Aim

The aim of this study was to review the referral pattern of Soft Tissue Sarcoma (STS) in the Mersey region. We were interested in the referrals that came from other specialties [not primary care] and how they were managed before being finally referred on to the Tumour Unit.

Scapular instability is a disabling deformity that results in pain and influences the overall upper limb function ; for which scapular stabilization may be necessary.

Aim: To review the results of this procedure.

Methods: 9 patients who underwent this procedure could be contacted and were assessed. We used the Disability of Arm, shoulder and Hand score(DASH) and the constant score for shoulder function including subjective assessment of patients pain and overall satisfaction and radiographs for evidence of unionwith a mean age of 36 yrs(range 21–57 yrs), performed in the period between July 1996 and October 2002 with a mean follow up period of 35.7 months,(range 10–72 months).6 of them were primary procedures and two were revisions for failed primary stabilisation . The main pre-operative complaint of these patients was dragging pain, scapular winging, painful forward flexion and abduction and sense of instability. The underlying pathology was Fascio-scapulo-humeral dystrophy in 3, sprengels shoulder in 2,brachial plexus palsy in 1, following trapezius muscle excision in 1, residual winging following shoulder fusion in 1.

The technique used for fusion was plate and wires in 6, Rush pin and wires in 2. All of them had bone grafting .

At the last follow up the mean DASH score was 37 and the mean constant score was 74.67.

All patients had mild or no pain,felt their scapula stable and were satisfied with the outcome. The main post operative complaint was wire breakage and migration that necessitated removal in 3 patients.

We conclude that scapulothoracic fusion is a valuable procedure and can restore reasonable shoulder function and relieve pain in patients with scapular instability.

Repair of distal biceps tendon rupture is a subject that has received increasing attention in the past decade. In the active individual who desires as close to normal function as possible, repair of biceps tendon is recommended.

The author describes a tehnique with a single anterior incision and fixation with superanchors. This method was successfully used in 25 patients with excellent functional results. There were no failures and no complications of neurological injury. The single anterior incision approach in which superanchors are used is recommended as an alternative to the traditional two-incision method.

The Biceps brachii is an important flexor of the elbow and is the main supinator of the forearm. Avulsion of its distal tendon insertion is rare injury that mostly affects middle-aged men. It represents only 3% of all biceps tendon ruptures. There is an average of 1.24 spontaneous complete distal biceps ruptures per 100,000 people per year.

The decline in the number of distal biceps tendon ruptures with increasing age correlates with a decrease in at-risk activities after the fourth decade of life. Decreased vascularity, tendon impingement, degenerative changes of the distal biceps tendon and the use of anabolic steroids have been postulated to predispose to tendon rupture.

Our study shows that repair of distal biceps tendon ruptures using superanchors is safe and gives clinically objective and functional results similar to bone tunnel fixation.

We had no major complications, no suture anchor failures and no occurrence of synostosis and neurological injuries. We recommend the use of superanchors for the treatment of distal biceps tendon ruptures.

Introduction: Distal humeral fractures represent a constant challenge to the most experienced surgeon. This is the first report of the use of an unlinked prosthesis for the treatment of distal humeral fractures in elderly persons.

Materials and Methods: From July 2000 to June 2001, 9 iBP elbow arthroplasties were performed in patients with acute fractures of the distal humerus. The average age of the group was 71 years. The mean interval between injury and TER was 11 days. The follow-up period averaged 12 months (range 5 to 16).

Results: Functional outcome was evaluated with patient-completed questionnaires. All patients had a flexion contracture of the elbow ranging from 15 to 30 degrees. All patients were able to perform daily activities, pain relief was satisfactory and patient satisfaction was high. All elbows met the criteria for functional motion and were stable at the latest follow-up examination. There were no major complications such as dislocation, ulnar nerve dysfunction or deep infection.

Conclusion: Unlinked non-congruous elbow arthroplasty when combined with a surgical exposure that allows proper soft tissue balance and instrumentation that enables correct positioning of the components can be a successful alternative in the management of acute distal humeral fractures in selected patients when conventional fixation is not a viable option.