Imaging of the Unstable Shoulder

Unstable shoulder can occur in different clinical scenarios with a broad spectrum of symptoms and presentations: first-time (or recurrent) traumatic acute shoulder anterior dislocation or chronic anterior instability after repeated dislocations.Imaging in unstable shoulder is fundamental for choosing the right treatment preventing recurrence.The goal of imaging depends on clinical scenario and patient characteristics

Ultrastructural aspects of articular cartilage and subchondral bone in patients affected by post-traumatic shoulder instability: preliminary observations

Post traumatic shoulder instability is a frequent condition in young active population. Notwithstanding a lot of data have been collected on capsular-legament lesions and gleno-humeral defects, no data are available on early ultrastructural ostheo-condral damages that are known to be highly associated with the onset of invalidating pathologies, like osteoarthritis (OA). Thus, the mechanisms of joint instability and the identification of which components in the articular complex are primarily affected in instability are of clinical significance, particularly in the light of deepening knowledge on the onset/development of OA. In the present study, biopsies of the articular cartilage and sub-chondral bone were taken from 10 patients (aged 26-40) underwent surgery in Policlinico of Modena. The withdrawals were immediately fixed and embedded for Transmission Electron Microscopy (TEM). The observations were performed in tangential, arcuate, and radial layers of the articular cartilage as well as in sub-chondral bone. TEM observations showed that chondrocytes in the superficial layers (i.e. tangential and arcuate) display normal and very well preserved ultrastructure, probably due to synovial liquid supply; otherwise, chondrocytes in the radial layer (not only in calcified but also in the un-calcified one) show various degrees of degeneration, with cytoplasm partially coerced and variously-sized vacuoles, both signs of suffering; occasionally, in the radial layer, chondrocytes with morphological signs of apoptosis or autophagy were also observed. As far as sub-chondral bone is concerned, osteocytes next the deeper calcified cartilage (within 80-100 micra from the cement line) also show evidences of degeneration, while osteocytes more distant from the osteo-chondral border display normal ultrastructure probably due to the vascular bone supply. In all patients of the study, the ultrastructural features of osteo-chondral complex are not depending on age. The present study represents the first ultrastructural investigation of the articular osteo-chondral complex in shoulder instability, evaluating the state of preservation/viability of both chondrocytes and osteocytes throughout the successive layers of the articular cartilage and sub-chondral bone. These preliminary observations are the basis to understand if the early surgical treatment in shoulder instability could avoid the onset of OA

Ultrastructural aspects of articular cartilage and sub- chondral bone in patients affected by post-traumatic shoulder instability: preliminary observations

Post traumatic shoulder instability is a frequent condition in young active popula- tion. Notwithstanding a lot of data have been collected on capsular-legament lesions and gleno-humeral defects, no data are available on early ultrastructural ostheo-condral damages that are known to be highly associated with the onset of invalidating pathologies, like osteoarthritis (OA). Thus, the mechanisms of joint instability and the identification of which components in the articular complex are primarily affected in instability are of clinical significance, particularly in the light of deepening knowledge on the onset/development of OA. In the present study, biopsies of the articular cartilage and sub-chondral bone were taken from 10 patients (aged 26-40) underwent surgery in Policlinico of Modena. The withdrawals were immediately fixed and embedded for Transmission Electron Microscopy (TEM). The observations were per- formed in tangential, arcuate, and radial layers of the articular cartilage as well as in sub-chondral bone. TEM observations showed that chondrocytes in the superficial layers (i.e. tangential and arcuate) display normal and very well preserved ultrastruc- ture, probably due to synovial liquid supply; otherwise, chondrocytes in the radial layer (not only in calcified but also in the un-calcified one) show various degrees of degeneration, with cytoplasm partially coerced and variously-sized vacuoles, both signs of suffering; occasionally, in the radial layer, chondrocytes with morphological signs of apoptosis or autophagy were also observed. As far as sub-chondral bone is concerned, osteocytes next the deeper calcified cartilage (within 80-100 micra from the cement line) also show evidences of degeneration, while osteocytes more dis- tant from the osteo-chondral border display normal ultrastructure probably due to the vascular bone supply. In all patients of the study, the ultrastructural features of osteo-chondral complex are not depending on age. The present study represents the first ultrastructural investigation of the articular osteo-chondral complex in shoulder instability, evaluating the state of preservation/viability of both chondrocytes and osteocytes throughout the successive layers of the articular cartilage and sub-chondral bone. These preliminary observations are the basis to understand if the early surgical treatment in shoulder instability could avoid the onset of OA

Complex fractures of the humeral shaft treated with antegrade locked intramedullary nail: clinical experience and long-term results

indications for surgical treatment of complex humeral shaft fractures are still controversial. The purpose of this study was to evaluate the outcomes of treating humeral shaft fractures using antegrade locked  intramedullary nail, compared to the treatment with traditional more aggressive techniques such as plate and screws

Assessment of bone defects in anterior shoulder instability

Glenohumeral bone defects are a common finding in shoulder instability and they are strongly correlated with recurrence of dislocation and failure following arthroscopic Bankart repair. Most authors agree that open surgery should be considered in the presence of certain conditions: glenoid bone loss > 25%, a lesion involving > 30% of the humeral head, an engaging Hill-Sachs lesion, bipolar bone lesions even without engagement. A careful imaging evaluation must therefore be performed in order to identify, quantify and characterize the bone defects. Even though magnetic resonance has important additional value in the assessment of the glenoid labrum and rotator cuff, computed tomography scan is the examination of choice for studying bone defects. Several methods have been proposed to quantify the extent of the glenoid bone defect; the most accurate ones utilize two-dimensional computed tomography images with multiplanar reconstructions (PICO method) or more sophisticated three-dimensional reconstruction software. Conversely, the literature lacks studies that accurately quantify humeral bone defects and, above all, that demonstrate definitively the clinical and prognostic significance of the lesion location and size

SHOULDER INSTABILITY: GLENOID AND HUMERAL-HEAD BONE DEFECT

Glenohumeral bone loss is one of the most important factors responsible for failure and recurrence after a shoulder arthroscopic instability repair. A high percentage of patients with traumatic, recurrent anterior instability have some level of glenohumeral bone loss. It is necessary to recognize the amount of bone loss preoperatively in order to determine successful management strategies. Standard radiographs may be inadequate for detecting the extent of glenoid and humeral-head bone los

SHOULDER INSTABILITY: GLENOID AND HUMERAL-HEAD BONE DEFECT

Glenohumeral bone loss is one of the most important factors responsible for failure and recurrence after a shoulder arthroscopic instability repair. A high percentage of patients with traumatic, recurrent anterior instability have some level of glenohumeral bone loss. It is necessary to recognize the amount of bone loss preoperatively in order to determine successful management strategies. Standard radiographs may be inadequate for detecting the extent of glenoid and humeral-head bone los

Causes and treatments of lag screw's cut out after intramedullary nailing osteosinthesis for trochanteric fractures

Background. Superior cut-out of a lag screw remains a serious complication in the treatment of trochanteric or subtrochanteric fractures and it is related to many factors: the type of fracture, osteoporosis and the stability of fracture reduction. Little is known about the outcome after revision surgery for complications of the gamma nail. We assessed the outcome in patients who had revision surgery because of lag screw's cut out after gamma nailing for a trochanteric fracture.Material and Method. We present a study of 20 consecutive patients who underwent treatment after 20 cut-out of the lag screw \ufb01xation of a trochanteric fracture with Gamma Locking Nail from September 2004 to November 2010. In 16 patients hip prothesis was performed, in 1 the removal of the implant and in 3 the reosteosynthesis. We reviewed 13 patients: 10 total hip arthroplasty, 2 endoprothesis and 1 reosteosynthesis of nail and lag screw (mean follow up: 26 months, mean age: 73 years old), 7 patients died. Patients were reviewed retrospectively by an independent observer. Clinical evaluation was performed, Oxford score and Harris Hip score were measured. X-Ray examination was performed after a minimum of 12 months of follow up.Results. Mean Harris Hip Score mean was 67 and mean Oxford score was 32 in hip prothesis group (12 patients). We had several complications, Implant-related complications were: 2 ipometria > 2cm, 2 recurrent hip arthroplasty dislocations (1 reoperated), 4 persistent thigh pain. In only 4 patients none complications were observed. Another patient,\ua0 who had been subjected to reosteosinthesis, obtained better results (HHS:95, Oxford score:45) but with a 2 cm ipometria and occasional pain in the thigh.Conclusion. Cut out after gamma nail is consequent to biological or mechanical causes. Treatment of this complication is hip prosthesis (parzial or total hip arthroplasty), reosteosynthesis of the lag screw and/or the nail and the removal of the implant. Conversion to total/parzial hip arthroplasty may be a demanding operation with a higher complication rate respect to the standard, while reosteosynthesis is possible in selected patients and early cutting out

Arthroscopic Rotator Cuff Tear Transosseous Repair System: The Sharc-FT Using the Taylor Stitcher

Transosseous rotator cuff tear repair was first described in 1944. Over the years, it has represented the gold standard for such lesions. Through open and mini-open approaches, as well as the arthroscopic approach, the transosseous repair system represents one of the most reliable surgical techniques from a biological and mechanical perspective. Nevertheless, further improvements are required. This article describes an arthroscopic rotator cuff tear transosseous repair system, developed in collaboration with NCS Lab (Carpi, Italy): the Sharc-FT using the Taylor Stitcher. Our first experience in the clinical application of the arthroscopic technique using the transosseous suture system has shown encouraging clinical outcomes, confirming its efficacy. The patient satisfaction rate was high, and no patient expressed concern about the implant. The complication rate was very low. By improving the suture technique in the treatment of rotator cuff tears, a remarkable increase in the success rate in the treatment of this pathology could be reached; nevertheless, complications such as retears of the rotator cuff still occur