Aims

It is imperative to understand the risks of operating on urgent cases during the COVID-19 (SARS-Cov-2 virus) pandemic for clinical decision-making and medical resource planning. The primary aim was to determine the mortality risk and associated variables when operating on urgent cases during the COVID-19 pandemic. The secondary objective was to assess differences in the outcome of patients treated between sites treating COVID-19 and a separate surgical site.

Background. In elderly patients with complex proximal humerus fractures and osteoporotic bone reconstruction is not always possible. Although hemiarthroplasty is an alternative, non-union or tuberosity migration can lead to inferior functional results. Implantation of a Reverse Total Shoulder Arthroplasty (RTSA) seems to be an interesting alternative. In the present study we retrospectively analyzed the short-term results of RTSA for complex proximal humerus fractures in the elderly. Methods. From 31.10.2005 to 20.07.2010 RTSA was performed in 29 patients (average age 80 years [67;90], 25 women, 4 man) with subcapital, three- or four-part fracture of the proximal humerus as a primary treatment. All procedures were performed using the Anatomical Inverse Shoulder (Zimmer) with fracture stem. A deltopectoral approach was used in every case with reattachment of the tuberosities. Pain, range of motion, subjected shoulder value (SSV) as well as the Constant score (CS) were used to evaluate shoulder function. Implant positioning and signs of loosening were analyzed on standard x-rays. Results. Included were 23 patients with a minimal follow-up of 12 month. The average follow-up was 17 month (12 month to 5 years). The mean SSV was 81% [40;100]. The absolute CS averaged 67 points [34;84] and the relative CS 97% [52;139]. The mean pain score (VAS) was 13.7 of 15, the mean activity score 18.4 of 20, the mean mobility score 28.6 of 40 and the mean strength score 5.1 of 25. The mean active anterior elevation was 130° [80;160], the mean active abduction 128° [80;170] and the mean active external rotation in 0° abduction 21° [-30;70]. All patients reached the same activity level as before surgery and could return to independent living. The results after 12 month were already comparable to those after 24 month (10 patients). Radiographically no signs of loosening were detected. There was a total of 3 complications and reoperations, two due to a hematoma and one because of a periprosthetic fracture. Conclusions. In elderly patients with complex proximal humerus fractures and osteoporotic bone RTSA seems to be a very satisfactory procedure. The short-term clinical results are excellent and predictable with a rapid postoperative recovery of daily comfort. The complication rate is low and acceptable

Introduction. Insufficient arthroscopic cuff tear reconstruction leading to massive osteoarthritis and irreparable rotator cuff tears might be salvaged by implantation of an inverted total shoulder prosthesis Delta in the elderly. However, despite the generally high success rate and satisfying clinical results of inverted total shoulder arthroplasty, this treatment option has potential complications. Therefore, the objective of this study was a prospective evaluation of the clinical and radiological outcome after a minimum of 2 years follow-up of patients undergoing inverted shoulder replacement with or without prior rotator cuff repair. Patients and Methods. Sixty-eight shoulders in 66 patients (36 women and 30 men) operated between February 2002 and June 2007 with a mean age of 66 years (ranging from 53 to 84 years) were first assessed preoperatively and then at minimum 2 years follow-up, using the Constant score for pain, Constant Shoulder Score, Oxford Shoulder Score, UCLA Shoulder rating scale, DASH Score, Rowe Score for Instability and Oxford Instability Score. 29 patients (Group A) had undergone previous shoulder arthroscopy for cuff tear reconstruction at a mean of 29 months (range 12 to 48 months) before surgery and 39 patients (Group B) underwent primary implantation of an inverted total shoulder prosthesis Delta. Any complications in both groups were assessed according to Goslings and Gouma. Results. We report statistically significant improvements of all obtained scores at a mean follow-up of 42 months (ranging from 24 to 96 months) in both groups. Significant outcome differences between 29 patients with previous shoulder arthroscopy for cuff tear reconstruction and 39 without previous shoulder arthroscopy were not observed. Eight complications occurred altogether, in terms of a nerve lesion once, loosening of the humeral stem three times, and loosening or fracture of the glenoid component four times. Conclusion. We did not detect any statistically significant impact of previous insufficient shoulder arthroscopy for cuff tear reconstruction on the outcome and survival rate after the implantation of the inverted total shoulder prosthesis Delta. We conclude that reverse total shoulder arthroplasty with the Delta prosthesis is significantly beneficial in terms of less shoulder pain, higher stability and gain of range of motion without this beneficial effect being significantly weakened by previous insufficient shoulder arthroscopy for cuff tear reconstruction. We believe that previous arthroscopic cuff tear reconstruction should therefore be included in the treatment algorithm

Aims

The aim of this study was to explore whether time to surgery affects functional outcome in displaced proximal humeral fractures

Aims

In order to determine whether and for whom serial radiological evaluation is necessary in one-part proximal humerus fractures, we set out to describe the clinical history and predictors of secondary displacement in patients sustaining these injuries.