Purpose: To evaluate the association between rotator cuff tear (RCT) size and long head biceps tendon (LHBT) pathology. Methods: We retrospectively enrolled 202 consecutive patients (114 women and 88 men with mean age at surgery of 62.14 years [SD, 7.73]) who underwent arthroscopic rotator cuff repair for different sized full-thickness RCTs. LHBT pathology was evaluated considering the presence of inflammation, section alteration, loss of integrity, dislocation, dynamic instability, and absence. The site of LHBT pathology was evaluated considering 3 portions: (1) the insertional element; (2) the free intra-articular portion; (3) the part that enters the intertubercular groove. Statistics were evluated. Results: The LHBT was absent in 22 cases (10.9%): 2, 4, 15, and 1 patients with small, large, massive, and subscapularis RCTs, respectively. A significant correlation was found between the prevalence of LHBT absence and massive RCTs (P < .001). In 53 patients (26%), there was a healthy LHBT; a healthy LHBT was present in 47%, 20% and 8% of small, large and massive RCTs, respectively. A significant correlation between LHBT inflammation, section alteration, loss of integrity, and RCT severity was found (P < .001, P < .001, and ). The insertional portion was the most involved (57% of cases); RCT severity was significantly associated with the number of involved portions (P < .001). Conclusions: Shoulder LHBT pathology is associated with increasing rotator cuff tear size. Clinical Relevance: Surgeons should be aware that biceps pathology is particularly prevalent in patients with larger RTCs.

The arthroscopic treatment of rotator cuff tear involves 2 distinct phases: intra-articular and subacromial. We present the 2-scope technique with the aim to simultaneously perform these phases, entrusting them to 2 experienced surgeons, and to obtain possible benefits compared with the classic 1-scope technique. Better nosology of the lesion and a more accurate evaluation of suture passer action (equidistance of the sutures and avoidance of degenerated articular-side tendon areas) represent benefits of this technique. In contrast, the 2-scope technique needs an additional lateral portal and could give rise to an erroneous distribution of costs and surgeons.

IntroduzioneAll'incremento della popolazione anziana corrisponde un aumento della percentuale di fratture scomposte dell'estremo prossimale dell'omero [1]. Il trattamento di queste fratture è ancora controverso e la prima scelta dovrebbe essere quella dell'osteosintesi dei frammenti [2,3]. Sappiamo però che nei soggetti anziani la cattiva qualità dell'osso e la possibilità di necrosi cefalica portano spesso a cattivi risultati clinici [4]. Altri Autori sono ormai d'accordo che le fratture scomposte a 3 o 4 frammenti e le fratture-lussazioni dell'epifisi prossimale dell'omero possano avere una soluzione protesica [5]. Sappiamo però che i risultati delle protesi anatomiche sono spesso imprevedibili e nessuno è riuscito a ottenere i risultati di Neer, che in una pubblicazione del 1970 riportava oltre il 90% di risultati soddisfacenti [6]. L'imprevedibilità dei risultati proviene da vari fattori come la "compliance" del paziente e il disegno protesico, ma in particolare questa chirurgia, per la scarsa incidenza di queste fratture, nasconde molte difficoltà che spesso si traducono in errori di tecnica chirurgica, di cui i più comuni e importanti sono: il cattivo posizionamento delle tuberosità (in particolare trochite posizionato troppo basso o troppo alto o posteriore) e il cattivo posizionamento della protesi (errori di altezza o di versione) [7]. Inoltre, anche in impianti ben eseguiti, possiamo trovare la migrazione secondaria delle tuberosità per mancata consolidazione e quindi pseudoartrosi delle stesse o il loro riassorbimento, che aumenta nettamente in pazienti over 75 e porta a risultati poco soddisfacenti nel tempo [8,9]. Alla luce di questi risultati, quando ci troviamo di fronte a una frattura pluriframmentaria scomposta dell'epifisi prossimale dell'omero con o senza lussazione, in un paziente anziano con tuberosità pluriframmentarie e/o con cuffia dei rotatori inesistente, usiamo la protesi inversa. La protesi inversa è il risultato di un'idea geniale di Paul Grammont, ortopedico francese, il cui uso primario è stato il trattamento della "cuff tear arthropathy" [10][11][12][13]. La protesi inversa in effetti è composta da una componente glenoidea emisferica convessa, mentre la componente omerale è concava, invertendo ap-55 LO SCALPELLO ( ABSTRACT -RATIONALE OF REVERSE PROSTHESIS IN FRACTURE TREATMENTAs the population ages, the number of displaced fractures of the proximal humerus in stillactive patients is increasing. In three-or four-part displaced fractures emiarthroplasty is the first indication, but results aren't always satisfactory and predictable. The inverted prosthesis of Grammont works only with an intact deltoid muscle, but, in selected complex proximal humerus fractures, this prosthesis is considered to be a superior treatment option for elderly patients.

Background and Objective: On March 2020, our country became a protected area due to the COVID-19 pandemic. The consequences of COVID-19 on trauma surgery were great. We aimed to evaluate the activity of the Trauma Centre of a highly populated suburban area over 30 days starting from the first day of restrictions, to compare it with the same period of 2019 and 2022 and to evaluate whether a progressive return to normality has taken place. Materials and Methods: All patients older than 18 years managed in our Trauma Unit between 8 March 2020 and 8 April 2020 (the first COVID-19 period) were compared to the same period of 2019 (a COVID-19 free period) and 2022 (the second COVID-19 period). Clinical records were examined. Five categories of diagnoses and six mechanisms of injury were distinguished. Results: There were 1351 patients [M:719–F:632; mean age (SD):49.9 (18.7)], 451 [M:228–F:223; mean age (SD):55.9 (18.4)] and 894 [M:423–F:471;mean age (SD):54.1 (16.7)] in the COVID-19 free and in the first and second COVID-19 periods, respectively (p < 0.05). In 2020, the most significant decrease was registered for sprains/subluxations (80%); contusions decrease by 77% while fractures decrease only by 37%. The lowest reduction was found for dislocations (26%). In 2022, dislocations decreased by only 16% and both fractures and sprains decreased by about 30% with respect to the pre-pandemic period. Patients with minor trauma (contusions) were half compared to 2019. Accidental falls remain the most frequent mechanism of injury. The incidence of proximal femur, proximal humerus and distal radius fractures remained almost unchanged during both pre-pandemic and pandemic periods. Conclusions: COVID-19 has markedly altered orthopaedic trauma. Injuries related to sports and high energy trauma/traffic accidents drastically reduced in 2020; however, we are slowly going back to normality: the same injuries increased in 2022 due to the progressive easing of restrictions. Elderly fractures related to accidental falls remained unchanged.