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We applied a new methodology in 7 patients with a fracture of the upper humeral head that required hemiarthroplasty, to implant a humeral prosthesis with an individualized posterior version. Our goal was to determine preoperatively the distance from the posterior edge of the bicipital groove where the lateral fin of the humeral prosthesis should sit, in order to reproduce the individual retroversion during surgery. Using three computed tomography scan sections of the upper humerus and image processing software, we estimated the above-mentioned distance in the sound humerus and implanted the prosthesis in each patient accordingly. The differences in retroversion between the left and right humeral heads permit a better approximation to normal applying this methodology than inserting the prosthesis in a standard retroversion. [ABSTRACT FROM AUTHOR]

The mechanical role of the anterior and posterior cruciate ligaments in the passive and functional stability of the knee joint has been well documented. Both these knee joint ligaments contain Ruffini, Pacinian, Golgi and free nerve endings with different capabilities of providing the central nervous system with information regarding movement and position as well as chemical events. The posterior cruciate ligament provides 95% of the restraining force to a posterior tibial displacement, is significantly stronger than the other knee ligaments, and sensory nerve endings are located in the tibia and femoral bone insertions. This report aims to review the anatomy and physiology of the various mechanoreceptors of the posterior cruciate ligament, placing special emphasis on their role in knee joint stability. It concludes that the posterior crude ligament may not only serve as a 'mechanical stabilizer' of the knee joint, but also probably has an important 'sensory function' that should be taken into account when dealing with injuries to it.

We studied 45 dry cadaveric humeri to determine whether the bicipital groove of the humerus can be used as a landmark for a proper, individualized orientation of a humeral prosthesis, especially in the case of a fracture. We performed 3 computed tomography sections (at a level just below the lower portion of the head, at the middle of the humeral head, and at a distance 5 cm below the first section), and we used special software for 3-dimensional image processing. To reproduce the individual posterior version of the head, when a humeral prosthesis is implanted for fracture, the lateral fin of the prosthesis should be a mean distance 5.2 +/- 2.6 mm (-1.5 to 10.7 mm) from the posterior edge of the bicipital groove. If the lateral fin of the humeral prosthesis seats just behind the posterior edge of the bicipital groove, a difference of -6.3 degrees to 41.7 degrees from the normal posterior version occurs. A new, simple methodology for an individualized posterior version of a humeral prosthesis in cases of fracture is proposed. We applied this in 6 consecutive patients with fracture of the humeral head that required hemiarthroplasty.

Study Design: In this prospective study, the results of treating unstable thoracolumbar and lumbar injuries with Cotrel-Dubousset instrumentation were investigated., Objective: To determine the pain and work status of the patients, to evaluate neurologic status, and to assess the efficacy of instrumentation in the short term., Summary of Background Data: Short-segment pedicle screw construct is the method of choice for reduction and stabilization of unstable thoracolumbar spinal injuries. Many investigators have recently reported a high rate of instrument failure. In this study, the use of segmental transpedicular fixation two levels above the kyphosis decreased instrument failure and sagittal collapse., Methods: Thirty patients, who had unstable thoracolumbar and lumbar spinal injuries, underwent application from a posterior approach of Cotrel-Dubousset instrumentation two levels above and one below at the thoracolumbar junction and short segment fixation in the lumbar area. Radiologic parameters were evaluated before and after surgery., Results: The mean follow up was 31 months (range, 25-49) months. There were statistically significant differences between the pre- and postoperative values in all radiologic parameters. Neurologic status improved in 70% of the patients, with a mean Frankel grade of 1.3 grades., Conclusions: Cotrel-Dubousset instrumentation provided spinal stability in unstable injuries, forming a rigid construct and restoring physiologic thoracolumbar and lumbar postural contours because of its highly corrective effect in the sagittal profile with no loss of correction.

In 134 deltoid preparations taken from 67 fresh cadavers we examined the position of the axillary nerve in relation to the upper border of the muscle. The vertical distances from the upper deltoid border to the nerve in 17 of 67 cadavers was less than 4 cm in both shoulders. The minimal distance, measured from the mid-middle portion of the deltoid to the axillary nerve, was 2 cm. There was a significant negative correlation between the deltoid ratio (width/length) and the vertical distance, measured in all examined sites. The shorter the deltoid length the greater the danger of damaging the nerve in the short distance during surgical splitting of the muscle.

We studied endogenic factors for the occurrence of cervical hip fractures in 256 patients. 230 underwent hemiarthroplasty, and 26 were treated with internal fixation or without surgery. The condition of the fractured hip and of the ipsilateral knee, as well as the mobility of the patient before the fracture, were studied in all 256 patients. The removed femoral heads were examined, photographed and radiographs were taken with sensitive film. The acetabulum and the femoral head were macroscopically normal in all 230 cases and there was no radiographic evidence of arthrosis. 64% of the patients were fully mobile before the fracture, 34% were mobile with the aid of a cane and 2% were dependent. In 88%, the ipsilateral knee was normal both clinically and radiographically, and in 12%, there was moderate arthrosis. When comparing the mobility before the fracture and the condition of the ipsilateral hip and knee in 100 patients having a cervical fracture with 100 patients having a trochanteric fracture matched for age and sex, we found that a normal hip joint was sine qua non while a normal ipsilateral knee and a fully mobile individual were important additional conditions for the occurrence of a cervical hip fracture, instead of a trochanteric one, after a fall in an elderly person.

An unusual indication--not previously reported--for surgical treatment of a clavicle fracture, in a 56-year-old male, is presented. The proximal fragment had been entrapped under the coracoid, and there were symptoms from impairment of the musculocutaneous nerve. Reduction by closed means proved unsuccessful, and an open procedure was necessary for this rare type of the common clavicle fracture.

Shoulder dislocation associated with ipsilateral humeral shaft fracture is an uncommon combination. Two cases treated, one by open and the other by closed methods, are presented. The mechanism of this complex injury is detailed and the treatment modalities are discussed. The relevant literature is reviewed.

The broadband ultrasound attenuation (BUA) of the right calcaneus was measured in 49 women with Colles' fracture, in 36 women with hip fracture, and in 77 normal women. All were postmenopausal, and the fractures were all of fragility type. BUA correlated with age only in the normals. BUA distinguished between the fracture cases with sensitivities of 97 percent and 70 percent and specificities of 72 percent and 92 percent at 61 dB/MHz and 51 dB/MHz, respectively. The women with hip fracture had lower BUA than those with Colles' fracture. For screening purposes, BUA below 51 dB/MHz may arouse suspicion of a fracture risk, notably if other factors such as a tendency to fall, dietary and other habits, inactive lifestyles and early menopause are present.