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: Self-administered questionnaires are commonly used to evaluate functional and satisfaction results of different treatments applied. The objective of the study is to analyze the effect of the doctor-patient interview in the self-evaluation of the patient of the pain, level of function and satisfaction in different shoulder procedures.

Material and Method: 95 consecutive patients were recruited. There were 70 females and 25 males. Mean age of 64,18 yo (20–88). There were 28 fracture cases, 37 cuff disorders, 6 instabilities and 21 gleno-humeral arthritis. 46 patients had received surgery while 49 did not. 24 patients were excluded because of wrong complementation of the questionnaire. All the patients were asked to fill 3 analogical scales (level of shoulder pain, level of shoulder function and satisfaction with the procedure) before and after the clinical visit. Non parametric values studied through U-Mann-Whitney.

Results: Analyzing the whole series there were significant differences between the pain experienced in the shoulder before and after the visit (p=0,039). There were marginally significant differences between the level of function of the shoulder experienced before and after visit (p=0,061), and there were no differences in satisfaction with the procedure (p=0,462). If the cohort of patients that had received surgery is analyzed apart, there are significant differences in pain perception (p=0,05) and also in function perception (p=0,046) but no differences were noted with satisfaction even though patients tend to perceive more satisfaction after visit. Females significantly considered less pain after visit than males (p=0,034) and no differences were noted because of age, diagnosis or time elapsed since surgery.

Conclusions: Globally, patients with shoulder disorders significantly consider to have less pain perception after clinical visit. Patients that had received surgery because of the shoulder disorder significantly perceive less pain and better shoulder function after visit. Satisfaction with the procedure tends to improve after visit but that is not significant.

Even a simple analogical scale has a 25% drop-outs because of wrong complementation.

When planning patient self-evaluation of pain and function the effect of the clinical visit has to be considered in order to avoid masking results.

Introduction: Life expectancy is increasing, this leads to a major number of hip fracture and its subsequent complications and costs.

Proximal femur fracture is not only a medical problem but also a social handicap.

Our objective is to see, by means of a prospective observational study, how the function varies after hip fracture and which are the most influencing factors in order to get maximum benefits of resources for this patology.

Materials and Methods: 262 patients had been hospitalized suffering hip fracture in our centre between june 2006 and December 2007.107 of them were included in the study, the others were excluded for different reasons: cognitive impairment (based on Folstein test), previous hip fracture or pathologic fractures.

86 female and 21 male. Mean age 74 years (65–93).44 suffering subcapital fracture and 63 pertrochanteric fracture. 76 patients underwent gamma nail or canulated screws and 31 hemi or total hip replacement. Mean surgery delay 3 days (1–14) At the moment of hospital registration we also determined marital status, familiar support, living at home or institution, morbidity pre- fracture (according to Charlson index), level of dependence (Barthel index), mental status (Folstein Mini Mental State Examination)quality of life perceived (short form 36 (SF-36)) and depression symptoms (Geriatric Depression Scale 15 (GDS 15)).

At three months post discharge we determined again all the test mentioned before and also recorded the functional level (Harris test), which haven’t been passed preoperatively because it includes a part of physical evaluation, not possible to do in a fractured leg.

Statistics: Analysis of Variance for repeated measures, Spearman correlation coefficient, level significance 0.05

Results: Most part of patients came from their own houses (87,6%), where only returned 23% of them at hospital discharge. In the control visit al 3 months most of them had returned at home (79%)

There were no significant differences between functional outcome al three months and delay of the surgery (p 0.76) or the type of surgery (artroplasty vs osteosintesis) (p0.308).

There was a negative correlation (rho-spearman −0.656)between depression and functional outcome, the more depressed a patient is the worse functional outcome he has (p 0.002)

There was a positive correlation (rho-spearman 0.605) between function (Harris test) and dependency (Barthel index).Patients less independent pre fracture are the ones with low function at three months. (p 0.000)

Discussion: There are a lot of patients needing nursing or social facilities at hospital discharge with the high costs that this supposes. We have seen that depressed people at hospital income are going functionally worse than non depressed and consequently are more dependent persons. Maybe early diagnosis ant treatment of depression will help to get maximum results of rehabilitation procedure.

Introduction: Functional results of hemiarthroplasties in proximal humeral fractures are unpredictable. The correct consolidation of the tuberosities back to the prosthesis seem to be of capital importance in the functional outcome. The objective of the study is to analyze the changes of the tension registered in the sutures passed through the tuberosities when changing the height and version of the prosthesis in a static model and in a dynamic model.

Material and Method: Prosthesis positioning: in both static and dynamic model, the prosthesis was placed in anatomical position, anatomical increasing 20° retroversion, increasing height in 1cm and anatomical version, decreasing height in 1 cm and anatomical version, increasing height in 1cm and increasing 20° retroversion, decreasing height in 1 cm and increasing 20° retroversion,

Static study: a 4-part fracture was reproduced in four fresh-frozen shoulder specimens. Sutures were placed between lesser tuberosity and diafisis (sensor 1) between both tuberosities (sensor 2) and between greater tuberosity and diafisis (sensor 3). Traction was performed through supraspinatus, infraspinatus and subescapularis attachments until the breakage of the suture or 1 cm gap between bony fragments. Tensions registered in a computer model.

Dynamic study: a 4-part fracture was reproduced in a humeral saw bone. Sutures placed in the same position that in the static model. Saw bone fixed at a robotic arm reproducing cycles of 90° anterior elevation, 30° lateral rotation, 30° internal rotation and retropulsion to starting point. Registering of the tensions. Quantitative values studied through t-student and non parametric values studied through U-Mann-Whitney and Kruskal-Wallis test.

Results: In the Static study, the suture placed between the tuberosities is the one that significantly receives more tension. The breakage of the suture happens more frequently when the prosthesis is placed in a lower position and in a lower more retroverted position.

In the dynamic study, the suture placed between the greater tuberosity and the diafisis is the one significantly receives more tension. The breakage of the suture happens more frequently when the prosthesis is placed in a lower position and in a lower more retroverted position.

Conclusions: When planning sutures between tuberosities in proximal humeral fractures treated with hemiarthroplasty postoperative rehabilitation program has to be considered because different sutures are at risk depending on static or dynamic model.

The worst positions of the hemiarthroplasty as far as over tensioning sutures is concerned are the low position and the low more retroverted position.

Background: The presence of bacteria forming biofilms or prior antimicrobial use has been shown to reduce the sensitivity of the standard technique (PT cultures) in patients with infection of orthopedic implants. Culturing fluid resulting from sonication (FRS) of prosthesis could improve the microbiologic diagnosis.

Objective: To analyze the diagnostic validity of culturing FRS of different orthopedic implants and PT culture

Methods: Between Jan 2007 and Apr 2008, patients undergoing knee or hip prosthesis removal, and those with ostheosyntesis or spinal instrumentation removal, were prospectively included (44 hip prosthesis, 63 knee prosthesis, 91 osteosynthesis and 14 spinal instrumentations). 5 PT specimens were collected for culture. Removed implants were sonicated during 5 min. (40Hz). Both, PT and FRS, were inoculated in aerobic agar (Chocolate Polyvitex), anaerobic agar (Schaedler + 5% blood) and in thioglycolat, for 7 days. Positive culture cut-off was defined as growing of > 5 CFU. Clinical diagnosis of prosthetic-joint infection was made as commonly accepted. Previous antimicrobial therapy was assessed. Diagnostic validity was calculated for both culturing methods. Sensitivity of methods was compared by Chi-square test (SPSS 15.0).

Results: 212 cases were included. Diagnostic of infection was made in 17 hip prosthesis (THA), 20 knee prosthesis (TKA), 24 osteosynthesis (OS) and 6 spinal fusions (SI).

Tissue culture was positive in 9 THA, 11 TKA 18 OS and 4 SI. Sonication culture was positive in 14 THA, 18TKA, 23 Os and 6 SI.

Tissue culture: Sensibility: THA53%, TKA 55%, OS 75% and SI 66%. Specificity: THA 96%, TKA 100%, OS 96%, SI 100%

Sonications: Sensibility: THA 82%, TKA 90%, OS 95% and SI 100%. Specificity: THA 96%, TKA 100%, OS 92%, SI 100%

Statistical differences favoring sonication were found in sensitivity in knee arthroplasty and osteosynthesis implants. 6 patients received antibiotics for > 7 days before implant was removed. Sonication culture was positive in 4 of them whereas only one standard culture yielded positive.

Conclusions: FRS cultures are more sensitive than PT cultures. Sensitivity of the method depends on which device is evaluated. Sonication also improves sensitivity of culture after preoperative antimicrobial therapy.

Introduction and Objectives: Bleeding during lumbar surgery requires the use of blood products for its management. Autotransfusions are an alternative to blood transfusions, since these are not free of risk. Although autotransfusion is a very effective technique, its efficiency is conditioned by its high cost and the fact that a large number of autodonations have to be destroyed when the patients do not require them during the postoperative period. We wanted to discover the factors that determine the use of blood products during the postoperative period so as to obtain blood autodonations from these patients.

Materials and Methods: We carried out a retrospective study of 143 patients that underwent surgery for degenerative conditions of the lumbar spine. We assessed different variables: Age, sex, lumbar level operated on, operation time, pre and postoperative hemoglobin and associated conditions (Charlson comorbidity index and ASA scale).

Results: We found a significant statistic correlation with female sex, age over 60, ASA 3, preoperative hemoglobin < 136 gr/l. Using logistic regression we found that the combination woman, ASA 3 was the most important prognostic factor with a specificity above 90%. We also found that the possibility of requiring a transfusion in a woman/ASA 3, was 61% and at the other end of the spectrum 1.1% in a man/ASA< 3,

Discussion and Conclusions: If we plan an autotransfusion in a woman with ASA 3, there is a probability of 61% that she will require a transfusion with specificity greater than 90%.