Purpose: Anatomic repair of an acute distal biceps tear has been demonstrated to improve flexion and supination strength compared with conservative treatment. The most commonly used fixation methods for a distal biceps tendon repair include suture anchors, bioabsorbable screws, and endobutton. The goal of this study was to

perform a radiologic evaluation of bioabsorbable screw tunnel osteolysis and

Method: We included twenty (20) consecutive patients who underwent primary anatomic repair of the distal biceps tendon since 2005. We used a 7x23mm biote-nodesis^® screw (Arthrex) in 18 cases, and 8x23mm and 8x12mm screws in the other two cases. First, from the x-ray view done in the immediate postoperative period showing the complete screw tunnel, we measured the ratio of the volume of the bone tunnel to the volume of the radius bone section. A mathematical formula for cylindrical volume was used (¶ x r2 x h). We used a relation between two volumes rather than the tunnel volume itself for scaling purposes. Secondly, we calculated the same relation on the x-ray from the last follow-up. We then obtained the percentage of tunnel enlargement by relating the volumetric ratio from the first x-ray to the ratio from the last x-ray. Afterwards, we performed a retrospective chart review noting any bioabsorbable screw-related and postoperative complications.

Results: In the group, the average age was forty-six (46) years. All subjects were male. Eighteen (18) cases were acute complete ruptures operated in the first three weeks, one case was a partial rupture and one case was chronic (one year). The average follow up was eighteen (18) months. We found that the average initial relative volume occupied by the screw tunnel was 47 % of the bone section. At the last follow-up, this volume increased to 68%. After our chart review, we found that one patient presented with a broken screw and increased pain and that another patient developed a severe foreign-body reaction with re-rupture of the tendon requiring three reoperations.

Conclusion: The use of a bioabsorbable screw for distal biceps tendon fixation results in significant osteolysis of the radial bone at short term follow-up. Consequences of osteolysis in the radius are worrisome since iatro-genic fractures are more likely to occur. Osteolysis can be secondary to an inflammatory reaction to the screw material, bone necrosis secondary to pressure or initial thermal necrosis. We also noted two cases of severe bio-tenodesis screw-related complications among our series of twenty (20) patients. These results call into question the use of the bioabsorbable screw in distal biceps tendon repair and are important to present. Exact volume of bone loss using 3D computed tomography scan analysis as well as quality of life questionnaires and strength testing will be available for presentation.

To determine union rate in complicated nonunions of the scaphoid treated with a vascularised bone graft.

Vascularised bone grafting for scaphoid nonunions (1–2 ICSRA, Zaidemberg technique) has shown initial enthusiasm. Its usefulness has been challenged in cases where the proximal pole of the scaphoid is avascular. Complicated nonunions where the proximal pole is highly likely to be avascular occur in revision surgery and proximal pole nonunions.

Fourteen patients were retrospectively followed up. Eight had nonunion following previous scaphoid surgery (two previous ORIF, two previous nonvascular grafting, and four with two previous surgeries). Six patients had no previous surgery for a proximal pole nonunion of 12.5 months’ duration. All patients were male with an average age of twenty-four. Delay from fracture to vascularised bone grafting was twenty months. Graft harvesting was done according to the Zaidemberg technique by two orthopaedic surgeons. CT-scan was used to confirm union in all patients except two who were lost of the follow-up. Twelve patients were followed up by an independent surgeon at a postoperative minimal period of four months. Functional status was assessed with the DASH questionnaire and follow x-rays were performed to determine the presence of degenerative changes.

Union was confirmed by CT-scan in eleven of twelve followed patients (92%) at an average time of six months following vascularised graft. Radio-scaphoid osteoarthritis was seen in the one patient that didn’t achieve union.

This series suggests that the Zaidemberg graft is useful and may be proposed in situations of revision surgery and proximal pole non-unions. We achieved a high union rate in these complicated nonunions even though there was high likelihood that the proximal pole was avascular. This study stresses the importance of protective immobilization until documented union by CT-scan in this difficult subset of patients.

Although new locking plates allows for secure fixation of osteoporotic fractures in the proximal humerus, extensive soft tissue dissection is needed for their insertion. We report on a prospective clinical trial of the first thirty patients treated with plating of the proximal humerus though a minimally invasive percutaneous approach. All fractures healed within the first 6 months with no avascular necrosis or axillary nerve injury. At the latest follow-up, the median Constant score was sixty-eight and the mean DASH score was twenty-seven. This study suggests that percutaneous plating can be a safe and effective method of fixation.

To evaluate the safety and efficacy of minimally invasive plating of the proximal humerus using validated disease-specific measures.

Percutaneous insertion of a locking proximal humerus plate is safe and produces good early functional and radiologic outcomes.

Plate fixation of the proximal humerus fractures may now be more desirable with the use of a biological approach by limiting surgical insult and allowing accelerated rehabilitation.

All fractures healed within the first six months with no loss of correction. Two reoperations were needed to remove intra-articular screws placed too long. No infection or avascular necrosis were seen. At the lastest follow-up, the median Constant score was sixty-eight points, with an age ajusted score of seventy-six. The mean DASH score was twenty-seven points. Only age was independantly predictive of both the Constant and DASH functional scores.

During a period of one year, thirty patients were operated with use of the LCP proximal humerus plate (Synthes) through a 3cm lateral deltoid splitting approach and a second 2 cm incision at the deltoid insertion. The axillary nerve was palped and easily protected during insertion. Only two-part (N=22) and three-part impacted valgus type (N=8) were included in this study since they can be reduced indirectly thru this percutaneous technique. The average follow-up was thirteen months (eight to twenty months). All patients had the Constant and DASH evaluations.