Background: Although most proximal humerus fractures occur in postmenopausal women and are attributed to osteoporosis, they are usually not considered individually in osteoporotic studies due to their theoretical lower incidence. We hypothesized that proximal humeral fractures patients are among the commonest fractures associated to osteoporosis, and may represent a major cause of functional disability.

Objective: To evaluate the incidence of non-displaced proximal humeral fractures in comparison with other outpatient treated osteoporotic fractures, and to assess their functional impact and on the quality of life perceived by the patients.

Methods: In this multicenter, cross-sectional, prospective study, all osteoporotic fractures in postmenopausal women aged 50 years or older treated non-operatively in 358 trauma centres were recorded during a three month period. The fractures were considered osteoporotic if they were caused by a low-energy trauma. Pathologic fractures were ruled out. The incidence of proximal humeral fractures in relation to other osteoporotic fractures was calculated. Patients were interviewed by telephone six months after the fracture using the Spanish versions of the DASH and EuroQoL 5D questionnaires.

Results: 5762 women (mean age: 73± 7.5 years) were studied. 912 (17.5%) had suffered proximal humeral fractures. Overall, proximal humerus fracture was the most frequent site, after distal radius and vertebral fractures, and was the most common in patients older than 75 years (393 cases, 43.1%). The mean DASH score was 26,62±17,9. The EuroQoL 5D questionnaire showed that 67,3% had pain or discomfort, and disclosed significant reductions in the functional capacity, especially concerning problems with self care (44,5%), performing usual activities (56,5%), and anxiety or depression (32,7%).

Discussion: Non-displaced proximal humeral fractures are among the most common fractures associated to osteoporosis, and constitute the most frequent non-operatively treated fracture in patients older than 75 years. Even if they are non-displaced, they can be a major cause of functional disability, and result in a reduction in the patient’s subjective perception of health.

Aim of the study: In order to compare the short-term results of a mini-incision in primary hip replacement with the results of the standard incision we developed a prospective study with 80 patients. Forty of them had a hip replacement using a mini-incision technique, and the 40 remaining patients using a classic approach.

Methods: All the patients were treated with an anatomic non cemented stem (ABG-II, Striker). No statistical differences were found related to age, gender and weight between groups. The patients were distributed into two surgical teams according to the date of their first visit to our service. Each team develop only one kind of procedure.

Results: No differences were found related to the incidence of surgical or postoperative complications, placement of the implants and need of early rehabilitation. Patients having a mini incision were discharged from the hospital only 1 day earlier than those having a standard incision (5.6 days vs. 6.7 days). Only blood transfusion showed a significant improvement: 8% in the mini-incision group and 32% in the standard approach needed a transfusion.

Conclusions: No major improvements were found related to the use of mini-incisions in primary hip replacement. To obtain the positive clinical outcomes related to this new technique some improvements should be done in anesthetics, pain control an early rehabilitation in selected and motivated patients.

Aims: The aim of this study is to determine the forefoot pressure distribution in normal subjects and in patients with metatarsalgia and to present an application of the electronic pedobarography in the design of orthoses. Methods: A control group of 358 normal subjects and a pathological group of 100 patients with metatarsalgia were studied with a wireless portable system for plantar pressure dynamic measurement. Each patient of the pathological group had their metatarsal head loads reequil-ibrated according to the loads obtained in the control group, by means of a set of orthopaedic sights located below the metatarsal heads which supported the lowest load, increasing its pressure support and lightening thus the overloaded metatarsal heads. The aim was to obtain a balance between the þve metatarsal heads similar to the control group. This balance was assessed with the electronic portable system. Results: The pathological group had a signiþcantly higher pressure under the third metatarsal head. The third metatarsal head pressure was significantly decreased, and the þrst, fourth and þfth metatarsal head pressures were signiþcantly increased by means of orthopaedics sights. Conclusions: The forefoot pressure distribution in patients with metatarsalgia differs from normal subjects. Redistribution of metatarsal head loads assessed by means of a electronic system can contribute to the design of orthoses to treat metatarsalgia.

Aims: The purpose of our study was to evaluate the results of using a longitudinal oblong revision (LOR) cup in the management of types III and IV acetabular defects. Methods: Thirty-þve longitudinal oblong revision (LOR) cups were used to reconstruct 29 type III and 6 type IV acetabular defects. Defects were þlled with morcellized allografts in all cases. Structural allografts were used in 2 cases. All patients were followed up for 2 to 6 years (mean, 3.3 years). Results: At latest follow-up, 32 cups were stable (91.4%) and 3 had migrated (8.6%). Two of these cups failed one year after surgery and one four years postoperatively. We found a signiþcant relation between an incomplete cup contact with the acetabular rim and the subsequent failure (p=0.042). The postoperative abduction angle was signiþcantly increased in the group of unstable cups (p=0.032). Pain, limp, use of walking aids, functional level and limb-length discrepancy signiþcantly improved postoperatively (p< 0.0001). Conclusions: For patients with type III and IV acetabular defects, this implant provided encouraging clinical results and showed satisfactory stability at early to midterm follow-up.

Aims: The purpose of this study is to present our experience with the A.B.G.-I hip system after ten years follow-up. Methods: Prospective study about 162 hip prosthesis implanted from 1990 to 1992. We have assessed clinical and radiographic results immediately before surgery and at a minimum follow-up of ten years. Statistical analysis has been developed with S.P.S.S. Results: Sex distribution of the 162 initial prosthesis: 50.71% men and 49.29% women; affected side: right in 50.71%, left in 49.29%. First hip disease: rheumatoid arthritis in 7.48%, osteoarthritis in 77.57% and avascular necrosis in 14.95%. At this moment only 102 prosthesis continue on study: 8 revised (7.27%), 21 patients died (20.39%), 28 disappeared (17.18%) and 4 (2.45%) have not been considered. Clinical assessement let us be very satisþed, with a Merle DñAubigne score improving from 7.9 preoperative to 15.8 at ten years follow-up. Clinical results have been: excellent in 54.81%, good in 27.88% and bad in only 3.85%. Radiographic results are worse than expected: 84.11% of femoral stems developed some grade of stress shielding phenomenon and polyethylene inners wore excessively (mean value = 1.77 mm). The inßammatory response to polyethylene particles originated osteolytic lesions in 88.78% of femurs and 56.48% of periacetabular bones. Today 15.53% of patients in study are waiting for a revision. Conclusions: In spite of the very good clinical results, the radiographic assessement is very concerning. We think the þrst problem is the bad quality of polyethylene inner, that is responsible for grave osteolytic lesions.

The records of 82 patients (129 feet) with resistant clubfoot deformity treated surgically by means of different releases were retrospectively reviewed. There are many treatment regimes for clubfoot. Some authors recommend manipulation with minimal multi-stage surgery, whereas others recommend neonatal corrective surgery. However, objective comparison of different treatment programs is not easy because different criteria are used to evaluate the results.

Teratologic or neuromuscular clubfeet were not included in this revision. Between 1982 and 1998, 82 patients (27 girls, 55 boys) with 129 clubfeet underwent surgical treatment. All feet were initially treated with a serial long-leg cast for a minimum of four months. Mean age at the time of first surgery was 5.5 months (range 3.5 to 24). Minimum follow-up was two years.

Primary posterior release was performed on 105 feet. Subsequent medial release was performed on 16 feet, posteromedial release on three, and a subtalar (Cincinnati) release on three. Primary isolated posteromedial release was performed on 14 feet, and two of these required a subsequent subtalar (Cincinnati) release. Primary isolated medial release was performed on seven feet.

Primary isolated lateral release was performed on one foot and primary isolated subtalar (Cincinnati) release was performed on two feet. Subsequent derotative tibial osteotomy was performed in seven cases, wedge tarsectomy on four feet, triple arthrodesis on five, and calcaneocuboid fusion on one foot.

Residual varus was present in seven feet. Calcaneal gait caused by overlengthening of the Achilles tendon occurred in one foot, and residual equinus in two feet. Residual valgus heel was observed in three feet.

The surgeon must assess each foot and plan the surgery accordingly. A total release is not required for every foot.