After twenty-five years, half of the primary anterior shoulder dislocations that had been treated nonoperatively in patients with an age of twelve to twenty-five years had not recurred or had become stable over time.

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This study was designed to investigate human surgical specimens from patients with impingement ( n = 16), ruptured supraspinatus tendons ( n = 7), frozen shoulder (n = 2) and controls (n = 9) with respect to histological changes and the presence of fibronectin and Matrix metalloprotease-1 (MMP-t).The biopsy of the middle part of the supraspinatus tendons was analyzed microscopically after staining with hematoxyline eosin, Van Giesons hematoxyline and Phospho Tungstic Acid Hematoxyline for visualization of fibrin. Immunofluorescent stainings for fibronectin and MMP-I were performed. Histology and immunofluorescence were assessed blindly.Necrotic tendinous tissue and fibrin were found only in some specimens from ruptures. The staining for fibronectin was significantly increased among patients with a rupture. MMP-1 was, however, only infrequently found in specimens from patients with impingement and ruptures. Fibrosis and thinning of fascicles seemed to be a more non-specific finding, appearing in control, impingement and rupture specimens.In conclusion, necrotic tendinous tissue, fibrin and fibronectin appear to be signs of tendon degeneration, whereas fibrosis and thinning of fascicles were found also in controls.

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The authors have evaluated a trauma simulator based on virtual reality techniques. Ten surgeons and 15 medical students performed distal locking of a femoral nail (A). Furthermore, 10 medical students performed simulated osteosynthesis of a femoral neck fracture (B). Total surgery time (A) (mean value) was shorter for surgeons (108 s) compared with students (157 s) at the first (p = 0.033), second (102 respectively 138 s, p = 0.13) and third (96 respectively 160 s, p = 0.15) operation. Total fluoroscopy time (A) (mean value) was shorter for surgeons compared with students at the first (45 respectively 89 s, p = 0.001), second (48 respectively 83 s, p = 0.02) and third (50 respectively 107 s, p = 0.10) operation. The positioning of the hip nails (B) improved between the first and last trial. Total surgery and fluoroscopy time were reduced. All participants thought that this and similar simulators should be part of the programme and that this simulator would be helpful if they were about to learn the procedures.