Rotator cuff disease encompasses a spectrum from partial to full thickness tears. Despite being 2–3 times more common than full–thickness tears, effective non-operative treatment for partial thickness tears has remained elusive. Platelet enriched plasma (PRP) has been proposed to enhance rotator cuff healing by enhancing the natural healing cascade. However, its utility in rotator cuff disease remains controversial. The purpose of this study was to compare the patient reported outcomes between PRP and corticosteroid injection in patients with symptomatic partial thickness tears.

This double blind randomized controlled trial enrolled patients with symptomatic, partial thickness rotator cuff tears or rotator cuff tendinopathy proven on ultrasound or MRI. Patients were randomized to either corticosteroid or PRP ultrasound-guided injection of the affected shoulder. Patients completed patient reported outcomes at 6 weeks and 12 weeks. The primary outcome was Visual Analog Scale (VAS) pain scores. Secondary outcomes included the Western Ontario Rotator Cuff (WORC) index, American Shoulder and Elbow Surgeons (ASES) score, and failure of non-operative management as determined by consent for surgery or progression to operative intervention.

Ninety-nine patients were enrolled in the study with equal demographics between the two groups. Taking into account pre-injection scores, patients with PRP injections demonstrated a statistically significant improvement in VAS scores compared to patients receiving corticosteroid injections at 12 weeks (p=0.045) but not at 6 weeks (p=0.704). There was no difference in other outcome measures or progression of the two groups to surgical intervention.

The use of PRP in the management of partial thickness rotator cuff tears demonstrates significant improvement of pain scores at 12 week follow up compared to corticosteroid injections. However, this did not affect the rate of progression to surgical intervention. Continued study is required to determine the utility of PRP in this patient population.

Purpose: Operative treatment of diaphyseal humeral fractures is indicated for transverse displaced fractures, pathological or impending fractures, non unions, fractures with radial nerve palsy and oblique fractures after conservative treatment failure.

Different techniques are available but many surgeons have recently expressed a preference for retrograde nailing. We present our results with new generation retrograde self-locking nail.

Methodology: From 1998 to 2004, we treated 112 patients with the cannulated retrograde EXP nail (LIMA LTO). All patient have been operated in the prone position on a conventional orthopaedic table.

Proximal locking, in this device, is obtained by the angled protrusion of a wire from the nail proximal extremity. Experimental tests in the lab have confirmed the excellent torsion stability of this mechanism.

Distally, the EXP nail has two little wings shaped to sit on the medial and lateral columns of the olecranic fossa and to thus provide an effective rotational and traction control.

We treated 67 traumatic fracture, 15 pathological fractures, 10 impending fracture and 20 a non-unions. 10 patients in this series were obese.

Results: Average surgical time was 40 minutes (min 30 – max 110). Average radiation exposure was 1 minute and 15 seconds (20 seconds for proximal locking).

Union was obtained in all the 67 primary fractures and stability was secured for all the impending and pathological cases. All but 1 non-union healed after an average of 2.6 months. In 2 patients of the primary fractures and in 3 patients of the non-union group we had a delayed union. The 3 non-union patients healed after 5, 7 and 9 months respectively. Overall 9 of the 10 obese patients healed. No patients suffered shoulder pain. In 8 cases a reduction of less than 10 degrees of elbow extension was detected. Forty-five nails have been removed so far after an average of 11 months after nailing. No major problems in nail removal have been encountered.

Conclusions: Retrograde nailing of the humerus presents significant advantages over other techniques and is meeting more and more consensus. The nail employed in this series provides satisfactory stability, it is cannulated and requires minimal radiation exposure.