PurposeTo compare the clinical and radiological results between internal fixation using the proximal femoral nail system and bipolar hemiarthroplasty (BHA) in reverse oblique intertrochanteric hip fractures in elderly patients.Materials and MethodsFrom January 2005 to July 2012, we reviewed the medical records of 53 patients who had been treated surgically for reverse oblique intertrochanteric fracture and had been followed-up on for a minimum of two years. All patients were ≥70 years of age, and divided into two groups for retrospective evaluation. One group was treated with internal fixation using the proximal femoral nail system (31 cases), and the other group was treated with BHA (22 cases).ResultsEarly ambulation postoperatively and less pain at postoperative three month were significantly superior in the BHA group. However, by 24 months postoperatively, the internal fixation group exhibited higher Harris scores and correspondingly less pain than the BHA group. There were no significant differences in union rate, duration of hospitalization or lateral wall fracture healing between the two groups. Four patients in the internal fixation group underwent reoperation.ConclusionIn the treatment of intertrochanteric fracture of the reverse oblique type, open reduction and internal fixation should be considered to be the better choice for patients with good health and bone quality. However, in cases of severe comminition of fracture and poor bone quality, BHA is an alternative offering advantages including early ambulation, less pain at early stages, and a lower risk of reoperation.

PurposePeople with dementia have poor mobility and discharge outcomes following hip fractures. The purpose of this study was to evaluate the clinical and radiological results of internal fixation of undisplaced femur neck fractures (Garden types 1 and 2) by proximal femoral nail antirotation (PFNA) in dementia patients.Materials and MethodsWe studied retrospectively 19 patients with undisplaced femur neck fracture. All patients were over 70 years of age, walked independently with a cane or crutches and suffered moderate-to-severe dementia. Patients were treated with PFNA and followed-up for more than 2 years. Revision, loss of fixation, complications, and walking ability outcomes were measured.ResultsIn walking-ability evaluation, patients showed an average decrease of just 0.2 points at the final follow-up. Walking ability was evaluated from before injury to 4 weeks after surgery and decreased by less than 0.5 points. Radiological bone union was achieved in 17 cases; the average time to bone union was 4.14 months (range, 2.5-7 months). Complications included non-union in two cases and femoral head avascular necrosis in one case of non-union.ConclusionWe found that for patients with osteoporotic bone tissues in their femoral heads or patients (e.g., those suffering dementia) for whom cooperating with medical workers for postoperative walking control or rehabilitation exercises is difficult, implanting a mechanically stable spiral blade for fixation of femoral neck fractures could facilitate walking after surgery.

The widespread use of diagnostic radiography, especially using magnetic resonance imaging, has helped to increase the diagnosis of paralabral cysts in patients with chronic shoulder pain. These paralabral cysts are frequent in the anterior, the superior, and the posterior compartment of the shoulder joint but are rare in the inferior compartment. Paralabral cysts in the shoulder appear particularly in men in their third and fourth decades but rarely in elderly patients. We report a case of an inferior paralabral cyst in an elderly patient whom we treated through arthroscopic decompression. The increased use of diagnostic magnetic resonance imaging (MRI) in patients with chronic shoulder pain has correlated with the increase in the diagnosis of paralabral cysts. Paralabral cysts are commonly associated with labral or capsule tears through which synovial fluid seeps out into the extra-articular space; the labral or the capsule tear essentially becomes a 'one-wayvalve'.1,2) Paralabral cysts are present in 2% to 4% of the population, most of whom are 30-to 40-year-old men. They are rarely present in the elderly population. Generally, the cysts are located in the posterior, the superior, or the anterior compartment of the shoulder and are rarely located in the inferior compartment.3)The symptoms of pain and dysfunction can vary according to the position of the cysts. In this study, we present a case of a paralabral cyst in the inferior compartment of the shoulder in a 79-year-old man whom we treated using arthroscopic decompression. Case ReportThe 79-year-old man admitted to our hospital presented with a chief complaint of left shoulder pain that began and deteriorated without particular trauma from a month before. Specifically, he complained of pain around the posterior compartment of the shoulder, and without particular reason he complained that the pain exacerbated at night. At the time of admittance, the patient scored a visual analogue scale for pain of 6 points. Through physical examination, we found that the range of motion of the left shoulder showed a forward elevation of 160 ; the patient displayed slight restriction in motion. We did not observe other physical or neurological abnormalities that indicated instability. Visually, we could not find evidence for atrophy of the muscles, and muscle strength was within the normal range. Because symptoms prevailed with drug therapy, we carried out plain radiography and MRI. At the preoperative MRI, we found and diagnosed a ganglion cyst, which was fused to the articular surface, with a dimension of 2.5×1.5×2 cm at the inferior labrum, and an inferior labral tear (Fig. 1). Despite conservative treatment of the paralabral cyst through drug therapy, rest, and modified activity for 3 months, the symptoms did not improve; thus, we decided to treat the patient surgically.Under general anesthesia, we placed the patient in the right