No abstract

We carried out a retrospective analysis of 17 total shoulder replacements using the reversed Delta III prosthesis in patients with rheumatoid arthritis of the glenohumeral joint complicated by rotator cuff dysfunction. Outcome was assessed using the Constant-Murley scoring system. In addition, general health status was assessed with the Short Form Health Survey and radiographical analysis of the prostheses undertaken. Mean age at the time of surgery was 64 years. Thirteen shoulders were followed up for more than 5 years (mean 87 months). Median Constant-Murley score was 59.0; median scores for general health were 33.40 and 49.36 for the physical and mental components respectively. Radiographical analysis revealed evidence of lucencies about the humeral component in all cases and about the glenoid component in five cases. Despite the good clinical results, the high incidence of radiographical lucencies is of concern. Résumé Nous rapportons une analyse rétrospective de 17 remplacements prothétiques de l'épaule qui utilisent la prothèse renversée Delta III chez des malades atteint de polyarthrite rhumatoïde compliquée par un dysfonctionnement de la coiffe des rotateurs. Le résultat a été étudié en utilisant le scores de Constant-Murley et une analyse radiographique. De plus, l'état général a été apprécié avec le score « Short Form Health Survey ». L'âge moyen à l'opération était 64 années. 13 épaules ont été suivies plus de cinq ans (moyenne 87 mois). Le score de Constant-Murley médian était 59.0. Les Scores médians pour l'état général étaient 33.40 et 49.36 pour les composants physiques et mentaux respectivement. L'analyse radiographique a révélé des liserés autour du composant huméral dans tous les cas et autour de la glène dans cinq cas. En dépit des bons résultats cliniques, la haute fréquence des liserés radiographiques est inquiétante. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

This prospective study investigated a cohort of 59 scaphoid waist fractures which were treated nonoperatively in a below-elbow plaster cast for 4 weeks and then underwent a Week 4 CT scan to assess displacement and progress to union. Forty-three were classed as undisplaced and 37 of these 43 were also classed as 'united'. All the 37 undisplaced and 'united' fractures united with up to 8 weeks' cast immobilisation, including 26 which were taken out of plaster at 4 weeks and mobilised. We conclude that scaphoid waist fractures which appear to be undisplaced and united on a week 4 CT scan will unite, and may not need to be immobilised in a plaster cast for more than 4 weeks. Such a treatment policy may reduce the period of disability and time off work associated with nonoperative treatment.

This study compares the mechanical properties of locking Kessler and four-strand flexor tendon repairs and examines for difficulties related to technical ability. Two trainee surgeons each carried out 10 locking Kessler and 10 four-strand single-cross flexor tendon repairs on an in vitro porcine model. Outcome measures included gap formation and ultimate forces, operative time and repair bulk. Ultimate force was 81% greater for the four-strand repair compared to the Kessler (52 N, SD 5, versus 29 N, SD 6). Operating times were similar between the two techniques (Kessler 10.0 minutes, four strand 10.1 minutes). Rupture force and operating times improved slightly during the study for the Kessler repairs, but in the four strand repairs results remained stable throughout the study. We conclude that the single-cross four-strand repair tolerates superior loads yet is no more technically demanding than the modified Kessler, and can be reliably performed without additional operating time.