The aim of this study was to evaluate whether anterior cruciate ligament (ACL) reconstruction using the double bundle technique (DB) improves stability in the knee compared with the single bundle technique (SB) with the femoral tunnel in a more horizontal position (2 or 10 o'clock). We conducted a randomized, prospective study. Forty patients were randomized to the DB group (20 patients) and the SB group (20 patients). Four-stranded semitendinosus and gracilis autologous grafts were used in the SB group and in the DB group the conventional four tunnel technique was carried out using the same tendons. The IKDC complete form was used for the preoperative evaluation, and in the follow-up the IKDC subjective knee evaluation form, IKDC current health assessment form and IKDC knee examination form were used. Anteroposterior (AP) laxity was evaluated by standardised and forced radiology in all patients. No significant preoperative between-group differences were found. During the follow-up, no differences were found between groups, except for significant between-group differences (P < 0.05) between the preoperative and postoperative evaluations. The IKDC index also showed significant differences in the 2-year follow-up. Median scores increased from 48 (range 41-54) to 81 (range 75-87) (P = 0.01) in the SB group and from 52 (range 46-58) to 80 (range 72-88) (P = 0.02) in the DB group. There were no significant differences between the groups in terms of functional scores. In conclusion, the 2 and 10 o'clock placements showed no significant differences between SB and DB techniques in the pivot-shift test, manual and radiological anterior posterior laxity and IKDC scores. However, significant between-group differences were found between the preoperative and postoperative evaluations.

No abstract

There were 21 fractures of the proximal part of the humerus and 7 fractures that also involved the shaft; 15 of the fractures were two-part fractures (surgical neck), 5 were three-part fractures, and 1 was a four-part fracture. All fractures healed in a mean period of 2.7 months. There was one delayed union that healed in 4 months. One case of avascular necrosis of the humeral head was observed (a four-part fracture), but remained asymptomatic and did not require further treatment. In one case a back-out of one proximal screw was observed. A final evaluation with a minimum 1 year follow-up was performed by an independent observer; in 18 patients, the mean Constant score was 65.7 or 76.1% with the adjustment of age and gender; in 19 patients, the mean Oxford Shoulder Score was 21.7. The results obtained with the T2-PHN nail indicate that it represents a safe and reliable method in the treatment of two- and three-part fractures of the proximal humerus. The proximal fixation mechanism diminishes the rate of back-out of the screws, a frequent complication described in the literature. Better functional results were obtained from the patients younger than 70 years, but these were not statistically significant.

The aim of this study is to compare the functional and radiological results of Philos plate and NHP-T2 nail for the treatment of displaced 2-part proximal humeral fractures. Between May 2005 and June 2006, we operated 29 2-part humeral fractures. The selection of the implant was not randomized, but it was surgeon choice. There were 15 patients operated with the NHP-T2 nail (group A) and 14 patients with the Philos plate (group B). There were no statistical diVerences between the preoperative data of the two groups: mean age, sex distribution, level of activity, mechanism of injury, type of fracture, associated fractures, or the hematocrit levels. The patients were assed clinically and radiologically months after surgery. At 1-year followup, an independent evaluator additionally determined the Constant and Oxford scores. All fractures except one healed in the Wrst 3 months. In group A, there was one delayed union that healed at 4 months. There were 2 malunion cases in each group. No case of avascular necrosis of the humeral head was observed. There were no statistical diVerences between the functional results of the implants. We had more patients who required blood transfusion in group B and more fractures of the entry point and implant removal in the group A. The consolidation rate and functional results are similar in both groups, with no statistical signiWcance. The complications appeared seemed to be approach related and did not inXuence the Wnal results. An accurate technique and suYcient experience are needed to achieve a correct reduction and Wxation.

Retrospective case series, Level IV.