Aims

The present study aimed to investigate the long-term functional results of scapulothoracic fusion using multifilament cables in patients with facioscapulohumeral dystrophy (FSHD) to identify if the early improvement from this intervention is maintained.

Only a few randomised, controlled studies have compared different non-operative methods of treatment of mid-shaft fractures of the clavicle.

In this prospective, randomised controlled study of 60 participants (mean age 31.6 years; 15 to 75) we compared the broad arm sling with the figure of eight bandage for the treatment of mid-shaft clavicle fractures. Our outcome measures were pain, Constant and American Shoulder and Elbow Surgeons scores and radiological union.

The mean visual analogue scale (VAS) pain score on the first day after treatment was significantly higher (VAS 1 6.8; 4 to 9) in the figure of eight bandage group than the broad arm sling group (VAS 1 5.6; 3 to 8, p = 0.034). A mean shortening of 9 mm (3 to 17) was measured in the figure of eight bandage group, versus 7.5 mm (0 to 24) in the broad arm sling group (p = 0.30).

The application of the figure of eight bandage is more difficult than of the broad arm sling, and patients experience more pain during the first day when treated with this option. We suggest the broad arm sling is preferable because of the reduction of early pain and ease of application.

Cite this article: Bone Joint J 2015;97-B:1562–5.

Several authors have suggested that the final five weeks of gestation are a critical period for the development of the hip. In order to test the hypothesis that gestational age at birth may influence the development of the hip joint, we analysed the sonographic findings in 1992 hips (in 996 term newborns) with no risk factor for developmental dysplasia of the hip. The 996 infants were born at a mean gestational age of 39 weeks (37 to 41).

The mean bony roof angle (α), cartilage roof angle (β) and the distribution of the type of hip were compared between the 37th, 38th, 39th, 40th and 41st birth week groups. There was a significant difference in the distribution of type of hip between the different birth week groups (p < 0.001), but no significant difference between the α angles of all groups (p = 0.32). There was no correlation between birth week and roof angle (p = 0.407 and p = 0.291, respectively) and no significant correlation between birth weight and roof angle (p = 0.735 and p = 0.132, respectively).

The maturity of the infant hip, as assessed sonographically, does not appear to be affected by gestational age, and the fetal development of the acetabular roof appears to plateau from 37 weeks.

Cite this article: Bone Joint J 2013;95-B:266–70.

Introduction: It was hypothesized that ipsilateral upper extremity loading will decrease hip abductor activity by decreasing the adductor moment and thus relieving the symptoms of patients with gluteus medius tendinitis. The aim of the study was to test the hypothesis with a electrophysiological and clinical study.

Materials and Methods: Seven voluntary men with no hip complaint were included in the electrophysiological phase of the study. The motor unit activities of the gluteus medius were measured for each subject during the consecutive loading of the ipsilateral, contralateral and both upper extremities, with 2, 3, 5 and 7 kilograms.

Seventeen patients (age range 34–67) with acute symptoms of gluteus medius tendinitis were included in the clinical phase of the study. Dynamic VAS scores were recorded for each patient during gait with consecutive loading of the ipsilateral, contralateral and both upper extremities, for each 2, 3, 5 and 7 kilograms. Wilcoxon and Mann-Whitney U tests were used in statistical analysis. The p values below 0.05 were considered significant.

Results: In the electrophysiologic study the ipsilateral upper extremity loading with 7 kg in 4 patients, and with 5 and 7 kilograms in 2 patients resulted in a motor unit activities with moderate interference, while motor unit activities with full interference were recorded during all other loadings. The motor unit activity interference scores recorded during the ipsilateral upper extremity loading with 5 kilograms of above, were significantly less then all other loading combinations (p < 0.05).

In the clinical study, the ipsilateral upper extremity loading with 3 kilograms and above resulted in significantly less VAS scores then the other loading combinations (p< 0.05).

Conclusion: Ipsilateral upper extremity loading decrease the motor unit activity of the ipsilateral gluteus medius muscle and relieves the symptoms of the patients with gluteus medius tendinitis. Ipsilateral upper extremity loading can lead up to new strategies in the rehabilitation of gluteus medius tendinitis.

Purpose: The purpose of this study is to evaluate the biomechanical properties and the stability between locking clavicle plate, dynamic compression plate and external fixation systems on an unstable displaced fracture model under torsional and 3 point bending loading.

Materials and Methods: Forty eight human adult formalin fixed clavicles were paired according to their BMD (DEXA) homogeneously into three groups; Group 1: Locking clavicle plate, Group 2: Dynamic compression plate and Group 3: External fixator. Each specimen was then osteotomized in the midshaft; and a 5mm bone segment was removed in order to stimulate a displaced fracture model. Biomechanical tests were applied in a cyclic loading model in MTS, Bionix 2. Torsional and three point bending forces were performed for 1000 cycles in all subgroups, stiffness was recorded at 10 cycles (initial) and periodic every 100 cyclic intervals. Failure load and moment were obtained after 1000 cycles. Initial stiffness, failure loads and the percentage of initial stiffness for each subgroup were compared across each group. One-way ANOVA and Bonferoni post- hoc tests were utilized to determine which were significantly different from one another with the significance level set as p< 0.05.

Results: The mean initial stiffness(Nmm/deg) - mean failure moments(Nmm) for torsional tests were 703.2 – 7671.7 (locking plate), 448.1 – 4370.3 (compression plate), 365.2 – 2999.7 (ex-fix) and the mean initial stiffness(Nmm) – mean failure loads(N) for bending tests were 32.6 – 213.2 (locking plate), 23.4 – 131.1 (compression plate), 20.6 – 102.7 (ex-fix) respectively. ANOVA test confirmed an overall significant difference between the three constructs in terms of both failure loads and a significant difference only between locking plate and others in terms of initial stiffness. At all cyclic intervals after 100 cycles there was significant difference of percentage of initial stiffness between locking plate and others in bending and torsion. There was a significant difference between compression plate and ex-fix after 700 cycles in torsional group and no difference found in bending group between (any of) them at any cyclic interval.

Conclusions: Locking anatomic clavicle plate is significantly more stable than unlocked dynamic compression plate and external fixator under torsional and bending cyclic loading in an unstable displaced fracture or non-union clavicle model.

Introduction: Identifying normal ranges for calcaneal angles is important for the assessment of morbidity after calcaneal fractures. We have evaluated the distribution and normal ranges of calcaneal angles.

Method: A retrospective study was performed to review 105 lateral radiographs of 87 patients (62 female, 43 male). Radiographs with fractures, deformities and fusion were excluded. The mean age was 42.6 (18–79). Böhler and Gissane angles were measured by the same surgeon with the macros of the Hipax program. T test and Pearson correlation coefficients were used for statistical analysis with SPSS software with a significance level of P< 0.05.

Results: The mean Böhler angle was 34.4±4.12º (range 23–44), the Gissane angle was 116.4±6.23º (range 103–133). There was no statistically significant difference between the mean Böhler angles of women (34.9º±4.5) and men (33.9º±3.79) (t test: p> 0.05). There was no correlation between the two angles (r=−0.044; p> 0.05). There was a negative correlation between the Böhler angle and age (R=−0.36; P< 0.01). The regression equation of this correlation was y=−0.01x+38.51. There was no significant correlation between the Gissane angle and age (r=−0.046; p> 0.05).

Discussion: The reported ranges for Böhler and Gissane angles are widely spread (14–50 and 95–130, respectively). Our results were consistent with 4 (Hauser; Loucks; Didia; Igbigbi) of the 5 previous studies. However, unlike the other studies Böhler angle results did not show sex dimorphism and revealed a negative correlation with aging. Posterior facet collapse may be the cause of this correlation.

We compared time-dependent changes in the biomechanical properties of single-and double-row repair of a simulated acute tear of the rotator cuff in rabbits to determine the effect of the fixation techniques on the healing process.

A tear of the supraspinatus tendon was created in 80 rabbits which were separated into two equal groups. A single-row repair with two suture anchors was conducted in group 1 and a double-row repair with four suture anchors in group 2. A total of ten intact contralateral shoulder joints was used as a control group. Biomechanical testing was performed immediately post-operatively and at four and eight weeks, and histological analysis at four and eight weeks.

The mean load to failure in group 2 animals was greater than in group 1, but both groups remained lower than the control group at all intervals. Histological analysis showed similar healing properties at four and eight weeks in both groups, but a significantly larger number of healed tendon-bone interfaces were identified in group 2 than in group 1 at eight weeks (p < 0.012).

The ultimate load to failure increased with the number of suture anchors used immediately post-operatively, and at four and eight weeks. The increased load to failure at eight weeks seemed to be related to the increase in the surface area of healed tendon-to-bone in the double-row repair group.

In the last decade many changes happened in arthroscopic shoulder instability treratment. As all arthroscopic procedures cause less pain and early rehabilitation. Stabilisation techniques began with very demanding transglenoid suture techniques. After innovation and developments of suture anchors, arthroscopic stabilisation becam safe and reliable operation. Bankart repair with anchors and arthroscopic knot is a well-accepted method in anterior instability. The stronger the repair is, patient can return daily and sports activities earlier and safer. Treatment of capsular laxity is still controversial. Shrinkage with radio-frequency was presented in last years for tretment of laxity in unidirectional and multidirectional instabilities. Despite its easy application, treatment principles are not clear and the long-term results are unknown yet. New capsular plication with arthroscopic suture might be alternative and more reliable method but it needs great experience in arthroscopic shoulder surgery. Some lesions such as SLAP may diagnosed and treted arthroscopically easily. Further more arthroscopic labrum repair after first traumatic dislocation is getting widely accepted in younger patients because of high recurrence rate. An overview of thermal shrinkage, multidirectional instability, associated lesions and treatment of first traumatic dislocation will be discussed in this symposium.