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The conventional approach for antegrade intramedullary nailing (AIN) of humerus fractures is associated with persistent pain and compromised shoulder function. Damage to the critical hypovascular zone of the rotator cuff near its insertion on the humerus and/or irritation of the subacromial space by prominent hardware are the factors believed to be responsible for poor shoulder function after AIN of the humerus. This study describes a new entry portal through the rotator interval that minimizes iatrogenic damage to the rotator cuff at its insertion. This approach offers a solution for the disappointing postoperative shoulder function and pain scores associated with conventional antegrade nailing techniques. This study consisted of 33 patients with 34 humeral fractures followed for an average of 34 months. The overall satisfaction rate was more than 90%, according to the ASES (American Shoulder and Elbow Society) score. The mean Constant Score was 84 (SD, 14; range, 17 to 98), and primary bone union was achieved in 32 of the 34 cases.

This report compares the radiologic and early clinical results of total knee arthroplasty (TKA) performed by the same surgeon using 3 techniques. In this prospective study, 75 knees were randomized to conventional technique (25 knees), image-free navigation system (25 knees), or minimally invasive surgery (MIS) (25 knees). Age range of the 43 women (65 knees) and 5 men (10 knees) was 58 to 81 years. Posterior stabilized knee prosthesis was used in all patients. Data was collected according to Knee Society System for radiologic evaluation of x-rays. Knee Society clinical (KS-C) and functional knee scores were measured preoperatively and at 6 weeks, 3 months, 6 months, 1 year, and 2 years. The postoperative KS-C was not statistically better in the MIS group (mean, 88 ± 11.5; range, 70-100) than the conventional (mean, 85.9 ± 7.8; range, 74-94) (P=.68) or navigation group (mean, 85 ± 11; range, 63-100) (P=.59). Mean postoperative delta (mechanical axis) angle was significantly different (P=.014): 2.38° in the conventional group (SD=2.88°; 95% CI, 1.19°-3.57°; range, -1.59° to 6.86°), 0.61° in the navigation group (SD=2.07°; 95% CI, -0.24° to 1.46°; range, -2.07° to 4.25°), and 4.25° in the MIS group (SD=6.52°; 95% CI, 1.56°-6.94°; range, -6.72° to 15.60°). Significant difference could be elicited between navigation-assisted and MIS groups, with navigation-assisted surgery providing more accurate alignment of the mechanical axis (P=.014). Of the three techniques, navigation-assisted surgery gives superior prosthesis alignment and promising longevity of TKA.

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