Aim

Two different techniques to release subscapularis during total shoulder replacement (TSR) have been described (tenotomy and osteotomy) with no consensus as to which is superior. In this study we review the clinical outcomes of a sequential series of patients in whom a TSR for primary osteoarthritis had been performed using either technique at our institution. Subscapularis function was tested using a new graded belly press test, a modification of the traditional belly press test which is described for the first time here.

Subscapularis function following Total shoulder joint replacement has been a concern in recent literature. It has been postulated that lesser tuberosity osteotomy approach may have better Subscapularis function than transtendonous approach.

To assess whether lesser tuberosity osteotomy vs. subscapularis tenotomy is better for post-operative function of subscapularis in total shoulder replacements done by a single surgeon in a District general hospital.

117 shoulder replacements performed by the senior author (TH) at Waikato district general hospital between years January 2002 to January 2010 were reviewed retrospectively. Revision replacement, inverse shoulder replacement & acute traumatic hemiarthroplasty were excluded. Patients with previous rotator cuff problems, previous surgery to subscapularis, rheumatoid arthritis and post-trauma sequelae were also excluded from the study. Inclusion criteria were normal subscapularis function and intact subscapularis on MRI pre-operatively.

41 shoulders were eligible to participate in study of which 1 pt died (bilateral TSR), 1 pt unfit to participate due to cervical disc problems. Of remaining 38 shoulders 11 shoulders had transtendonous and 27 shoulders had lesser tuberosity osteotomy approach. 37 shoulders were reviewed clinically for range of motion of the shoulder and subscapularis strength. Range of motion and subscapularis strength was significantly higher in the osteotomy group. All osteotomies were united on axillary radiograph.

Lesser tuberosity osteotomy approach result in better subscapularis function than transtendonous approach.

The term os-acromiale denotes the failure of fusion of acromial apophysis to the scapular spine. The prevalence of os is considered to be about 8% in the general population with higher prevalence in African Americans and males. The treatment options for a symptomatic os acromiale range from arthroscopic excision to decompression to ORIF and bone grafting. In this study, we reviewed retrospectively patients who had undergone ORIF and bone grafting for a painful os acromiale.

Patients surgically treated for os acromiale from 1998 to 2009 were included in the study. All patients were diagnosed to have a symptomatic os acromiale clinically and radiologically. A pre operative MRI of the affected shoulder was done in all patients. All patients had failed conservative management. The surgical technique was standard in all patients. The rotator cuff was repaired if it was torn. Patients were followed up at 3, 6 and 12 months postoperatively. Post operative X-rays were done at 3 months to assess healing. An ASES scoring was done at the final follow up at a mean of 30.5 months post op.

16 patients with 17 shoulders which included 10 males and 6 females were available for the last follow up. 11 shoulders involved dominant hand, 15 shoulders had a history of trauma. Surgery was performed after an average of 7.2 months of conservative management. 11 out of the 17 shoulders had associated rotator cuff tears. Out of the 6 patients with intact cuff, 2 had associated clavicle fractures and 1 patient had an Acromio clavicular joint dislocation. A clinical and radiographic union was achieved in all patients. Mean ASES score in patients without rotator cuff tear was 89 whereas patients with associated rotator cuff tear had an ASES score of 74. Pain score and percentage ADL score were better in patients without rotator cuff tear (92 and 1.3) as compared to those with a cuff tear (83 and 2.2). There was no significant difference in scores in patients who had second surgery at final follow up. 15 of the 16 patients were satisfied with the surgery and would have the surgery on the other side for a similar problem.

Open reduction and internal fixation of symptomatic os acromiale yields predictable clinical outcome. Bigger studies randomising treatment methods in similar group of patients may be needed to find out the superiority of one method over the other.

Dirt-bike and motocross riding are popular recreational activities in New Zealand. There are many competitive and recreational events organised for children within our catchment area every year. T he aims of this study were to document the pattern of paediatric motorbike injuries admitted at our level one trauma centre.

Retrospective analysis of all patients under the age of 16 who were admitted to Waikato Hospital following a motorbike accident from January 2006 to May 2008. Patients were identifying using ICD 10 coding (U 651). Patient notes were retrieved and reviewed. Patients were excluded if they were not admitted from the emergency department.

There were 70 admissions identified in 58 patients on ICD coding. Three admissions were excluded. Nine patients had two or more separate admissions during the study period. Fifty-seven were male and the average age was 12.5 (range 6 to 15). There were 21 admissions in 2006, 27 in 2007 and 19 in the first five months of 2008. 64 (96%) were admitted under the orthopaedic/trauma service. 87% were helmeted and 73% were wearing protective gear. Motocross riding was responsible for 60% of admissions. No patients died. One patient had documented loss of consciousness at the scene and the mean injury severity score was 5.8 (range 1 to 27). There were 108 documented injuries and 28% of patients had multiple injuries. Of all injuries, lower extremity (33%) and upper extremity (28%) and head injuries (12%) were most common. Three percent of patients required surgery with 24.4% of these requiring multiple anaesthetics. The average length of stay was three days (range 1 to 10). One patient was transferred to another centre for spinal surgery and rehabilitation.

Severe motorbike injuries are common in Waikato. The number of severe injuries is increasing. Most injuries are associated with motocross and more than half require surgery. This increasing workload has financial implications on orthopaedic, trauma and emergency departments. Children riding motorbikes should wear helmets and protective gear at all times.