Introduction

The reliability of currently available proximal humeral fracture classi?cation systems has been shown to be poor, giving rise to the question whether a more objective measure entails improved predictability of surgical outcome. This study aims to apply a novel software system to predict the functional range of motion of the glenohumeral joint after proximal humeral fracture.

Objective: There is no non-invasive gold standard for measuring gap formation following rotator cuff repair; re-tears are reported both on MRI and Ultrasound. We present a novel RSA technique using a combination of 1mm tantalum beads and metal sutures to allow monitoring of gap formation following rotator cuff repair.

Methodology: We carried out ten open rotator cuff repairs with using trans-osseous sutures on patients with moderate to massive tears. During surgery RSA markers were inserted into the shoulder to allow postoperative monitoring of the repair. These markers took the form of 1mm RSA tantalum beads in the greater tuberosity, distal to the repair site, and three metal sutures in tendon, proximal to the repair site. Direct measurements of the distance between the markers each side of the repair were taken intra-operatively (T=O). RSA images were taken of the repair immediately postoperatively (T=1–2 hours), day 3, 2 weeks, 3 months and 1 year post-operatively. Ultrasound imaging was performed at the same intervals by consultant musculo-skeletal radiologists blinded to the RSA data.

Results: At the 3 month stage post-operatively RSA data shows an increase in the average gap between the 2 sets of markers, with considerable variation between patients (5mm to 19mm).

Conclusion: The results are highly suggestive of gap formation in the repair. The greatest increase in gap formation has been seen between 2 weeks and 3 months. During this time patients come out of their abduction arm sling and commence physiotherapy. It may be that due to excessive loading on the repair before it has fully healed has causes failure in some cases.