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Gleno-humeral arthrolysis by arthroscopy combined with hardware removal after proximal humerus ORIF in one step is safe and beneficial for post-traumatic stiffness of the shoulder. It provides significant pain relief and increase of range of motion and allows to treat associated articular pathology.

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Shoulder hemiarthroplasty has historically been the gold standard treatment for proximal humeral fractures not suitable to open reduction and internal fixation. In the last decades, reverse shoulder arthroplasty has gained more and more importance. Aim of this study is to retrospectively analyze subjective and objective outcomes of a group of consecutive patients. Fifty-one patients were evaluated with a mean follow-up of 18 months (range 12-60). For all the cases, the same surgical technique was performed in all cases. Range of motion, Constant-Murley score, ponderate Constant-Murley score, visual analog score and a patients' self-assessment scale were calculated. Anatomic tuberosities healing, stem positioning or mobilization were evaluated on postoperative X-rays and follow-up CT-scans. Statistical analysis was performed to calculate a correlation between subjective and objective results. Thirty-five patients (75%) declared to be satisfied of the operated shoulder. The mean CMS was 50 (17-91), the mean pCMS 72 (16-111). The mean forward flexion measured was 98° (40°-170°), the mean external rotation with adducted arm 22° (0°-60°), the mean internal rotation at sacrum (gluteus-T12). Four implants needed revision. Forty-seven stems were correctly positioned; 84.3% of tuberosities was anatomic or low positioned and consolidated in 74.5% of cases. Statistical analysis revealed significant correlation between CMS, pCMS, VAS and subjective satisfaction and between anatomic tuberosities healing and 3-part fractures. HA implant is a valid and reliable technique for the treatment of proximal humeral fracture. From our data, patients' satisfaction depends upon pain relief more than upon restore of function.

SummaryBackground: quadriceps tendon subcutaneous rupture is an uncommon injury affecting predominantly middle-aged men as a result of direct or indirect trauma; aim of this work is to evaluate clinical outcome and tendon morphology in patients treated surgically with transpatellar drilling suture. Methods: 20 patients (20 male) with an average age of 54 (42-59) were evaluated with a mean follow-up of 36 months. Measurements of range of motion (ROM) and of tight circumference were collected. Lysholm and Rougraff Score were also performed. All the patients underwent a US evaluation the morphologic changes of the repaired tendon. Results: mean active ROM was 1°-117°; average difference in the circumference of the quadriceps was 2.6% 10 C and 3.3% 15 C. The mean Lysholm Score calculated was 88/100; the mean Rougraff Score 17/25. At ultrasonographic evaluation all tendons were continuous; heterotopic ossification was present in 18 quadriceps tendons. Thickness was augmented in 18 quadriceps tendons and in 5 patellar tendons. Vascularization was always conserved. Lateral subluxation of patella was reported in 1 case. Conclusions: patellar drilling holes repair is a nondemanding procedure, inexpensive and technically uncomplicated. US evaluation confirms tendon healing; tendon remodeling does not affect patient's clinical outcome and quality of life. Level of incidence: IV