Background One of the most frequent complications in patients affected by traumatic anterior dislocations is bony Bankart lesion. This study evaluates the clinical and functional outcomes of 10 patients with isolated large glenoid fracture and acute glenohumeral dislocation treated with reverse shoulder arthroplasty. Methods Patients older than 69 years who underwent reverse shoulder arthroplasty after isolated large glenoid fracture and acute glenohumeral dislocation between 2016 and 2022 at the same institute were selected. Shoulder range of motion and pain level was assessed. The impact on quality of life has been evaluated through four measures: the constant scale, the simple shoulder test (SST), the OXFORD scale, and The University of California—Los Angeles (UCLA) shoulder scale. Results The mean Constant score was 77.1 (range 68–84), the mean SST score was 9.4 (range 8–10), the Oxford score was 44.3 (range 35–48), and the UCLA shoulder scale was 27.1 (range 24–30). No reoperation was performed on any patient in this series. Conclusion Reverse shoulder arthroplasty for elderly patients with bony Bankart lesion and acute glenohumeral dislocation represents a valuable option in terms of clinical results, patient satisfaction and early- to medium-term complications.

BACKGROUND: Proximal humerus fractures are widespread injuries. They are the third most common non-vertebral fracture pattern in older patients with osteoporotic bone. The treatment of these fractures is often tricky, and indications constantly evolve. Among the various possible surgical options, plate osteosynthesis is the most used. In addition to the traditional deltopectoral approach, a minimally invasive technique (minimally invasive plate osteosynthesis [MIPO]) is introduced. This retrospective case-control study compared these two approaches' clinical outcomes and complications.METHODS: From June 2015 to June 2020, 36 patients (28 women, 8 men) with a mean age of 62.26 years (range: 41-80) were surgically treated for three parts valgus-impacted proximal humeral fractures. Twenty patients were treated with open reduction-internal fixation (ORIF), while 16 patients were with MIPO. Surgical time, functional scores (the Constant-Murley, the Simple Shoulder Test, and the Disabilities of the Arm, Shoulder, and Hand Scores), ROM and complications were used to compare these two different procedures.RESULTS: Thirty-six patients were available for clinical evaluation at a mean follow-up of 16.03 months (6-33 months). We found three complications in our study, all in patients treated with ORIF. The mean surgery time was 103.53 minutes: MIPO required less surgery time (mean 93.64, range 57-150, SD +/- 26.273) than ORIF via deltopectoral approach (mean 110.45, range 46-255, SD +/- 51.316). The SST, CS and DASH were higher in the MIPO group, but there was not a statisti-cally significant difference. Likewise, no significant differences from a statistical point of view were found in the range of motion values by comparing the two types of intervention. However, patients in the MIPO group have experienced a greater ROM.CONCLUSIONS: Several options are available for the treatment of proximal fractures of the humerus. However, no standardized treatment algorithm based on scientific evidence is currently in the literature. According to the analysis of the results, the surgical treatment of three parts proximal humeral fractures impacted in valgus shows good clinical re -sults. The MIPO technique is safe and offers good clinical outcomes comparable to the traditional technique. A significant superiority of a procedure does not emerge compared to the other in treating this type of fracture.(Cite this article as: Ferraro S, Bugge F, Faoro L, Felotti D, Corti M, Ippolito G, et al. Osteosynthesis of three parts valgus-impacted proximal humeral fractures: comparison between deltoid-pectoral approach and minimally invasive transdeltoid. Minerva Orthop 2023;74:107-13. DOI: 10.23736/S2784-8469.23.04279-7)

Background: Minimally invasive approaches for Total Hip Arthroplasty (THA) are extremely popular among both patients and surgeons. Even though many surgical techniques have been described with overall satisfactory results, one of the most feared complications that still burdens THA is early dislocation, particularly for the most popular, posterior-lateral, approach. Objectives: The purpose of this report is to describe an original, minimally invasive, posterior-lateral technique, which spares the proximal external rotator muscle tendons of the hip (Higher External ROtator-Sparing; HEROS), while presenting its preliminary clinical and radiographic results. Methods: From 2018 to 2020, 100 patients underwent THA, performed by the same surgeon using the HEROS technique. In all cases, the same cementless prosthesis was implanted. The Modified Harris Hip Score (MHHS) was obtained before surgery and at the last follow-up visit. The osteointegration and orientation of the prosthetic components were radiographically evaluated, and the restoration of the femoral offset was analyzed. Results: Seventy-seven patients were assessed at a mean follow-up of 28 months. At the time of surgery, the average age of the patients was 72 years. There were 36 females and 41 males with a mean BMI of 27. The diagnoses were primary arthritis, avascular necrosis of the femoral head and fracture of the femoral neck. The mean surgical time was 76 minutes. The average MHHS score at follow-up was excellent. The mean offset variation was approximately 1 mm. There was an intra-operative fracture and an early infection of the wound. There were no dislocations. All patients returned to activities of daily living and were satisfied with the cosmetic appearance of the wound. Conclusions: The present study confirmed that this simple, minimally invasive approach is effective for restoring pain-free joint function and preventing implant dislocation with a low incidence of complications.

Rare shear-type fracture of the talar head in a thirteen-year-old child — Is this a transitional fracture: A case report and review of the literature

This study compares two surgical techniques used to treat patients with posterior shoulder dislocation with an engaging reverse Hill–Sachs lesion. We assessed ten patients who were treated at the Surgical Orthopedic and Traumatological Institute (ICOT) of Latina and the Clinic of Orthopedic and Traumatological Surgery of the ASST Sette Laghi of Varese between 2016 and 2019. The patients were divided into two groups: the first comprising six patients who underwent the open surgery McLaughlin procedure as modified by Neer, the second including four patients who underwent the arthroscopic McLaughlin procedure. All patients received postoperative rehabilitation to achieve the best possible functional recovery of the affected shoulder. We then assessed the shoulder range of motion, the pain level, and the impact on quality of life with four tests: the Constant Scale, the Simple Shoulder Test (SST), the OXFORD Scale, and The University of California—Los Angeles (UCLA) Shoulder Scale. The mean scores of the first group were: 81.3 ± 9.8 SD (Constant Scale), 10.8 ± 1.06 SD (SST), 42.5 ± 5.4 SD (Oxford Scale), 30.8 ± 3.02 SD (UCLA Shoulder Scale); we calculated the following mean scores in the second group: 80.25 ± 4.1 SD (Constant Scale), 11.5 ± 0.8 SD (SST), 42 ± 4.06 SD (Oxford Scale), 32 ± 2.9 SD (UCLA Shoulder Scale). We found no significant differences between the two groups.

BACKGROUNDTalar fractures are exceedingly rare in childhood. There are very few studies on the clinical aspects, the long-term outcomes and the appropriate treatment of these fractures in pediatric patients. The mechanism of trauma consists of the application of a sudden dorsiflexion force on a fully plantar-flexed foot. Traumatic mechanism, symptoms and imaging of injuries of the talar head are similar to transitional fractures that are normally described at the distal epiphysis of the tibia: the so-called transitional fracture is defined as an epiphyseal injury when the growth plate has already started to close.CASE SUMMARYA thirteen-year-old girl reported a high-energy trauma to her right foot, due to falling from her horse. X-rays at the Emergency Department were negative. Because of persistent pain, the patient was assessed by an orthopedic surgeon after two weeks and computed tomography scans revealed a misdiagnosed displaced shear-type fracture of the talar head. Hence, surgical open reduction and fixation with two headless screws was performed. The girl was assessed regularly, and plain films at follow-up revealed complete healing of the fracture. Within six months after surgery, the patient returned to pre-injury sport activities reporting no complications.CONCLUSIONInjuries of the talar head in childhood should be considered as transitional fractures. Open reduction with internal fixation aims to reduce malalignment and osteoarthritis. Computed tomography scans are recommended in these cases.