A retrospective review of 19 elderly patients (65 years of age or older) with operatively managed tibial plateau fractures demonstrated that most patients had acceptable functional results, based on Rasmussen's criteria. The follow-up period was of 8-14 years (average 11 years). Seventy-nine percent of the patients (15/19) had excellent or good results. They regained their preinjury walking capacity and suffered only occasional pain. Four patients had fair results with limitation of walking capacity, pain on certain positions, and/or pain after activity. One of these 4 patients had significant medial instability. In this age group, internal fixation of tibial plateau fractures and early mobilization appeared to be beneficial in achieving good functional results.
Introduction: Irreparable rotator cuff tear (RCT) presents a difficult treatment challenge for the orthopaedic surgeon. Many treatment strategies with varying degrees of success have been performed over the years. One of the suggested surgical treatment options is the use of a biodegradable sub-acromial balloon spacer. Methods: A retrospective study of patients treated with sub-acromial balloon spacer between the years 2011 and 2016 was conducted. Mean follow-up time was 14.4 months. Patient charts were reviewed to evaluate the early clinical results and complications of sub-acromial spacer for irreparable RCTs. Results: The study cohort included 24 shoulders in 22 patients. The average postoperative Disability of the Arm, Shoulder and Hand score was 62.4. The average preoperative University of California at Los-Angeles Shoulder score was 10.9 and improved to 15.9 ( p = 0.001). Forty-six per cent of patients were satisfied with their clinical postoperative outcome. We found moderate–strong positive correlation ( r = 0.64) between preoperative range of motion (ROM) and general satisfaction. None of the postoperative radiographs showed an improvement regarding the proximal migration of the humeral head. In total, four (16.7%) patients experienced postoperative complications, and two (8.3%) patients required an additional surgery as a consequence of a postoperative complication. Conclusion: Our results show unsatisfactory improvement in patients with irreparable RCT treated with the sub-acromial balloon spacer. Careful patient selection with attention to preoperative ROM should be considered. Level of Evidence: Therapeutic level IV.
The shoulder rotator cuff (RC) is crucial to shoulder function and involvement in shoulder pathology. RC tears have been extensively studied, and several classifications have been devised to quantify their magnitude. Various RC measurement techniques were introduced previously, utilizing cadaveric specimens, X-rays, CT scans, and MRI with different results published regarding humeral heads' different plane diameters and the correlation to age, gender, and height. There are very few studies measuring RC length in the general population.We aimed to assess the geometrical relation between rotator cuff tendon length and humeral head sagittal and axial diameters.A total of 100 shoulder MRI scans of labral tear-suspected patients were reviewed, and the geometrical parameters of the rotator cuff length and proximal humerus sagittal and axial diameters were measured.The healthy population has wide variability in humeral diameter and rotator cuff length. We found a high correlation between humeral head sagittal and axial plane diameters and the rotator cuff tendon dimension. The orthogonal plane diameters disagree with the humeral head being round but rather spheric. The rotator cuff length changes according to the patient's gender and height.This is a novel method for rotator cuff measurement, description, and classification according to the percentage of tear instead of length (cm). This method is more clinically oriented and relevant than most other previous methods.
The presented study investigated the difference of positioning sense of the shoulder before and after surgery (capsular shift or Arthroscopic Bankart repair) for shoulder instability. For this purpose a sample of patients with recurrent dislocations of the shoulder that underwent surgery and patients with instability before surgery volunteered to participate in a set of experiments. Their results were compared to the results obtained from a matching sample of healthy subjects. All subjects completed all movement’s conditions that included the performance of hand movements towards memorized visual target in A-horizontal plane condition and B-Three dimensional movement condition. The mixed design (3 groups x 3 2D levels x 3 3D levels) with repeated measures allowed the comparison among the groups in terms of final accuracy measures (Absolute and Variable Errors) and variability around mean tangential velocities and end-point paths. The results showed that operative shoulder stabilization improves the ability to accurately position the arm on a target at the end of the movement and in addition the kinematic profile, which is disturbed before stabilization, improves as well. These measures may be used as an objective tool to asses the success of conservative as well as operative treatment for shoulder instability.
Background Magnetic resonance imaging (MRI) is considered to be the best non-invasive procedure for the evaluation of rotator cuff (RC) tendon tears. Burkhart’s classification is a geometric classification of full-thickness RC tears on MRI. Purpose To correlate MRI and arthroscopic geometric full-thickness RC tears according to the Burkhart’s classification with pre- and postoperative clinical findings. Material and Methods Patients who underwent arthroscopic RC repair between 2006 and 2010 were retrospectively evaluated. Preoperative MRI and arthroscopic surgical reports were reviewed for tear geometry (Burkhart’s) by three (1 radiologist, 2 surgeons) and two (surgeons) readers. MRIs were also evaluated for tear size and change of tear size in successive sagittal sections and for muscle mass and fatty infiltration. Clinical examinations were performed preoperatively and at least 12 months afterwards. Postoperative function questionnaires were filled in by the patients. Results Forty-six patients (35 men, 11 women; mean age, 57 years; range, 41–72 years) were evaluated. Tears depicted on MRIs were classified as crescent in 11 patients (24%), longitudinal in three (6.5%), massive contracted in 29 (63%), and cuff arthropathy in three (6.5%). Muscle changes were noted almost exclusively in patients with massive tears and cuff arthropathy (16/32 patients, P = 0.013). MRIs and arthroscopic geometric classifications were in close agreement. Tear type did not correlate with pre- and postoperative physical examination or with postoperative clinical questionnaires scores. Conclusion Geometric RC tear characterizations on preoperative MRIs were closely associated with arthroscopic findings. Postoperative results were not affected by the geometric pattern of the tears.
