The use of a Shoulder Hemiarthroplasty for the treatment of Proximal Humerus Fractures (Neer 3 and 4 Parts) is the subject of this study.

71 patients with 71 Proximal Humerus Fractures were treated with this method. Four were exluded from the study (they did not match the follow-up criteria). From the remaining 67, 60 were women and 7 men, aging from 38 to 96 years (average 67.13 year, S.D. 14,769s). Of these patients 22 were Neer 3 (1 with a dislocation) and 45 were Neer 4 (17 with a dislocation). There were 4 cases of a failed ORIF and in 8 cases the operation followed failed conservative treatment (2 non-unions and 6 AVN). Time between fracture and surgery ranged from 1 to 5 days in 54 cases, while in the rest it exceeded 8 weeks. The fracture classification was performed with the use of 3 plain X-rays (AP, Lateral and Axillary views) and the results were evaluated using the Constant Score. The mean follow-up was 55.75 months (range 36 to 105). The average Constant Score was 67.4 (S.D. 14.3). There were no significant statistical differences regarding sex and age in respect to the Constant Score (t 65 =.243, p =.81), range of motion (t 65 =.048, p =.96), strength (t 65 =.741, p =.46), activities of daily living (t 65 =.030, p =.97) and pain relief (χ2 [1] =.001, p =.98). On the other hand the group of patients with the higher pain relief scores presented higher Constant Score values and better shoulder joint function in respect to the group which presented lower pain relief scores.

In conclusion the treatment of Proximal Humerus Fractures (Neer 3 and 4 Parts) with the use of a Shoulder Hemiarthroplasty is a good treatment method offering substantial pain relief, functional improvement of the joint leading to a faster rehabilitation in the majority of patients, regardless age and sex.

The aim of this biomechanical study was to investigate the role of the dorsal vertebral cortex in transpedicular screw fixation. Moss transpedicular screws were introduced into both pedicles of each vertebra in 25 human cadaver vertebrae. The dorsal vertebral cortex and subcortical bone corresponding to the entrance site of the screw were removed on one side and preserved on the other. Biomechanical testing showed that the mean peak pull-out strength for the inserted screws, following removal of the dorsal cortex, was 956.16 N. If the dorsal cortex was preserved, the mean peak pullout strength was 1295.64 N. The mean increase was 339.48 N (26.13%; p = 0.033). The bone mineral density correlated positively with peak pull-out strength.

Preservation of the dorsal vertebral cortex at the site of insertion of the screw offers a significant increase in peak pull-out strength. This may result from engagement by the final screw threads in the denser bone of the dorsal cortex and the underlying subcortical area. Every effort should be made to preserve the dorsal vertebral cortex during insertion of transpedicular screws.

Aim: The results of operative treatment of acetabular fractures, as well as its role in the prevention of post-traumatic osteoarthritis are presented. Methods: From 1990 to 2000, þfty patients had an open reduction and internal þxation of an acetabular fracture. Thirty-two patients were male and eighteen were female, with an average age of 37,8 years (range: 18 to 71 years). The mechanism of injury was a motor vehicle accident in most cases (84%). 22 fractures were A-type, 24 B-type and 4 C-type according to the AO classiþcation, while according to the Letournel-Judet classiþcation 21 fractures were simple and 21 complex. Osteosynthesis was achieved with either lag screws alone or with a combination of lag screws and a buttress plate. Results: Follow-up ranged from 2–10 years (average: 5,8 years). Clinical evaluation according to the Dñ Aubigne-Postel scoring system gave 20 excellent (40%), 18 good (36%), 5 fair (10%) and 7 poor (14%) results. Early postoperative complications included 5 cases of common peroneal nerve palsy and 3 cases of wound infection. Late complications included 1 case of avascular necrosis of the femoral head, 12 cases of post-traumatic osteoarthritis (24%) and 5 cases of Brooker III heterotopic ossiþcation (10%). Conclusions: Operative treatment of ace-tabular fractures although demanding bears very good results. Post-traumatic arthritis remains a common complication, even if care is taken for the anatomic reduction of the fracture.

Aims: The purpose of our study is to evaluate the results of the treatment of unstable upper humerus fractures with the implantation of the Plant-Tan Plate which is a combination of an internal fixator with a neutralization plate. Methods: In a period of 17 months (January2001–May2002), 10 fractures in 10 patients (7female – 3 male) were treated. Their ages ranged from 45 to 75 years (mean 67.8 years). Patients with unstable fractures (two to four according to Neer’s classification are include in the study. The Plant-Tan Plate was used. Two head screws were placed in all fractures. The follow-up ranged from 4 to 21 months (mean 14.5months). The ASES scoring system was used to evaluate the results. Results: All our patients achieved clinical and radiological union of the fractures in a period of 4 months. The average cumulative score of activities of daily living of ASES Scoring System was 23 out of 30 (76.66%). One superficial wound infection occurred which was resolved with the administration of antibiotics. Conclusions: The Plant-Tan Plate rapresents a new, promising method of internal fixation for fractures of the proximal humerus, which offers anatomical reduction and a stable osteosynthesis (provding angular and rotational stability), so that an early rehabilitation program can be instituted.

Humeral diaphysis fractures consist a rather frequent injury. The aim of our study is to evaluate the results of the treatment of humeral diaphysis fractures with the use of an interlocking intramedullary nail.

During the period March 1999 – December 2001, 25 intramedullary nailings were performed in 24 patients with a humeral fracture (16 women and 8 men), aged 26–81 years (Average: 57.1 years) using a Russell-Taylor humeral nail. There were 16 cases of acute humeral fractures, 3 cases of pathologic fractures, and 6 cases of delayed union or non-union. Follow-up ranged from 6 to 36 months (Average: 20 months). Fracture union was recorded, and the results were evaluated according to the scoring system of Neer.

No immediate postoperative complications were recorded. The final result was excellent in 9 cases (36%), good in 12 (48%), unsatisfactory in 3 (12%), while there was one failure (4%), where a reoperation was required. Fracture union was achieved within 4 months in 21 cases (84%), while 2 cases of delayed union and 2 non-unions were recorded.

Interlocking intramedullary nailing offers a dependable solution in the treatment of humeral diaphysis fractures, providing a very satisfactory functional outcome and a high union rate. It offers an excellent option in the treatment of pathologic fractures of the humerus, as well as in severely comminuted fractures and humeral fractures in polytrauma patients.

We measured torsion of the humeral head in 38 patients (40 shoulders) with recurrent anterior dislocation of the shoulder (RADS) and in 40 normal subjects. We found a reduced mean retroversion in the patients with RADS at 4.3 +/- 10.56 degrees (17 degrees anteversion to 32 degrees retroversion) as compared with 16.1 +/- 11.07 degrees in the control group (0 degrees to 49 degrees) (p = 0.0001). There was anteversion in 11 of the 40 shoulders in the RADS group (27.5%) and in none of the control group. The first dislocation had occurred after minimal force in 18 of 25 patients with less than 10 degrees retroversion, but in only three of 15 with over 10 degrees retroversion. We conclude that decreased retroversion of the humeral head is often associated with RADS and with first dislocation of the shoulder caused by minimal force.