BackgroundThe purpose of this study was to evaluate the role of medial support and clinical factors responsible on outcomes and major complications associated with treatment of unstable proximal humerus fractures using a locking plate and suture augmentation.MethodsSixty-three cases in 62 patients (42 female, 20 male) were evaluated between September 2004 and October 2008. Cases were divided into either a medial support group (36 cases) or non-medial support group (27 cases). Clinical and radiographic evaluations included Neer’s evaluation criteria, the neck-shaft angle using the Paavolainen method, and complications. We analyzed the correlation between bone- and fracture- related complications and three independent clinical variables, such as the presence of medial support, fracture type, and osteoporosis by way of multivariate logistic regression.ResultsThere were statistically significant differences in the overall incidence of complications based on the presence of medial support (p = 0.014) and preoperative fracture type (p = 0.018), but no differences based on the presence of osteoporosis (p = 0.157). According to multivariate logistic regression analysis, the restoration of medial support was the most reliable factor to prevent bone- and fracture- related complications. In addition, when we compared the incidence of bone- and fracture-related complications in the presence or absence of medial support among 30 patients with osteoporosis, the group with restoration of medial support had only one complication of humeral head osteonecrosis despite the presence of osteoporosis (5.9% vs. 46.2%, p = 0.025). According to Neer’s criteria, excellent or satisfactory clinical results accounted for seventy-three percent of the total cases (46 of 63 cases). Seventy-eight percent (49 of 55 cases) showed good radiographic results by the Paavolainen method. There were 14 complications in 13 of 63 cases (20.6%).ConclusionsIn the treatment of unstable proximal humerus fractures with locking plate technology and suture augmentation, we suggest that obtaining medial support is an important factor in preventing major bone- and fracture-related postoperative complications such as reduction loss or nonunion.
To evaluate short-term clinical and radiographical results of fixed bearing unicondylar knee arthroplasty (UKA) comparing results between over-corrected group and under-corrected group. Materials and Methods: Clinical and radiographical outcomes of 47 Miller-Galante ® UKAs with a minimum of 4-year follow-up were evaluated. We also compared both clinical and radiographical results between over and under corrected groups, which were divided by 2 o varus of mechanical axis postoperatively. Results: HSS and WOMAC scores improved from 75.4 and 57.7 preoperatively to respectively, 95.2 and 12.1 at the last follow up. Radiographically, the mechanical axis changed from 7.2 o varus preoperatively to 2.8 o varus at the last follow-up. A partial radiolucent line on the medial side of the tibia was observed in 23% of the 47 cases. Degenerative changes in the lateral compartment and the patellofemoral joint were observed, respectively, in 23% and 26%. There were no significant differences between the two groups in clinical and radiographical results (p>0.05). In the undercorrected group, three cases converted to total knee arthroplasty because of medial tibial collapse. Conclusion: Miller-Galante ® UKA showed good outcomes in short-term follow-up with the exception of three failures. There were no significant differences between more than 2 o varus corrected and under 2 o varus corrected groups in clinical and radiographical results. However, all 3 conversions to total knee arthroplasties occurred in the undercorrected group.
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