No abstract

In 42 elderly patients, 33 women and nine men with a mean age of 72 years, we treated displaced fractures of the proximal humerus (34 three-part, 8 four-part) using a blade plate and a standard deltopectoral approach. Functional treatment was started immediately after surgery. We reviewed 41 patients at one year and 38 at final follow-up at 3.4 years (2.4 to 4.5). At the final review, all the fractures had healed. The clinical results were graded as excellent in 13 patients, good in 17, fair in seven, and poor in one. The median Constant score was 73 +/- 18. Avascular necrosis of the humeral head occurred in two patients (5%). We conclude that rigid fixation of displaced fractures of the proximal humerus with a blade plate in the elderly patient provides sufficient primary stability to allow early functional treatment. The incidence of avascular necrosis and nonunion was low. Restoration of the anatomy and biomechanics may contribute to a good functional outcome when compared with alternative methods of fixation or conservative treatment. Regardless of the age of the patients, we advocate primary open reduction and rigid internal fixation of three- and four-part fractures of the proximal humerus.

Volleyball is a complex discipline with high technical, tactical, and athletic demands on the players. Because of this there is a need for the players to specialise early in certain tasks in the game, such as spiking or setting. Setting is the way in which the ball is hit with the fingertips, the wrist being radially deviated and hyperextended. In spiking, the player hits the ball at the maximum height of a vertical jump, directing the hit downwards on the ball so that the ball cannot be returned. This specialisation causes uniform repetitive loads for the players.

Plantar fibromatosis is a rare, benign lesion involving the plantar aponeurosis. Eleven patients (13 feet) underwent 24 operations, including local excision, wide excision, or complete plantar fasciectomy. Clinical results were evaluated retrospectively. There were no differences among the subgroups in postoperative complications. Two primary fasciectomies did not recur. Three of six revised fasciectomies, seven of nine wide excisions, and six of seven local excisions recurred. Our results indicate that recurrence of plantar fibromatosis after surgical resection can be reduced by aggressive initial surgical resection.

Facet joint pain is an important aspect of degenerative lumbar spine disease, and radiofrequency medial branch neurotomy remains an established therapy, while cryodenervation has still been poorly examined. This study was undertaken to examine the effects of medial branch cryodenervation in the treatment of lumbar facet joint pain. This was a prospective clinical case series. Patient selection was based on the history, physical examination and positive medial branch blocks. Percutaneous medial branch cryodenervation was performed using a Lloyd Neurostat 2000. Target parameters were low back pain (VAS), limitation of activity (McNab) and overall satisfaction. Fifty patients were recruited, and 46 completed the study. The follow-up time was 1 year. At 6 weeks, 33 patients (72%) were pain free or had major improvement of low back pain; 13 (28%) had no or little improvement. Including failures, mean low back pain decreased significantly from 7.7 preoperatively to 3.2 at 6 weeks, 3.3 at 3 months, 3.0 at 6 months and 4.2 at 12 months (P<0.0001). Limitation of the activities of daily living improved parallel to reduced pain. Our results suggest that medial branch cryodenervation is a safe and effective treatment for lumbar facet joint pain.

The clinical characteristics of medial ankle instability are a feeling of giving way, pain on the medial gutter of the ankle, and a valgus and pronation deformity of the foot that can typically be actively corrected by the posterior tibial muscle. Arthroscopy was shown to be a very helpful diagnostic tool in verifying medial instability.

In a retrospective study, 100 patients underwent a clinical and radiological follow-up examination after a minimum of 7 years (range 7.0-9.3 years) following an arthroscopic partial medial meniscectomy. None of these patients had associated intra-articular lesions, apart from minor chondral damage (max. grade 2 Outerbridge classification; < 1 cm2) of the medial compartment at the time of the primary arthroscopy. According to the modified Marshall score, the follow-up evaluation showed excellent clinical results in 96%. Nevertheless, the radiological outcome, as measured by comparing preoperative and postoperative X-rays, demonstrated a development or progression of the osteoarthritis of the affected knee joint in 33%, with a statistically significant correlation between the radiological and clinical outcomes (P< 0.05). The age of the patients at the time of operation and any angular deformity of the knee joint did not influence the radiological results. Women had a statistically significantly higher risk of developing gonarthrosis after partial medial meniscectomy than men (P < 0.05). The arthroscopic partial medial meniscectomy led to excellent subjective and functional results but could not prevent the increase or development of late degenerative changes in the medial knee compartment.

In 42 elderly patients, 33 women and nine men with a mean age of 72 years, we treated displaced fractures of the proximal humerus (34 three-part, 8 four-part) using a blade plate and a standard deltopectoral approach. Functional treatment was started immediately after surgery. We reviewed 41 patients at one year and 38 at final follow-up at 3.4 years (2.4 to 4.5).At the final review, all the fractures had healed. The clinical results were graded as excellent in 13 patients, good in 17, fair in seven, and poor in one. The median Constant score was 73 ± 18. Avascular necrosis of the humeral head occurred in two patients (5%).We conclude that rigid fixation of displaced fractures of the proximal humerus with a blade plate in the elderly patient provides sufficient primary stability to allow early functional treatment. The incidence of avascular necrosis and nonunion was low. Several studies have shown an increase in the incidence of fractures of the proximal humerus, especially in older age groups. In the last 25 years open reduction and internal fixation (ORIF) of displaced fractures has become widely advocated. The deformity cannot, in many cases, be corrected and the reduction maintained by closed reduction and immobilisation. The blood supply of the head of the humerus is at risk however, not only from the injury, but also from dissection of the soft tissues at open reduction and fixation. 9 The incidence of malunion, nonunion, and avascular necrosis (AVN) after ORIF has been reported to be between 12% and 34% for three-part fractures [10][11][12] and between 41% and 59% for four-part fractures. 5,13,14 In elderly patients, osteoporotic bone, often in combination with a thin or ruptured rotator cuff, can lead to unpredictable clinical results. Extensive exposure and the insertion of implants increase the risk of the development of AVN 9,15 and limited exposure and dissection of the soft tissues at the fracture site with minimal internal fixation have been recommended. 9,12 Stable reduction is essential for healing of the fracture and allows early movement of the shoulder. In 1995, we started to use a rigid angular blade plate for fixation of displaced fractures of the proximal humerus. Our technique of reduction involves minimal exposure of the fracture. We describe our results in elderly patients after a minimum follow-up of 2.4 years. Patients and MethodsBetween 1995 and 1996, all patients with fractures of the proximal humerus treated at the Orthopaedic University Clinic in Basel were included in the study if they fulfilled the following criteria: over 50 years of age, a displaced three-or four-part fracture of the proximal humerus not caused by high-energy trauma and not pathological, at least 30% contact between the head and shaft of the humerus, no other fractures or deformities in the upper limbs, and no