Objective: To evaluate the outcome of open reduction and internal fixation of displaced proximal humerus fractures using a new locking plate.

Design: Prospective.

Setting: Level I university center.

Patients: Twenty-eight women and 22 men (mean age, 62.9 ± 19.l years). Twenty-nine patients were 65 years of age or older (mean age, 76.8 years). Fractures were classified according to AO/OTA as 11-A2 (n=3), A3 (n=12), B1 (n=4), B2 (n=18), B3 (n=1), C1 (n=1), and C2 (n=11). Mean follow-up was 19.8 months (range, 12 to 39 months).

Intervention: Open reduction and internal fixation with a proximal humerus locking plate.

Main Outcome Measurements: Raw and adjusted (sex and age) Constant score.

Results: Forty patients were available for follow-up. The mean raw Constant score was 66.6 (adjusted, 82.0). In patients under 65, the raw Constant score was 78.2 (adjusted score, 86.7). In patients over 65, the raw Constant score was 56.1 (adjusted score, 77.8). An excellent or good result was found in 72.5% overall. There was no secondary loss of position or implant cut-out. Seven patients (17.5%) developed avascular necrosis (AVN), 6 in C2 fractures in the older group. Their mean adjusted score was 60.7, as compared to 86.6 ± in those without AVN (p = 0.001).

Conclusions: The outcome was equally good in the younger and older age groups of patients, except in those who developed avascular necrosis. While the latter might be due to the nature of the fracture, it is also possible that surgical technique plays a role.

Aims: Evaluation of unicompartmental knee arthroplasty (UKA) as an alternative to total knee replacement. Methods: 66 patients (76 knees) underwent UKA with the Allegretto prosthesis. The indication was age greater than 60 years, single compartment arthrosis, normal functioning anterior cruciate ligament, and varus/valgus deformity < 20û. Etiology was primary or secondary osteoarthrosis, the latter secondary to avascular necrosis. Mean age at operation was 70 years (range, 55 to 90 years). Patients were evaluated using the Hospital for Special Surgery (HSS) rating score. Eight patients (8 knees), with less than 12 month follow-up were excluded. 58 patients (68 knees) were available at þnal review with a mean follow-up of 65 months (range, 12 to 120 months). Results: The average HSS score was 87.7 (range, 55 to 99). There were 53 (78%) excellent, 12 (17.5%) good, 2 fair, and 1 poor result. 52 patients (76%) had a BMI > 25. There was no signiþcant difference in HSS score between these patients and those with BMI < 25. Six knees (8.8%) were revised, 4 in obese patients (BMI > 25), and 2 in the same patient (bilateral) with a BMI of 32.9 (100kg). All 6 patients had a satisfactory outcome after total knee arthroplasty. There were no infections. Conclusions: UKA for uni-compartmental knee osteoarthrosis in properly selected patients produces satisfactory results. Moderate weight obesity is not an exclusion criteria.

Purpose: Heterotopic ossification is a recognised complication after total hip arthroplasty. Prevalence can reach 53%, particularly if prophylaxis is not given, leading to postoperative pain and limiting the functional prognosis. Non-steroidal antiinflammatory drugs have proven efficacy but also present the risk of gastroduodenal toxicity making postoperative administration hasardous. Recently, selective COX-2 inhibitors have been shown to have a similar antiinflammatory activity with a clear reduction in gastrointestinal disorders. We hypothesised that selective COX-2 inhibitors could be as effective as classical NSAID for the prevention of heterotopic ossifications.

Material and methods: This clinical trial was conducted according to a prospective randomised protocol comparing a group of patients given prophylaxis with Celecoxib (Celebrex®) and another group of patients given ibuprofen (Brufen®). All patients scheduled for total elective prostheses were radomised in a prospective manner to one of the two groups, either Celecoxib 200mg b.i.d. or ibuprofen 400mg t.i.d. for ten immediate postoperative days. Radiological assessment was performed by two independent investigators blinded to the study (an orthopaedic surgeon and a radiologist) who scored calcifications according to the Brooker classification (type I to IV) at three months after surgery. Reproducibility of radiogram reading was tested and analysed with a kappa test K=0.74).

Results: Two hundred ten patients were randomised and 73 have had their three-month radiograms. The Cele-coxib group included 37 patients: 24 with Brooker stage 0, eleven with stage 1, two with stage 2. The ibuprofren group included 42 patients, 15 with Brooker 0, 16 with Brooker 1; nine with Brooker 2 and two with Brooker 3. The statistical analysis will be performed at the end of this study (June 2002).

Discussion: The preliminary results show that Celecoxib appears to have the same efficacy as ipubrofen for the prevention of heterotopic ossification after total hip arthroplasty. There was a clear trend in favour of Celecoxib.