ObjectiveTo perform a retrospective epidemiological study of radiographs in order to evaluate the relationship between the anatomy of the scapula and the development of rotator cuff injuries (RCIs).MethodsThis study retrospectively evaluated the relation of the critical shoulder angle (CSA) and RCIs from January 2011 to November 2013; patients were examined in the Orthopedics and Traumatology Department of a university hospital. The CSA was measured by radiographic standardization of two groups: a control group of 34 asymptomatic shoulders and a study group of 44 shoulders with complete RCIs.ResultsThe mean age in the control group was 59.97 years (45–84) and the mean age in the group with RCIs was 59.75 years (45–84). Regarding the CSA, the control group had a mean angle of 33.59° (±3.37) and the group with RCIs had a mean angle of 39.75° (±5.35; p < 0.007).ConclusionThere is an association between CSA and RCIs.

Objectives: To evaluate the epidemiology of and surgical results from treating elbow fracture-dislocations, including only the cases in which dislocation is associated with fracture of the coronoid process and the radial head (terrible triad). Methods: Nineteen patients were evaluated: 12 males and 7 females. The medical records were analyzed to gather data about the mechanism of injury, fracture pattern, time elapsed until surgery and type of procedure applied. A clinical assessment was made to measure elbow range of motion, and the MEPS questionnaire was applied. Results: The most common mechanism of injury in our sample was a fall from a height (12 patients). All the patients underwent surgical treatment and the mean time elapsed between the date of the injury and the surgery was 16.1 days. The mean follow-up was 50.3 months. The mean range of flexion-extension obtained was 112° and the mean range of pronation-supination obtained was 127.9°. The mean score from the MEPS questionnaire was 86 points, and excellent and good results were obtained for 15 patients (79%). The time elapsed until surgery, final flexion-extension range greater than 100° and flexion contracture of less than 30° were shown to have a statistically significant relationship with a good final clinical result. Five patients had complications, of which three cases related to peripheral nerves, one case to pseudarthrosis and one case to recurrent instability. Conclusions: Despite the severity of the injuries found in the terrible triad of the elbow, most of the patients evaluated here achieved elbow stability with good clinical results. The factors that led to better clinical results were surgery not more than 14 days after the injury, flexion-extension range greater than 100° and flexion contracture less than 30°.

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Rotator cuff (RC) tears cause pain and functional disability of the shoulder. Despite advances in suture anchors, there are still reports about the incidence of surgical-related injuries to RC mainly associated with sutures. The purpose of this study was to design and evaluate the mechanical behavior of sutureless implants to repair RC tears. We hypothesized that the implants present mechanical characteristics suitable for the surgical treatment of RC tears as suture anchors. Three different implants (T1,T2,T3) were designed and fabricated with titanium: T1 has two rods and rectangular head; T2 has two rods with a small opening and enlarged rectangular head and T3 has three rods and a circular head. The implants were fixed in rigid polyurethane foam blocks by a series of blows, and the applied mechanical loads along with the number of blows were quantified. Pullout tests using tapes fixed between the implant head and testing machine grip were conducted until implant failure. The maximum pullout strength and displacement of the implant relative to the rigid foam block were computed. Statistical significance was set at p &lt; 0.05. Owing to its geometric configuration, implant T2 presented the best characteristics related to stability, strength, and ease of insertion. Implant T2 confirms our hypothesis that its mechanical behavior is compatible with that of suture anchors which could lead to the reduction of RC repair failures and simplify the arthroscopic procedure.

Aim: To assess the mechanic behavior of a new type of implant for the fixation of the rotator cuff without using sutures, regarding its insertional resistance and pullout strength. Materials and methods: The new implant's geometry is clamptype, although with ridges for locking. We assess three different configurations of clamp implants, varying a number of rods, the number of ridges and the base shape. We assessed the mechanical resistance of the implants considering the maximum load levels during insertion in a block with mechanic properties similar to bone. For this analysis, we developed an experimental apparatus in order to simulate impacts on the superior base of the implants. The pullout strength was assessed through a universal testing machine (MTS) using an experimental apparatus to simulate the traction on the tendons fixed to the block. We used controlled resistance bands to simulate the tendons. Results: A total of 21 implants were inserted in the block. Four implants failed during insertion. During insertion, the round head, three rods implant (type 3) needed a force of 149.0 N against 108.3 N for the two rods implant (type 1) and 119.2 N for the round head, 2 rods implant (type 2). The pull-out resistance to the round head, 2 rods implant (type 2) was higher than the other types of implants with an average value of 292.9 N, while the type 1 implant resisted with an average force of 165.2 N and type 3 with an average force of 135.2 N. Conclusion: Through testing, we can conclude that the type 2 implant has better mechanical features than the other two types of implants we tested, and its levels of force were consistent with its use in clinical practice. Clinical Relevance: An implant that eliminates the tendon-suture contact, transferring it to the implant may lead to a decrease in suture failures when repairing the rotator cuff and consequently reduce surgery time and cost, since the surgery would be simpler and can be performed in less time, due to not using sutures. These new implants can also be used as supports in traditional surgery aiming to increase the tendon's fixation resistance. For final validation, there is still a need for clinical testing for the verification of the results.