How to Treat Proximal and Middle One-Third Humeral Shaft Fractures: The Role of Helical Plates

Complex proximal third diaphyseal humeral fractures are uncommon patterns of injury mainly caused by high energy trauma. The anatomical shape of the humerus, the presence of the deltoid tuberosity and the close proximity of the radial nerve into the radial groove represent challenge elements to deal with. Historically, straight plates were manually twisted; subsequently, helical plates created for other anatomical sites (as distal tibia) were used in humeral fractures. In both these experiences surgeons observed several disadvantages. More recently, dedicated helical plates have been created. In this study, we expose our surgical technique for using helical humeral plates (A.L.P.S.® Proximal Humeral Plating System, Zimmer Biomet), with its advantages and operative recommendation. From 2019 to 2021, nine patients who were admitted to our institution for humeral fractures involving the proximal third diaphysis have been treated with humeral helical plates. At one and six months after surgery, standard antero-posterior and lateral radiographs were obtained, and at last follow-up (fourteen months on average) clinical evaluation was performed through range of motion assessment, Constant score and DASH score questionnaires. At six months, all fractures have healed. At last follow-up (fourteen months on average, 6–22) the average range of motion were flexion 135° (90–180°); abduction 124° (85–180°); external rotation 52° (20–80°), internal rotation at L3 (between scapulae-trochanter). Average Constant Shoulder Score was 70 (33–96), average Dash score was 21 (range 1,7–63). Three patients experienced temporary radial nerve palsy from injury, with subsequently improvement at EMG analysis within eight months from surgery. In our opinion this strategy avoids the deltoid tuberosity and reduces the risk of radial nerve injury, increasing the possibility of a rapid functional recovery after surgery

Informed consent in shoulder surgery

Informed consent is an essential tool for diagnosis and therapy in medicine, and is of fundamental importance in surgery, where it underpins the operation itself. Its origins can be traced back to US forensic medicine but is now incorporated into the Italian legal system, with different consequences depending on the context in which it is applied. This article describes our experiences in shoulder surgery, with suitable references to legislation and analysis of the literature studies in this area

Subacromial widening osteotomy of the scapular spine: Surgical technique and literature review

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Gleno-Humeral arthritis in young patients: Clinical and radiographic analysis of humerus resurfacing prosthesis and meniscus interposition

Recently, interest about glenoid resurfacing with lateral meniscus in osteoarthritis of the shoulder has been increasing. Aim of this study is to evaluate the results of this procedure, from a clinical and a radiographic point of view. Constant score, DASH (Disability of the Arm, Shoulder, and Elbow) questionnaire, some specific questions about satisfaction after surgery, and radiographic exams were performed pre-operatively and post-operatively, at a minimum follow-up of 2 years. Constant score improved from 49.8 to 66.2. 84.4% of the patients were satisfied. Mean Dash was about 24.2 points. Gleno-Humeral measurement on X-Ray shows a good widening of the articular space after surgery (5.92 mm), but a narrowing (2.07 mm), at 2 years of follow-up. We have suspended glenoid resurfacing because narrowing of the articular space at follow-up can be related to meniscal resorption and clinical results are good but comparable with humeral resurfacing alone, as seen in the literature. Long-term follow-up studies are needed. © 2011 Springer-Verlag

Correlation between radiographic risk for glenoid component loosening and clinical scores in shoulder arthroplasty

Glenoid component loosening is the weak point in the failure of total shoulder arthroplasty (TSA). In this study we analyse the radiographic risk factors observed on 86 cemented polyethylene glenoid components and their relationship with clinical signs at a mean follow-up of 5.8 years. Clinical assessment included Simple Shoulder Test (SST) and Constant-Murley score. Radiograms were taken to detect periprosthetic radiolucency, tilt, medial displacement and polyethylene thinning. Pearson's correlation coefficient and Spearman's rank correlation coefficient were calculated for statistical analysis. In 61 patients (71%) lucent lines were less than 2 mm wide (grade 2) and in 6 cases (7%) they were >or=2 mm wide (grade 3 and 4). Thinning of the polyethylene was found in 11 cases (13%), glenoid tilt in 6 cases (7%) and medial migration of the component in 5 cases (6%). Complete glenoid prosthetic loosening was found in 3 cases (3.5%) associated with polyethylene wear and glenoid bone loss. The Constant-Murley score associated with radiolucency grade 3 and 4 was less than 45% (38.39 +/- 8.9) (p < 0.05), while a score less than 56% (30.72 +/- 8.7) was found in patients with glenoid tilt and medial migration (p < 0.01). The mean SST score was 4.8 +/- 2.8 in case of glenoid tilt and migration of the component (p < 0.01). Removal of the glenoid component and conversion to hemiarthroplasty or reverse prostheses is suggested in painful glenoid loosening. An exhaustive analysis of radiograms is essential to detect early and late complications or risk factors of glenoid loosening

Surgical repair of acute and chronic pectoralis major tendon rupture: clinical and ultrasound outcomes at a mean follow-up of 5 years

Background: Pectoralis major (PM) tendon rupture is an uncommon injury whose incidence has risen in recent decades mainly as a result of the increasing number of sports-practising individuals. This study evaluates clinical and ultrasound (US) outcomes after surgical repair of acute and chronic PM tendon rupture. Materials and methods: Twelve men with PM tendon rupture (9 right and 3 left shoulders) were enrolled. Mean age was 34.6&nbsp;years, and mean follow-up was 60&nbsp;months (range 12–108). Rupture was diagnosed by magnetic resonance imaging. Eight patients underwent direct tendon repair (acute group) and 4 had allograft reconstruction (chronic group). Pain, range of motion, strength recovery and return to sports were assessed. Postoperative X-ray and US scans were obtained in all patients. Final outcomes were graded as excellent, good, fair or poor. Isometric strength in adduction/abduction, flexion, internal rotation (IR) and external rotation was recorded. Results: There were 9 excellent and 3 good outcomes. A comparative strength assessment failed to show significant differences in any plane. Mean strength was not significantly different between affected and unaffected arm. Slight but significantly lower strength in IR with the arm adducted (p&nbsp;=&nbsp;0.0306) was found in chronic patients. On US, all PM tendons appeared to be anatomically intact and continuous with the humerus. Discussion: Prompt surgical repair ensures satisfactory outcomes in patients with complete PM rupture; however, delayed allograft repair provides good results with only slight strength impairment. Fresh insights are provided on the role of US in evaluating PM anatomy and tendon attachment to bone