Background

The transverse acetabular ligament (TAL) has been described as an anatomic landmark to guide in the positioning of the acetabular component during total hip arthroplasty. On plain films, the radiographic teardrop (RT) has similarly been utilized as a measure of appropriate cup positioning. The goal of this study is to quantify the distance and location between the anatomic TAL and RT landmarks to aid in the positioning of acetabular component.

Introduction: The treatment of Complex Proximal Humeral Fractures and Fractures associated with Dislocation is not still resolved. Internal Fixation sometimes is not possible due to comminuted and osteoporotic bone which is commonly found in this kind of Fractures. The use of Hemiarthroplasty in this situation, not always achieves a good functional outcome, usually related to a Non Union or Malunion of the Tuberosities. We began using Reversed Shoulder Arthroplasty in this Fractures due to good results this implant had had in Glenohumeral Arthritis associated a Rotator Cuff Deficiency.

Material and Methods: From January 2004 to December 2008 we have treated 50 patients with Complex Proximal Humeral Fractures with a Reversed Shoulder Arthroplasty,38 were women and 12 were men with a mean age of 76 (38–84). The mean follow-up time was 20 months (10–36). We have used a Lima Reversed Arthroplasty in all the cases. The dominant arm were involved in 65 % of the patients. The Deltopectoral approach were used in all the cases. Thirty-five patients (70 %) were treated in less than 30 days after the fracture and 15 (30 %) were treated 30 days or more since the fracture happened. The operations were performed by 6 surgeons, but only 3 of them have performed more than 10 operations.

We used the Constant Score and the American Shoulder and Elbow Score to evaluate the outcome of the implant. The preoperative movement were estimated on the mobility score of the contralateral shoulder.

Results: The mean Constant and the mean modified Constant Score were 55 (23 to 73) and 70 (34 to 95). The average range of motion was 105 (45–140) for anterior elevation and 100 (35–125) for abduction. The mean modified American Shoulder and Elbow Surgeon was 64 (44–82).

The average operation time was 105 minutes with a range (60–170).

The main clinical complications has been: Three intraoperative Fractures of Glenoid, 2 post operative Glenoid Fractures, 2 Brachial Plexus Paralysis, 2 cases of Cubital Neuroapraxia, 2 Dislocations of the Prosthesis,2 superficial infections and 1 deep infection.

Radiography it has been found Scapular Notch in 17 patients (34%), Periprothesic Calcification in 42 (84 %) and migration of the Tuberosities in 22 (44%).

Conclusions: We have had better results in acute situations than chronics ones. Most of the complications occurs in the group of patients treated in more than 30 days since the Fracture has happened.

The Reverse Shoulder Arthroplasty is an alternative to the Hemiarthroplasty, and an important tool which an Orthopaedic Trauma Surgeon has to consider, to resolve this kind of Fractures specially in elderly patients.

Introduction: Traditionally conservative treatment has been used in fractures of more than 4 parts in patients over 65 years of age. Due to the increasing physical demands on the part of the patients and the increase in life expectancy we have had to reassess our attitude with respect to these fractures.

Materials and methods: We carried out a prospective study in patients with 4-part proximal humeral fracture treated with shoulder arthroplasty in 33 patients. Mean age 65–90, 81% women. The choice of prosthesis depended on the surgeon. The decision to use an inverted prosthesis was due to the impossibility of repairing the rotator cuff. The assessment parameters used were: clinical assessment, pain-scale, Constant Test, DASH questionnaire and satisfaction survey.

Results: The total complication rate was 45% (15 patients), 7 suffered a functional limitation of movement, 2 damaged their rotator cuff, 1 had a prosthesis dislocation, 2 had infections, 1 had pulmonary thromboembolism (PTE) and 2 were cases with previous neurological lesions. Twelve percent of all complications were independent of the technique used and in 42% there was no baseline pathological condition that justified their poor evolution. Good results were seen in 76% of functionally active patients.

Conclusions: In spite of the failure rate and the demanding technical requirements of this technique, shoulder arthroplasty may be considered the procedure of choice in active patients over 65 years of age.

Introduction Minimally invasive lumbar discectomy using the METRx™ System (MAST discectomy) has been advocated as an alternative to open microdiscectomy for symptomatic posterolateral lumbar disc herniation. This paper presents a quality assurance dual surgeon retrospective study with independent observer minimum twelve month follow-up.

Methods This study was approved by the Ethics Committee of the Princess Alexandra Hospital prior to commencement. All patients who underwent MAST discectomy using the METRx™ System for the management of radiculopathy caused by posterolateral lumbar disc herniation under the care of two surgeons (AN and RK) more than twelve months prior to the commencement of assessment were included in the study. The patient demographic data was collected contemporaneously, operation performance data was collected retrospectively from hospital databases and outcome data was collected by telephone interview by independent observers (PL, SO and JP) a minimum of twelve months after discharge from hospital.

Results 101 patients (53 males, 48 females) (average age 43 years, range 17 to 83 years) underwent 102 procedures between July 2001 and December 2004. Surgery was performed on the right side in 63 cases and was either at L4/5 (30%) or more commonly L5/S1 (70%). 21 were public patients and 80 private patients with 59 episodes of surgery occurring in a public hospital. 46 operations were performed with the METRx™ MED System and 56 with the METRx™ MD System. The average duration of surgery for patients at the Princess Alexandra Hospital (n = 48) was 88 minutes with an average length of post-operative hospital stay of 22 hrs 35 mins. 16 of these cases were performed as day surgery. Perioperative complications were: conversion to open (3), urine retention (7), nausea and vomiting (3), durotomy (5), wound haematoma not requiring surgery (1) and incorrect level surgery identified and rectified during surgery (1). The average length of time from surgery to independent follow-up was 679 days (range: 382 to 1055) with 78% successful contact. On the Modified McNabb Outcome Scale, 83% reported an excellent or good outcome, 9% reported a fair outcome and 8% a poor outcome. The time until return to work was identified as less than two weeks in 28% and between 2 weeks and 3 months in 39%. Patients whose surgery was funded by Workers Compensation were over-represented in both the poor outcomes and delayed return to work. 4 patients reported progressive severe low back pain, 10 patients reported ongoing lower limb pain (severe in 1 and mild in 9) and 1 patient underwent surgery for a recurrent disc prolapse. Further disc prolapse at different sites was identified in five patients.

Discussion The retrospective data in this study forms class IV evidence for efficacy. As a quality assurance exercise it suggests an acceptable level of safety and efficacy to allow further technique development and study. A prospective randomized controlled study is proposed. The high incidence of urine retention early in the series of one surgeon is considered to be related to the practice of placing depot morphine in the operative bed. The reduction in complications in general and the improvement in duration of surgery over the series is evidence of the learning curve for this procedure.

Introduction and purpose: Achilles tendon tears with a surgical indication can be approached by means of either a standard open surgery or an alternative technique, namely a percutaneous suture of the tendon rupture. This study compares the functional results and complications of both techniques in order to assess the differences between them. The purpose of the paper is to determine whether percutaneous sutures are a valid option for the treatment of these kinds of lesions.

Materials and methods: A prospective randomized study was carried out of two groups of patients. One included 26 patients where the Achilles tendon tear was repaired by means of a percutaneous suture; the other was a control group where the classical open surgery technique was used. The mean patient age was 41 years. 92% were male. 54% of lesions were on the left side. A comparison was made of functional results and of the complications which appeared in both groups.

Results: Both groups were homogeneous regarding age, laterality and relevant antecedents. Functional results and the complications’ rate were similar in both groups.

Conclusions: Although the percutaneous suture is not a widespread technique, the study shows it as a valid alternative for the treatment of Achilles tendon ruptures since it leads to a level of function similar to that of open surgery.

Aims: The treatment of proximal humeral fracture is controversial. We proposed a syntesis with a solid nail system in order to achieve a good functional recovery Material and methods: Prospective study of 12 patients, mean age of 51 years (33 y–85y), since 2000 – 2002. All alleatory included according surgeon assignation. The men/women: 6/6. The right/left side 5/7.

Follow up period: 8 month (6m–15m).

Associated pathology: 1 ipsilateral linfedema and 1 TCE, (politrauma) X-Ray evaluation: P.A., axilary and lateral scapular view. CT scan was made to evaluate fracture patterns.

Neer classification: 6: 3-Neer; 5: 4-Neer and 1: 2-Neer part non union fracture.

Polarus nail were used in all. All (except 2)start functional recovery in first postoperative day. Constant test and x-Ray were made at regulars period.

Results: All consolidated: mean 5 weeks (5–11 w) without residual mal union. In two: nail with little proximal procidence without repercussion. In 1 was necessary the extraction of one screw All recovery its functional range of movement after 3 month. Two: limited range of movement, both have returned to habitual home activities. The Constant test was improving, mean of 74% (54–94%) Conclusions: The Polarus nail is an excellent synthesis for these fractures: it’s minimally invasive, gives a solid synthesis without hardware failures and facilitates an early rehabilitation program.

Introduction and Objectives: Non-unions of long bones represents a challenge for the orthopaedic surgeon due to the difficulty of treatment and high use of resources (human, surgical, etc.) which certainly raises health care costs. The development of morphogenetic proteins for the treatment of this clinical condition provides a powerful means of achieving the desired result: consolidation of the non-union.

Materials and Methods: From June 2002 to May 2003, we treated 5 cases of non-union of long bones (2 of the humerus, 1 femur, 1 tibia, and one knee arthrodesis). The group included 3 males and one female, ranging in age from 23 to 71 years (mean 47.2 years). Three of the subjects had previously undergone surgery between 1 and 7 times. One case presented with a bone defect in the distal third of the humerus. All cases were treated using mechanical stabilisation of the fracture. In one case, a bone bank graft was used, and in another, an autologous graft was used.

Results: Bone healing was achieved in all cases, except in one humerus.

Discussion and Conclusions: BMP-7 (OP-1) appears to be an advance in the treatment of long bone non-unions. Though it does not eliminate the need for adequate surgical treatment of non-unions (resection of the focus, exposure until bleeding bone, and mechanical stabilisation), this method does favor osteogenesis at the fracture site and avoids the morbidity associated with extraction of autologous bone from the iliac crest.

Rupture of the tendons of both peroneus longus and peroneus brevis results in considerable disability. We have performed transfer of flexor digitorum longus (FDL) to peroneus brevis in two patients with lateral instability of the hindfoot due to chronic transverse tears of both tendons for which end-to-end repair was not possible. Both patients had excellent function when reviewed after eight and six years, respectively, with no symptoms. CT showed a normal appearance of the FDL in both patients, but the peroneal muscles looked abnormal. Transfer of the FDL provides a reliable solution to lateral instability of the hindfoot resulting from loss of function of both peronei.