Background: The primary objectives of this study were to evaluate the ability of a posteriorly stepped augmented glenoid component, used in patients with primary glenohumeral osteoarthritis with B2 or B3 glenoid morphology, to correct preoperative retroversion and humeral head subluxation and to identify factors associated with radiographic radiolucency and patient-reported clinical outcomes. Methods: We identified 71 shoulders with B2 or B3 glenoid morphology that underwent anatomic total shoulder arthroplasty with use of a posteriorly stepped augmented glenoid component and with a preoperative 3-dimensional computed tomography (3D-CT) scan and a minimum of 2 years of clinical and radiographic follow-up. The Penn Shoulder Score (PSS), shoulder range of motion, glenoid center-peg osteolysis, and postoperative version and humeral head subluxation were the main outcome variables of interest. Results: Follow-up was a median of 2.4 years (range, 1.9 to 5.7 years); the mean patient age at treatment was 65 ± 7 years (range, 51 to 80 years). PSS, range of motion, humeral head centering, and glenoid version were significantly improved among all patients (p < 0.0001). Patients with persistent posterior subluxation of the humeral head postoperatively had worse preoperative fatty infiltration of the teres minor and greater postoperative component retroversion (p < 0.05). Patients with center-peg osteolysis had more preoperative joint-line medialization and posterior glenoid bone loss (p < 0.05). Patients with more preoperative humeral head posterior subluxation had a lower PSS, adjusting for confounders (p < 0.05). Conclusions: Posteriorly stepped augmented glenoid components can improve pathologic retroversion and posterior subluxation of the humeral head in B2 and B3 glenoids, with significant improvements found in clinical outcome scores at a minimum of 2 years of follow-up in the vast majority of patients. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Although intertrochanteric femoral fractures in elderly patients are common injuries that have been studied extensively, little has been reported about high-energy intertrochanteric fractures in younger patients. This study examined the injury characteristics and outcomes of high-energy intertrochanteric fractures in patients younger than 65 years treated with either sliding hip screws (SHSs) or cephalomedullary nails (CMNs). A total of 37 patients younger than 65 years (mean age, 45 years) with high-energy intertrochanteric fractures and mean follow-up of 34 weeks were identified; 21 patients were treated with SHSs, and 16 patients were treated with CMNs. All fractures were AO/ Orthopaedic Trauma Association (OTA) fracture type 31A1 or 31A2. Injury characteristics, measures of surgical quality, treatment outcomes, and complications were compared. Despite high-energy mechanisms of injury, 84% of patients had AO/OTA type 31A1 fractures, 60% presented with an Injury Severity Score of 17 or higher, and 78% sustained other injuries. There were no significant differences in tip-apex distance (TAD), reduction quality, blood loss, or surgical time (P>.05) for fractures treated with SHSs or CMNs. The overall rate of major complications requiring revision surgery was 13.5%; this difference was not statistically significant (P=.36). Young patients with intertrochanteric fractures often have multisystem trauma; these fractures are difficult to reduce by closed means, and young patients are more prone to complications than older patients. In particular, varus collapse occurred at a high rate in young patients with intertrochanteric fractures treated with SHSs despite relatively simple fracture patterns, satisfactory TAD, and satisfactory reduction quality. [Orthopedics. 2017; 40(2):e293-e299.].

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