Reverse Total Shoulder Arthroplasty in Patients Who Exceeded Their Life-Expectancy: A Retrospective Study

BACKGROUND Reverse total shoulder arthroplasty (RTSA) has become an established treatment for cuff arthropathy, severe osteoarthritis and in certain fracture cases. Due to the increasingly aging population, patients who have already exceeded their life-expectancy pose a significant challenge to the shoulder surgeon. METHODS Patients older than 83 years who received a RTSA were included. Elective cases were compared to fracture cases. Patient demographics, hospital stay length, complication rate, functional outcome, patient reported outcome scores and mortality were assessed retrospectively. RESULTS We included 110 cases, 48 in the elective group and 62 in the fracture group. The average age at time of surgery was 86.6 ± 3.5 years. Mean follow-up was 30 months. Elective cases had a significant shorter hospital stay length (P = .014). Functional outcome scores showed better results for the elective group with ASES 79 ± 12 vs 69 ± 19 (P = .07), QuickDASH 29 ± 16 vs 37 ± 21 (P = .22), subjective shoulder value 86 ± 14 vs 75 ± 19 (P = .04*) and VAS .7 ± 1.5 vs 2.1 ± 2.5 (P = .02*). There was no significant difference in ROM and mean quality-adjusted-life-years (QALY) with 3.2 ± 1.8 vs 3.5 ± 2.5 years (P = .69). The complication rate requiring surgical intervention was 2.4% in the elective and 6.5% in the fracture group. The 1-year mortality was 3 (6%) respectively 9 (15%). CONCLUSION RTSA in elderly patients can be successful with good functional outcomes. Age should not be a contraindication. Instead, the patient's activity level and quality of life should be taken into account. Elective RTSA show better functional outcome scores and lower complication rates compared to RTSA in proximal humeral fractures

Incidence and variants of posterior arch defects of the atlas vertebra

In order to describe the incidence and existing variants of congenital anomalies of the atlas vertebrae in a Caucasian population, we examined 1069 CT scans of the upper cervical spine. We found 41 cases with altered atlas vertebrae, representing 3.8% of all analyzed patients. With 83% of all found anomalies, the predominant type is characterized by a small dorsal cleft (3.2% of all patients). Rare varieties feature unilateral or bilateral dorsal arch defects, combined anterior and posterior clefts (0.2% of all patients) or total erratic atlas vertebra malformation (0.1% of all patients). Atlas arch defects are found nearly 4% at the time. Most anomalies affect the posterior arch, whereas the anterior arch or both are rarely affected. Totally irregular C1 vertebrae are extremely infrequent

Gewaltbedingte Verletzungen in einem städtischen Umfeld aus Sicht einer unfallchirurgischen Notfallaufnahme

Violence is a growing problem worldwide. In Switzerland, interpersonal violence seems to be an increasing problem as well. The aim of the current study was to describe a comprehensive picture of violence in a swiss city with regard to medical and social aspects. A total of 1740 patients injured by violent crimes between April 2004 and January 2011 were enrolled into this study. Most of them were male. There were no relevant changes regarding the number of within the observation period. However, the proportion of affected females increased. Especially at the weekend, there is a need for preventive measures to reduce the high number of affected patients and the associated costs