlation analyses we found a negative correlation between age and scoring systems: the older the patient, the lower the score. Patient satisfaction was higher in the percutaneous or retrograde pinning group than the other types of open surgery.

We can conclude that although no statistical differences could be observed in our series, minimal invasive surgical techniques, less prone to complications, are preferable in the treatment of two and three part fractures of the proximal humerus and 4-part fractures of the younger population.

Introduction Osteoarthritis of the knee is a very common disease.In 80 to 90% of the cases it starts in the medial compartment and tends to remain there.Therefore, the Oxford Unicondylar Knee Prosthesis (OUKP) is a attractive device as it only replaces the diseased parts of the knee.For the past 15 years, the results of the OUKP, especially those achieved by the designer’s group, have mostly been very good. However, reports about long-term follow-up are scarce. For the designer group, Murray reported a 98% ten year survival. The only independent research bij Svard an Price and by Lewold of the Swedish Arthroplasty Study showed a good survival of 95% at 10 years and a poor survival of 87% at 8 years respectively.Our independent study reviews a ten year follow up of 149 OUKP’s.

Methods and Results One hundred forty-nine medial prostheses were implanted in 140 patients between 1988 and 1996. After a mean of 67 months 28 patients had died, without the need for revision. Seventeen prostheses were lost to follow-up. Revision surgery using a total knee prosthesis was performed in 16 cases. In 4 others, a lateral prosthesis was implanted subsequently to a medial one. One of these 4 was revised to a total knee prosthesis 6 years later. In another 4 cases, late complications of the meniscal bearing were treated with replacement of this bearing. In the group af patients older than 75 years, no revisions were recorded. The surviving prostheses were seen back after a mean of 126 months. The cumulative survival rate at 10 years was 82% for the whole population and 84% when knees with a previous high tibial osteotomy were excluded.

This difference is significant (p=0,0000).

Conclusion These results are in line with those of the Swedish arthroplasty register and compare poorly to the survival of total knee arthroplasty, therefore this prosthesis is not the first choice for most cases. Because it preserves a maximum of bone stock and is revised to a total prosthesis almost without difficulty, it is the first-choice implant for medial unicompartmental osteoarthritis in the relatively young patient.The survival rate in the group of patients older than 75 years is as good as or better than that for total knee arthroplasty.Since the OUKP can now be placed minimally invasive, it might have its place in this subgroup. It should not be used in osteotomized knees.

The retrograde Marchetti-Vicenzi humeral nail consists of four or five flexible branches. At one end these branches are fixed into a solid L-shaped cylinder and at the other, they are held together with a locking wire. The nail is inserted in a retrograde way through a cortical window proximal to the olecranon fossa. Once passed the fracture, removing the locking wire allows the branches to spread in the metaphysis providing proximal stability. Distal locking is achieved through screw fixation.

The Marchetti-Vicenzi nail presents several theoretical advantages. Its flexible branches facilitate nail insertion and might favour fracture healing. Distal locking is performed under direct vision from posterior to anterior and additional proximal locking is not required, preventing iatrogenic neurovascular damage. Distal locking avoids nail migration and retrograde nail insertion spares the rotator cuff. Early mobilisation is often possible. This leads to an equally good elbow function, but with a better shoulder function compared to antegrade nailing.

On the other hand, limited rotational stability, especially in transverse fractures, can cause non-union and hardware failure. In the initial design, the bulky L-shaped end made a large supracondylar insertion and removal window mandatory, increasing the risk of fracture in this area. In the later version, the angle of the L-shaped cylinder has therefore been modified.

In our opinion, the use of the Marchetti-Vicenzi nail is not advisable in comminuted or transverse humeral fractures, in fractures extending in the distal third or in patients (young ladies) with a narrow medullary canal. Nail removal should only be considered if absolutely necessary.

Aims: To assess the long-term results of the Oxford Uni-compartmental knee prosthesis for unicompartmental osteoarthritis and to discuss these results in comparison to other, scarce, long term follow-up. Methods: Sixty-þve medial and 6 lateral prostheses were placed in 67 patients. After an average of 10 years, they were evaluated with the Hospital for Special Surgery (HSS) knee score. Results: Fifteen patients died after a mean of 7 years, without need for revision. Eight prostheses were lost to follow-up. Ten (16%) revisions were noted: in 4 cases (6%) this was associated with an initially poor operative indication or a postoperative malalignment. The mean HSS score in 35 medial and 3 lateral prostheses was 164. (79% excellent or good, 10.5% moderate and 10.5% poor results) compared to 168 at 4.5-years of follow-up. There is no signiþcant difference between the score of patients older and patients younger than 65 years of age. Conclusions: Because this type of prosthesis preserves a maximum of bone stock and is revised to a total prosthesis without much difþculty it is the þrst choice prosthesis for medial unicompartmental osteoarthritis in the relatively young patient. In the light of other, very scarce long-term follow-up series, and compared to follow-up of total knee prostheses, the revision rate is high. Therefore, in spite of the very good and lasting HSS score in this group, this prosthesis is not the þrst choice in the elderly.