Purpose: Some of nowadays treatments in shoulder pathology are focused in pain drop, but is to be evidenced than pain is the most reliable item in shoulder patient’s quality of life. The purpose of this study is to analyze quality of life in patients affected of different shoulder pathologies and check how pain and movement influence quality of life perception (QLP).

Material And Methods: 134 patients correctly filled the shoulder functional Constant score and the SF-36 score. Patients were classified by age, sex, labor status, level of education and diagnosis. There were 56 men (41,79%) and 78 women (58,21%). Mean age was 53,77 (18–85). Amongst them, 74 patients were classified as subacromial syndrome, 19 as fractures, 29 degenerative pathology and 12 as shoulder instability. Student’s T test was performed to study quantitative variables. Qualitive variables were studied using ANOVA test. Impact of pain and mobility on patients’ quality of life was assessed by Rho-Spearman’s test. Statistical regression coefficient was used to evaluate the impact of pain and mobility in perceived quality of life.

Results: There were statistically significant differences amongst age, sex and diagnosis groups (p< 0,001). Patients older than 65 years old significatively (p< 0.001) perceived worst quality of life. Women and patients affected by a degenerative disorder significatively perceived worst quality of life (p< 0.001). A relationship between movement and quality of life was founded (linear trend). In patients with preserved range of motion, changes in pain perception significatively affected PQL (p< 0,001), meanwhile patients with poor range of motion, changes in pain perception did not affect PQL (p> 0,001). The regression coefficient for pain related to SF-36 Physical component scale was 0,629 (IC: 0,301–0.958), meanwhile the regression coefficient for external rotation is 1,196 (IC: 0,693–1,699), giving thus a predominant effect of extenal rotation in PQL.

Conclusion/Discussion: Age, sex and etiology of shoulder disorder determine different perceptions of quality of life independently of the shoulder functional scoring.

Range of motion significatively affect QLP independently of the level of pain. Pain affects QLP in patients whom range of motion is preserved. External rotation is the most important item affecting QLP.

Factors determining quality of life perception should be taken into account when planning surgery strategies for different shoulder disorders.

Introduction: Shoulder hemiarthroplasty is an established treatment for complex proximal humeral fractures but the functional results of these hemiarthroplasties in proximal humeral fractures are often poor and unpredictable. The capacity of restoring proximal humeral anatomy in such these complex fractures is of capital importance to obtain proper placement and secure fixation of the tuberosities to the prosthesis. The purpose of this study was to determine the value of the upper edge of the pectoralis major insertion as a landmark to determine proper height and version of hemiarthroplasties implanted for proximal humeral fractures.

Material and Methods: The upper edge of the pectoralis major insertion was referenced with a metallic device in 20 cadaveric humerus. A Computed Tomography study was performed in all the specimens. Total humeral length was recorded in all the specimens. The distance between the upper pectoralis major insertion and the tangent to the humeral head was also recorded. The anatomical neck of the humeral head was determined in the axial plane of the CT scan and a perpendicular line was drawn to represent the posterior fin of the prosthesis. To that image, the CT scan slice showing the upper insertion of the pectoralis major was superimposed and the distance of the metallic reference to the posterior fin of the prosthesis was recorded as it was the angle formed by the line connecting the upper pectoralis major insertion with the center of the anatomical neck diameter and with the posterior fin of the prosthesis.

Qualitative variables are presented in absolute and percentage values. Quantitative variables are presented with mean values and standard deviation.

Results: Mean total humeral length was 32,13 cm. The mean distance from the upper pectoralis major insertion to the tangent to the humeral head was of 5,64. The mean distance from the upper pectoralis major insertion to the tangent to the humeral head represents the 17,55% of the total humeral length. The mean distance of the upper pectoralis major insertion to the posterior fin of the prosthesis was of 1,06 cm. The angle between the upper pectoralis major insertion and the posterior fin of the prosthesis was of 24,65º.

Conclusions: Mean distance from the upper part of the pectoralis major insertion to the top of the humeral head of 5, 6 cm with a 95% confidence interval.

Placement of the prosthesis in the proper retroversion can be achieved by placing the posterior fin 1,06 cm posterior to the upper insertion of the pectoralis major or by placing the posterior fin at 24,65º with respect to the upper insertion line.

Upper insertion of the pectoralis major constitutes a reliable reference to reproduce anatomy in hemiarthroplasties for proximal humeral fractures.

Purpose of study was to determine the value of the upper edge of the pectoralis major (UPM) insertion as landmark to determine proper height and version of hemiarthroplasties implanted for proximal humeral fractures.

UPM insertion was referenced with metallic device in 20 cadaveric humerus. Computed Tomography study was performed in all specimens. Total humeral length and distance between the UPM insertion and the tangent to humeral head was recorded. CT scan slice showing UPM superimposition in humeral head was drawn to determine prosthesis retroversion. Qualitative variables are presented in absolute and percentage values. Quantitative variables are presented with mean values and standard deviation.

Mean total humeral length 32,13 cm. Mean distance from the UPM to the tangent to the humeral head 5,64. Mean distance from UPM insertion to the tangent to the humeral head represents the 17,55 % of total humeral length. Mean distance of UPM insertion to the posterior fin of the prosthesis of 1,06 cm. Angle between UPM insertion and posterior fin of the prosthesis 24,65°.

Mean distance from the UPM insertion to the top of the humeral head of 5, 6 cm with a 95% confidence interval. Placement of the prosthesis in the proper retroversion can be achieved by placing the posterior fin 1,06 cm posterior to the UPM or by placing the posterior fin at 24,65° with respect to the upper insertion line. UPM constitutes a reliable reference to reproduce anatomy in hemiarthroplasties for proximal humeral fractures.

Introduction: Defects in rotational alignment of the femoral component in total knee replacements (TKR) may cause poor alignment of the extensor apparatus. There are numerous references concerning the correct alignment of the femoral component of a prosthesis: transepicondylar axis, anteroposterior axis, and posterior condylar axis.

Materials and methods: Computer-assisted measurement of the relative differences between the transepicondylar axis, anteroposterior axis and posterior condylar axis in 38 TKR patients, excluding those with varus or valgus deformity greater than 15 degrees.

Results: The difference between the anteroposterior axis and the transepicondylar axis was 3.13 degrees of external rotation in the former.

Between the posterior condylar axis and the transepicondylar axis it was 1.18 degrees of internal rotation in the former.

Between the anteroposterior axis and the posterior condylar axis it was 5.51 degrees of external rotation of the former.

Conclusions: Probably the transepicondylar axis is the best landmark to enable reproducing the biomechanics of the knee in a patient bearing a prosthesis, although it is often difficult to reproduce it precisely. Several studies have noted errors among observers that are too great to make us feel certain that we are doing the best thing.

Although it is accepted that the perpendicular to the anteroposterior axis is reliable and corresponds to 4° of external rotation in relation to the posterior condylar axis, we have observed significant differences from one patient to another.

It would seem preferable to use a combination of the different axes, which we can do with a surgical browser.

Introduction: Study of the influence of anatomical restoration on the outcome of the surgical treatment of proximal humerus fractures treated by sutures and Ender nails.

Materials and methods: 44 fractures. Mean age 64.45. 12 men and 32 women. Mean follow-up 55.83 months (12.83-97). 14 2p fractures, 27 3p and 3 4p. Functional study using the Constant Scale. Quality of life measured with EuroQol-5D. Imaging done one year after surgery: AP X-Ray, full bilateral humerus with external measurement and control CT.

Results: Mean Constant score for series: 78.98. Mean EuroQol-5D rating for the series: 0.7681. Constant scores for total humerus length: Diminished length: difference < 1 cm, 84.71; difference ≥1 cm, 56. Increased length: difference < 1 cm, 79.2; difference ≥ 1 cm, 78.67. Constant score according to distance between head and trochlea: difference +: 77,94; difference −: 82.92. Differences by age groups: < 70 years, 84.12; ≥70 years, 73.5.

Conclusions: No significant involvement of function with differences of less than 2 cm in total humerus length. No significant involvement of function for differences of less than 1 cm in head-trochlea distance. Functional differences by age groups. Best result < 70 years of age.

Introduction: Meniscal extrusion is defined as the situation in which the meniscus is partially or totally luxated from the tibial plateau. The aim of this work is to ascertain the prevalence of meniscal extrusion in non arthritic patients and to define those factors related to it. Special attention was given to the fact of anatomic variations in the menisci attachments.

Methods: The knee MRI of 100 patients that were operated on arthroscopically in our institution was prospectively studied. Seventy-two males and 28 females, average age of 36.6 years (range between 13 and 64), entered in the study. There were 43 right-knees and 57 left-knees. The average weight of the patients was 77 kg (range 44 to 135).

Results: With respect to the medial meniscus 68.9% of the cases showed some degree of extrusion, averaging at 28% of the meniscal size (ranging from 10% to 60%). In the case of the lateral meniscus extrusion averaging 15% (ranging from 10% to 40%) was seen in 18.8% of the cases.

In this series the posterior types of anterior medial meniscus insertion were the most frequently found (69.5%).

Medial meniscal extrusion was significatively correlated to the presence of a chondral lesion (p = 0.008) and to anterior medial meniscus insertion (p = 0.001). No statistical significant relationship to the rest of parameters studied was encountered. None of the parameters studied were related to lateral meniscus extrusion

Discusion: Meniscal extrusion is frequent in our series and, the hypothesis that those patients who have an anterior variant of the anterior horn insertion of the medial meniscus tend to show greater extrusion is confirmed.

Introduction and purpose: The treatment of proximal humerus fractures is still controversial in terms of the surgical approach to be used and even of whether surgery is indeed necessary or not. The purpose of this study is to assess the functional result and the patients’ perception of their general health condition after treatment of displaced humerus fractures by means of transosseous sutures with or without the support of modified Ender nails.

Materials and methods: The study comprised a series of 40 patients (mean age: 66.21 years); 82% females /18% males. The patients had the following fracture types: 27% had two-part fractures, 60% had three-part fractures and 12% had four-part fractures and fracture-dislocations. The mean follow-up was 55.83 months (12.83-97). The final functional evaluation was carried out using the Constant score and the health perception was measured on the EuroQol-5D scale. All patients were submitted to a final radiological exam (AP and profile radiographs on the scapular plane).

Results: The mean value obtained on the Constant Scale was 74.18 in the involved arm and 84.06 in the contralateral one. As regards pain, the mean obtained was 12.57, while the value for forward arm elevation was 8.24. When comparing two age groups (> 70 vis-á-vis < 70 year olds) a significant difference was obtained with respect to Constant Scale’s global value (p 0.022). Furthermore, a significant difference was detected between the result of the EuroQol-5D scale, the global result of the Constant Scale (p 0.061), abduction (p 0.05), internal rotation (p 0.05) and strength (p 0.007). The rate of postop complications was 6% (2 surgical wound haematomas). The final radiological control revealed losses in reduction and necrosis in 9.37% and 3.03% of patients respectively.

Conclusions: (1) Good global functional results on he Constant Scale. (2) Significant differences in functional results based on patients’ age. (3) Difference in quality of life perceptions on the basis of the amount of mobility and strength obtained postoperatively. (4) Low complications rate.

Introduction and purpose: The functional result of the functional repair of the rotator cuff is multifactorial. The purpose of this study was to assess the influence of supraspinatus and infraspinatus fatty degeneration prior to surgery on the functional result of open rotator cuff repair surgeries.

Materials and methods: The study comprised 32 patients (19 females and 13 males) operated on for a rotator cuff tear by means of open surgery. Mean age: 58.16. The right arm was involved in 20 cases, whereas the left one was involved in the remaining 12. The acromion was type II in 28 cases and type III in 4. In all cases a previous MRi was available. The analysis of fatty degeneration was made on the basis of Goutallier’s criteria. The assessment of the functional result was made according to Constant’s score. Minimum follow-up: 1 year.

Results: Mean Constant score: preop 51.41 (range: 30–69); postop (at the end of follow-up) 83 (range: 77–100). Fatty degeneration of the supraspinatus was deg. I in 32.25% of cases and deg. II in 45.16%. As regards the infraespinatus, 38,7% of cases had no fatty degeneration and 41.93% had deg. I. No significant differences were found regarding the post Constant score between patients with deg. 0-I supraspinatus fatty degeneration and patients with 0-I infraspinatus fatty degeneration (p 0.604) or between patients with deg. II-III-IV supraspinatus fatty degeneration and those with deg. 0-I infraspinatus fatty degeneration (p.654).

Conclusions: (1) Surgical repairs of rotator cuff tears lead to a satisfactory final functional result. (2) Considering the size of our sample, there do not seem to exist significant differences with respect to functional result between patients with supraspinatus (degrees 0–4) and patients with infraspinatus fatty degeneration (limited to deg. 0–1).