Experimental guide wire placement for total shoulder arthroplasty in glenoid models: higher precision for patient-specific aiming guides compared to standard technique without learning curve.

Background: Patient-specific aiming devices (PSAD) may improve precision and accuracy of glenoid component positioning in total shoulder arthroplasty, especially in degenerative glenoids. The aim of this study was to compare precision and accuracy of guide wire positioning into different glenoid models using a PSAD versus a standard guide.

Methods: Three experienced shoulder surgeons inserted 2.

Tendon Repair Leads to better Long-Term Clinical Outcome than Debridement in Massive Rotator Cuff Tears.

Introduction: Massive tears in the rotator cuff are debilitating pathologies normally associated with loss of function and pain. Tendon reconstruction is seen as the standard treatment in order to preserve shoulder function and to inhibit cuff associated osteoarthritis. However, the effect on longer-term shoulder function and patient satisfaction is unknown.

Resurfacing of the humeral head: An analysis of the bone stock and osseous integration under the implant.

Cementless-surface-replacement-arthroplasty (CSRA) of the shoulder aims for functional joint restoration with minimal bone loss. Good clinical results have been reported, but due to the radiopaque metal shell no data is available on the structure, osseous integration, and bone stock under the implant. 14 hemi-CSRAs (4 manufacturers) with two geometries (crown [n = 7]/ stem [n = 7] fixation) were retrieved from patients undergoing revision due to glenoidal erosion.

Increasing pullout strength of suture anchors in osteoporotic bone using augmentation--a cadaver study.

Background: Rotator cuff tears are of increasing clinical impact in the physically active elderly patients. Recent research revealed, that a high percentage of these patients present with significant loss of bone mineral density at the insertion site of the rotator cuff, thereby compromising suture anchorage for operative repair. We therefore hypothesized that augmentation of suture anchors improves biomechanical properties in low bone quality.

Straight proximal humeral nails are surrounded by more bone stock in comparison to bent nails in an experimental cadaveric study.

Background: In the management of proximal humeral fractures intramedullary implants with bent and straight shape of the proximal part of nail are available. Based on data from previous studies on bone distribution in the humeral head, we hypothesized, that higher densities might exist in the bone stock surrounding straight nails in comparison to their angulated counterparts. With a known positive correlation between bone density and mechanical stability, this could indicate potentially higher rigidity of osteosyntheses done with straight implants.

Long-term functional outcomes (median 10 years) after locked plating for displaced fractures of the proximal humerus.

Background: Locked plating has become an accepted treatment for displaced fractures of the proximal humerus. However, to our knowledge, long-term outcomes have not been reported.

Methods: Between February 2002 and March 2004, 121 patients with displaced proximal humeral fractures were treated by open reduction and locking plate fixation.

Significant benefit for older patients after arthroscopic subacromial decompression: a long-term follow-up study.

Background: Patients suffering from isolated subacromial impingement (SI) of their shoulder but who are resistant to other therapies benefit substantially from arthroscopic subacromial decompression (ASD) if they are young (<60 years). Although physical demands rise notably in the older population, it still remains unclear if surgery leads to better results in these patients. Therefore, the aim of this study was to focus on the impact of age on the functional outcome in elderly patients suffering from SI.

X-treme CT analysis of cancellous bone at the rotator cuff insertion in human individuals with osteoporosis: superficial versus deep quality.

Purpose: Rotator cuff (RC) repair-especially in the elderly population-is problematic since the patients suffer to a high extent from bone mineral density loss at the reattachment site. Therefore, the study was primarily driven by the question whether it is possible to reach more or qualitatively better cancellous bone and thus a more stable postoperative result if anchors with greater length are used for RC repair and/or the conventional anchors are screwed deeper into the bone. In anatomical terms, the question is raised whether cancellous bone is of better quality close to or far off the RC enthesis.

Age and gender as determinants of the bone quality of the greater tuberosity: a HR-pQCT cadaver study.

Background: Age-dependent trabecular changes of the humeral head might weaken the fixation of suture anchors used for rotator cuff (RC) repair. This might lead to suture anchor loosening and thus compromise the integrity of the repair. The aim of this study was to analyze whether the trabecular microstructure within the RC footprint is influenced by age, gender or handedness.

The Munich Shoulder Questionnaire (MSQ): development and validation of an effective patient-reported tool for outcome measurement and patient safety in shoulder surgery.

Background: Outcome measurement in shoulder surgery is essential to evaluate the patient safety and treatment efficiency. Currently this is jeopardized by the fact that most patient-reported self-assessment instruments are not comparable. Hence, the aim was to develop a reliable self-assessment questionnaire which allows an easy follow-up of patients.

Fibrocartilage in various regions of the human glenoid labrum. An immunohistochemical study on human cadavers.

Purpose: The nature and the distribution of fibrocartilage at the human glenoid labrum are unclear, and a better understanding may help to restore its function in open and arthroscopic Bankart repair. Aim of this study was to describe the fibrocartilage extent within the labrum at clinically relevant sites of the glenoid in order to relate the molecular composition of the labrum to its mechanical environment.

Methods: Twelve fresh frozen human cadaveric shoulders (mean age 38 years) were obtained, and sections perpendicular to the glenoid rim at the 12, 2, 3, 4, 6 and 9 o' clock position were labelled with antibodies against collagen I and II, aggrecan and link protein.

Comparison of intraosseous versus central venous vascular access in adults under resuscitation in the emergency department with inaccessible peripheral veins.

Introduction: Current European Resuscitation Council (ERC) guidelines recommend intraosseous (IO) vascular access, if intravenous (IV) access is not readily available. Because central venous catheterisation (CVC) is an established alternative for in-hospital resuscitation, we compared IO access versus landmark-based CVC in adults with difficult peripheral veins.

Methods: In this prospective observational study we investigated success rates on first attempt and procedure times of IO access versus central venous catheterisation (CVC) in adults (≥ 18 years of age) with inaccessible peripheral veins under trauma or medical resuscitation in a level I trauma centre emergency department.

Treatment of distal humeral fractures using conventional implants. Biomechanical evaluation of a new implant configuration.

Background: In the face of costly fixation hardware with varying performance for treatment of distal humeral fractures, a novel technique (U-Frame) is proposed using conventional implants in a 180 degrees plate arrangement. In this in-vitro study the biomechanical stability of this method was compared with the established technique which utilizes angular stable locking compression plates (LCP) in a 90 degrees configuration.

Methods: An unstable distal 3-part fracture (AO 13-C2.

Malfunction of a Heimlich flutter valve causing tension pneumothorax: case report of a rare complication.

Background: Thoracic injuries play an important role in major trauma patients due to their high incidence and critical relevance. A serious consequence of thoracic trauma is pneumothorax, a condition that quickly can become life-threatening and requires immediate treatment.Decompression is the state of the art for treating tension pneumothorax.

A rapid method for the generation of uniform acellular bone explants: a technical note.

Background: Bone graft studies lack standardized controls. We aim to present a quick and reliable method for the intra-operative generation of acellular bone explants.

Methods: Therefore, ovine cancellous bone explants from the iliac crest were prepared and used to test several methods for the induction of cell death.

Comparison of two intraosseous access devices in adult patients under resuscitation in the emergency department: A prospective, randomized study.

Introduction: Current guidelines recommend intraosseous (IO) vascular access in adults if peripheral venous access is unavailable. Most available data derive from children, animal models, cadaver studies or the prehospital setting. Therefore we compared two different IO access devices in adults under resuscitation in the hospital setting.

Monoaxial versus polyaxial screw insertion in angular stable plate fixation of proximal humeral fractures: radiographic analysis of a prospective randomized study.

Background: Monoaxial and polyaxial screw insertion are used in angular stable plating of displaced proximal humeral fractures. Aim of the study was to compare both fixation techniques by radiographic evaluation.

Methods: Prospective randomized treatment with monoaxial or polyaxial screw insertion in angular stable anatomic preshaped plates of displaced proximal humeral fractures.

Assessment of bone quality within the tuberosities of the osteoporotic humeral head: relevance for anchor positioning in rotator cuff repair.

Background: Tears of the rotator cuff are highly prevalent in patients older than 60 years, thereby presenting a population also suffering from osteopenia or osteoporosis. Suture fixation in the bone depends on the holding strength of the anchoring technique, whether a bone tunnel or suture anchor is selected. Because of osteopenic or osteoporotic bone changes, suture anchors in the older patient might pull out, resulting in failure of repair.

Is the intraosseous access route fast and efficacious compared to conventional central venous catheterization in adult patients under resuscitation in the emergency department? A prospective observational pilot study.

Background: For patients' safety reasons, current American Heart Association and European Resuscitation Council guidelines recommend intraosseous (IO) vascular access as an alternative in cases of emergency, if prompt venous catheterization is impossible. The purpose of this study was to compare the IO access as a bridging procedure versus central venous catheterization (CVC) for in-hospital adult emergency patients under resuscitation with impossible peripheral intravenous (IV) access. We hypothesised, that CVC is faster and more efficacious compared to IO access.

Biomechanical comparison of a new staple technique with tension band wiring for transverse patella fractures.

Background: The tension band wiring technique is the most common method of transverse patella fracture fixation. Since post-operative instabilities have been reported for this technique, alternative osteosynthesis solutions are of interest. We investigated the biomechanical behaviour of a new staple technique for treatment of transverse patella fractures in a cadaveric model.

Consistency of long-term outcome of acute Rockwood grade III acromioclavicular joint separations after K-wire transfixation.

Background: Surgical approach to acute Rockwood grade III acromioclavicular (AC) joint injuries demands satisfying and reliable treatment results of shoulder function in the long term. This study investigates the operative outcome of acute grade III AC joint separations after temporary K-wire transfixation of the AC joint over the years. We hypothesize, that the well-established temporary articular transfixation of acute Rockwood grade III AC joint dislocations with K-wires provides good and consistent functional outcome at long term.

Mid-term outcome comparing temporary K-wire fixation versus PDS augmentation of Rockwood grade III acromioclavicular joint separations.

Background: The treatment of acute acromioclavicular (AC) joint injuries depends mainly on the type of the dislocation and patient demands. This study compares the mid term outcome of two frequently performed surgical concepts of Rockwood grade III AC joint separations: The temporary articular fixation with K-wires (TKW) and the refixation with an absorbable polydioxansulfate (PDS) sling.

Findings: Retrospective observational study of 86 patients with a mean age of 37 years underwent either TKW (n = 70) or PDS treatment (n = 16) of Rockwood grade III AC joint injuries.

Influence of head size on the development of metallic wear and on the characteristics of carbon layers in metal-on-metal hip joints.

Background And Purpose: Particles originating from the articulating surfaces of hip endoprostheses often induce an inflammatory response, which can be related to implant failure. We therefore analyzed the metal content in capsular tissue from 44 McKee-Farrar metal-on-metal hip prostheses (with 3 different head sizes) and we also analyzed the morphological structure of layers located on articulating surfaces.

Methods: Atomic absorption spectrometry (AAS) was used to analyze the metal content in capsular tissue.

Septic arthritis as a severe complication of elective arthroscopy:clinical management strategies.

Infection of a peripheral joint following arthroscopic surgery presents with an incidence of approximately 0.42% an extremely rare entity. However, septic arthritis is a serious situation possibly leading to an irreparable joint damage.