Hemiarthroplasty has been recommended for 3- and 4-part fractures of the proximal humerus. Outcomes are most affected by final implant and tuberosity position. Reports of outcome and management of head-split fractures with humeral head replacement are lacking. The purpose of this study was to report the outcomes after humeral head replacement and the radiographic characteristics identified in head-split fractures. Thirty-five hemiarthroplasties performed for the acute treatment of 3- and 4-part or head-split fractures were retrospectively reviewed in a blinded database. Thirty patients (8 head-split fractures) with a mean age of 67±12 years were followed for a mean of 52±32 months. Clinical, radiographic, and objective outcomes of the head-split fractures were collected at a minimum of 12 months' follow-up and compared with a control group of 22 three- and 4-part fractures. Radiographs were reviewed to identify characteristic features of the head-split fractures. Head-split fractures demonstrated superior forward elevation (138°±50° vs 106°±54°) but similar American Shoulder and Elbow Surgeons (68±33 vs 63±29) and Simple Shoulder Test (7.4±4.8 vs 7.0±4.0) scores compared with the control group. The pelican sign, a radiographic representation of the tuberosity and attached articular surface, was identified on preoperative radiographs. Head-split fractures are rare and commonly missed on preoperative radiographs. The recognition of the pelican sign improves the detection of head-split fractures. After hemiarthroplasty, forward elevation is improved in patients with head-split fractures compared with other fracture types.
La ruptura del tendón supraespinoso es una de las lesiones más comunes del manguito rotador. El objetivo de este estudio es evaluar el efecto de una ruptura del tendón en su capacidad de carga y estimar el tamaño de la ruptura a la cual el tendón no puede soportar carga en el rango fisiológico. Este estudio presenta un único índice que indica la capacidad de carga del tendón, Strength Index (SI)el cual se calcula usando un modelo computacional del tendón. También se calculó el tamaño crítico de la ruptura (CTS) definido como el tamaño de la ruptura a la cual el tendón no puede soportar una carga máxima. SI y CTS fueron estimados para 8 rupturas de tamaño creciente y 7 diferentes esfuerzos últimos para incluir variabilidad por crecimiento de la ruptura y del paciente, respectivamente. El SI de tendón disminuyó con el aumento del tamaño de la ruptura. El CTS para el tendón modelado fue estimado entre 6 y 19 mm, asumiendo un esfuerzo último en un rango fisiológico entre 1,6 y 12,6 MPa. La posible aplicación clínica del índice CTS es limitada al surgimiento de nuevas técnicas que permitan la estimación acertada del esfuerzo último del tejido
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