We reviewed forty-three patients who had humeral head replacement for proximal humeral fractures between 1992–2000, with a minimum of two years of follow-up. The patients were evaluated for range of motion, post-operative pain, and the overall activities using the American Shoulder and Elbow Surgeons Evaluation form (ASESE) and the Western Ontario Rotator Cuff Index (WORC). Patients with delayed surgery had more pain than those with primary hemiarthroplasty, all of which were treated with the Global type prosthesis. Postoperative pain was significantly associated with the presence of intra-operative cuff tear. The purpose of this study was to evaluate the functional outcome after hemiarthroplasty for proximal humeral fractures and whether the prosthesis type, intra-operative technique, or the presence of previous surgery would affect the outcome. The Medical records and radiographs of patients who had hemiarthroplasty for proximal humeral fractures between 1992–2000 were reviewed. Forty-three patients were identified, thirty-seven with acute fractures and six with fracture related complications. One surgeon performed fifteen cases (35%), while the rest divided among eleven others. The patients were evaluated for pain, range of motion, strength, stability, and function using the American Shoulder and Elbow Surgeons Evaluation form (ASESE) and Western Ontario Rotator Cuff Index. The radiographs were reviewed by the senior authors. The mean age of the patients at presentation was sixty-nine year (range forty-six to ninety-five year). The mean duration of follow-up was 4.6 years. The mean active forward elevation was ninety-six, active external rotation twenty-two, and the mean active internal rotation was eight. Fifteen percent of the patients reported severe pain and twenty-five percent were unable to sleep on the affected side. The patients with previous surgeries and those with intra-operative cuff tear were found to have more post-operative pain (p=0.027 and 0.022 respectively). The Global type prosthesis was used in all the cases of secondary hemiarthroplasty (p=0.031) and all the Neer prostheses were cemented (0.001). We concluded that integrity of rotator cuff and primary surgery were more inclined to better results. There does remain significant stiffness and pain in most patients however.
The late results of tarsometatarsal injuries in 33 patients have been reviewed. The average follow-up period was 15 years (range 11 to 20 years). Methods of treatment included cast immobilisation, and closed or open reduction with or without internal fixation. All patients noted diminishing symptoms after injury and all but six returned to their former occupation. Neither the initial fracture type nor the treatment had any apparent bearing on subsequent function; nor was there any correlation between radiographic assessment of the injury and the patient's symptoms.
Spondylolysis occurring after a spinal fusion is considered to result from operative damage to the pars interarticularis on both sides. Fourteen cases are reported, and compared with the 23 cases which have previously been published. The defects are usually recognised within five years of fusion, and usually occur immediately above the fusion mass. Other contributory causes may be: fatigue fracture from concentration of stress; damage and altered function of the posterior ligament complex; and degenerative disc disease immediately above or below the fusion. Fusion technique is critical, since virtually all cases occurred after posterior interlaminar fusions. This complication is easily overlooked in patients with recurrent back pain after an originally successful posterior spinal fusion.
