This study evaluates the long-term survival of spinal implants after surgical site infection (SSI) and the risk factors associated with treatment failure.

A Kaplan-Meier survival analysis was carried out on 43 patients who had undergone a posterior spinal fusion with instrumentation between January 2006 and December 2008, and who consecutively developed an acute deep surgical site infection. All were appropriately treated by surgical debridement with a tailored antibiotic program based on culture results for a minimum of eight weeks.

A ‘terminal event’ or failure of treatment was defined as implant removal or death related to the SSI. The mean follow-up was 26 months (1.03 to 50.9). A total of ten patients (23.3%) had a terminal event. The rate of survival after the first debridement was 90.7% (95% confidence interval (CI) 82.95 to 98.24) at six months, 85.4% (95% CI 74.64 to 96.18) at one year, and 73.2% (95% CI 58.70 to 87.78) at two, three and four years. Four of nine patients required re-instrumentation after implant removal, and two of the four had a recurrent infection at the surgical site. There was one recurrence after implant removal without re-instrumentation.

Multivariate analysis revealed a significant risk of treatment failure in patients who developed sepsis (hazard ratio (HR) 12.5 (95% confidence interval (CI) 2.6 to 59.9); p < 0.001) or who had > three fused segments (HR 4.5 (95% CI 1.25 to 24.05); p = 0.03). Implant survival is seriously compromised even after properly treated surgical site infection, but progressively decreases over the first 24 months.

Cite this article: Bone Joint J 2013;95-B:1121–6.

Introduction and objectives

High-energy pelvic fractures are life-threatening injuries. Approximately 15% to 30% of patients with high-energy pelvic injuries are hemodynamic unstable, hemorrhagic shock remains the main cause of death in patients with pelvic fractures, with an overall mortality rate from 6% to 35%. The correlation between fracture pattern and mortality in polytrauma with pelvic fracture has been previously investigated. However, the purpose of our investigation was to evaluate the relationship of hemodynamic instability with the pelvic fracture pattern according to different classifications.

INTRODUCTION

The TFCC injuries are usually diagnosed by a coronal MRI. We have described the Float image for the diagnosis of peripheral injuries of the TFCC. In a sagital image parallel to the ulnar diaphysis and placed lateral to the ulnar fovea, we can observe the radiocubital dorsal and volar ligaments of the TFCC. A distance of more than 4mm between the dorsal edge of the meniscus and the joint capsule suggests the presence of TFCC peripheral rupture.

Introduction

Chronic pain is one of the adverse outcomes in surgery for degenerative lumbar pathology (DLP). Postoperative complications as DVT, and chronic pain in pathologies as thoracotomy or breast cancer have been associated with poor control of postoperative pain.

Introduction

An important number of factors affecting the outcome of surgical treatment have been identified, and these factors can affect the patient's selection for lumbar surgery.

Introduction: Higher loosening rate, improvements in metalo n metal bearings and excellent immediate clinico-functional results related with current Standard total hip endoprosthesis, have suposed the rennaisance of the new hip resurfacing implants. In this work we present our experience the first 486 cases and minimal 5 years follow up.

Material and method: From July 2003 to December 2008 486 surface arthroplasties were implanted in our institution (4 bilateral) in 450 patients, 314 males y 136 females, mean age of 46,6 years (16 – 69). 9 BHR, 2 ASR, 3 ADEPT, 5 CORIN, 22 Mitch and 409 CONSERVE PLUS models were implanted. In 454 cases a modified Kocher-Langenbeck posterior approach and in 32 cases Hueter’s anterior approach were carried out. Surgical time, intraoperative bleeding and collected blood in drains, components orientation in AP radiographies, registered complications, Merle d’Aubigné, WOMAC and HHS clínico-funtcional scores were assessed. Statistical analysis was performed by means of chi-squared test and non – parametric tests.

Results: Mean surgical time was 1h 50’ (1h 15’ a 2h 30’), mean intraoperative bleeding 273,4 cc (210 – 360cc), drained blood 224,2 cc (180 – 380cc). During the first year 11 autodonated blood units were retransfused (during the first 5 months patients were encouraged for 1000cc. autodonation). Mean CCD angle was 139,7° (SD 130 – 147) and acetabular inclination 43° (SD 40 – 65°). There were 4 instances of femoral fractures during the first half year after surgery, which required conversiòn to a BFH total endoprosthesis, one too adducted cup (65°), which required only cup exchange. There was a very significant improvement in clinico-functional scores: MDA score improved from 12,9 pts. preoperative (11 – 14) to 17,4 at latest follow-up (15 – 18) (p< 0,001), WOMAC from 46,2 (19 – 67) to 93,2 (79 – 100) (p< 0,001) and HHS from 52,3 (range 42 – 60) to 96,7 (range 89 – 98) (p< 0,001). Main complications were 1 arterial femoral thrombosis, 1 deep venous thrombosis, 1 deep infection that required 2-stages exchange, 4 transient femoral pare-sia. Overall survivorship was 98,97%.

Conclusions: hip resurfacing implantation, when recommendations made by the first authors of these new models are properly carried out, provide excellent clinical-functional results, comparable to non cemented total hip implants, if not better. Longer follow up are required to assess more adequately these implants, although it will not probably mean in the majority of the cases any hip exchange of a standard THA in terms of morbidity and mid-longterm clinical-functional result. This assumption has been taken from our cases converted to a THA with BFH. For this reason we do think absolutely we dispose today a very promising implant for young adults with well stablished hip osteoarthritis.

Introduction: Pain and disability are two parameters used to indicate and evaluate treatment in lumbar degenerative spine (LDS). Visual Analogue Scales (VAS) and Verbal Rating Scales (VRS) are frequently used to assess pain intensity. Both scales are validated and they have good psychometric properties.

Aim: To evaluate concordance and grade of interchangeability between the two scales.

Design: Retrospective and observational study with dates collected prospectively.

Outcome measures: Pain intensity was evaluated by VAS. As VRS we used pain categoric question of SF 36. Kappa coefficient was used to measure agreement.

Material and Methods: We analysed 50 patients operated by LDS. 28 women and 22 men, mean age was 50 y (17–81 y). All patients filled preoperatively a set of questionnaires (SF 36, Oswestry Disability Index -ODI-, Core set of Deyo and VAS). We evaluated whether VAS follows or not a normal distribution, correlation and concordance between VAS and VRS. Even we study if there are different related to sex, age or study level. Statistically studies were done using SPSS. We considered p=0’05 as statistically significant

Results: VAS not have a normal distribution (Kolmogorov-Smirnov p=0’000). VAS and VRS have a low, but statistically significant, correlation (Rho-Spearman r=0’408 p=0’004), whatever the two scales have low concordance, with large overlap of responses (Kappa=0’345 IC 95% 0’174–0’543). This disagreement dates are aleatory (RV=0’174) and non systematic (RP=−0’093. RC=−0’00005). Making a stratified study, using analogue scale we not found differences by sex (p=0’283) but using VRS we shown more pain intensity in women (p=0’042) and this dates are associated with significative differences in women’s disability (ODI 46’74 vs 57’79 p=0’05)

Conclusions:

VAS data should be analyzed using non paramentrics methods because vas have non-linear properties

Study limitations: Using pain question of SF 36 we are asking about bodily pain and not specifically lumbar pain, but in a patient who are going to be operated by DLS we thing is a good approach.

Number of patients, although we find clinically and statistically significant differences

Introduction: Shoulder hemiarthroplasty is an established treatment for complex proximal humeral fractures but the functional results of these hemiarthroplasties in proximal humeral fractures are often poor and unpredictable. The capacity of restoring proximal humeral anatomy in such these complex fractures is of capital importance to obtain proper placement and secure fixation of the tuberosities to the prosthesis. The purpose of this study was to determine the value of the upper edge of the pectoralis major insertion as a landmark to determine proper height and version of hemiarthroplasties implanted for proximal humeral fractures.

Material and Methods: The upper edge of the pectoralis major insertion was referenced with a metallic device in 20 cadaveric humerus. A Computed Tomography study was performed in all the specimens. Total humeral length was recorded in all the specimens. The distance between the upper pectoralis major insertion and the tangent to the humeral head was also recorded. The anatomical neck of the humeral head was determined in the axial plane of the CT scan and a perpendicular line was drawn to represent the posterior fin of the prosthesis. To that image, the CT scan slice showing the upper insertion of the pectoralis major was superimposed and the distance of the metallic reference to the posterior fin of the prosthesis was recorded as it was the angle formed by the line connecting the upper pectoralis major insertion with the center of the anatomical neck diameter and with the posterior fin of the prosthesis.

Qualitative variables are presented in absolute and percentage values. Quantitative variables are presented with mean values and standard deviation.

Results: Mean total humeral length was 32,13 cm. The mean distance from the upper pectoralis major insertion to the tangent to the humeral head was of 5,64. The mean distance from the upper pectoralis major insertion to the tangent to the humeral head represents the 17,55% of the total humeral length. The mean distance of the upper pectoralis major insertion to the posterior fin of the prosthesis was of 1,06 cm. The angle between the upper pectoralis major insertion and the posterior fin of the prosthesis was of 24,65º.

Conclusions: Mean distance from the upper part of the pectoralis major insertion to the top of the humeral head of 5, 6 cm with a 95% confidence interval.

Placement of the prosthesis in the proper retroversion can be achieved by placing the posterior fin 1,06 cm posterior to the upper insertion of the pectoralis major or by placing the posterior fin at 24,65º with respect to the upper insertion line.

Upper insertion of the pectoralis major constitutes a reliable reference to reproduce anatomy in hemiarthroplasties for proximal humeral fractures.

Background: Control of acute postoperative pain remains a serious problem. Postoperative pain is associated with an increase in thrombotic or respiratory complications. In the other hand the association between surgery, acute postoperative pain and ongoing chronic pain is well defined.

Target: To evaluate the incidence of severe pain after surgery for degenerative lumbar pain, with two analgesic techniques; intravenous analgesia (i.v.) (group 1) and patient controlled analgesia (PCA) (group 2).

Study design: Retrospective study with dates obtains prospectively.

Patient sample: We studied 206 patients operated between january 04 and june 05. Group 1 (intravenous) 80 patients and 126 in group 2 (PCA).

Outcomes mesasures: Percentage of patients with severe pain, number of rescues and complications.

Materials and methods: The type of postoperative analgesia administrated was decided by the anaesthesiologist. To measure pain intensity the VAS was assessed every 6 hours and worst score was used, excluding recovery room. Type of rescue analgesia was the same in all patients and these was recommended in VAS > 3. We evaluate sex, age and comorbidity by ASA. We have defining analgesic ‘failure’ by the overall incidence of pain intensity in two categories: the percentage of patients who experienced moderate-severe pain (VAS > 3) and severe pain (VAS> or = 7). As the pain scores were not normally distributed we not used mean and SD of VAS. The number of rescues and complications were also evaluated.

Results: There was not differences in median age (group 1 50’85 sd 15’4; group 2 52’44 sd 15’4 p=0’47), ASA (group 1 1’89 sd 0’75; group 2 1’90 sd 0’57 p=0’88) or diagnosis between two groups. There were differences in percentages of sexes, group 1 with 40% of women and 62’69% in group 2 (p=0’013). There were not differences in incidence of patients with moderate-severe pain (group 1 15/80; group 2 30/126. p=0’392) neither in incidence of patients with severe pain (group 1 33/80; group 2 51/126. p=0’912). There were not differences in number of rescues (p=0’912) neither in number of complications between groups. Global incidence of VAS > 3 were 40’8 but the incidence of rescues were 25’2%

Conclusions: Our findings suggest that both techniques have similar effectiveness, although the global incidence of severe pain was not optimal (21’8%). It is important to remark the different between incidence of patients with VAS > 3 and number of rescues administrated.

The objective of this study is to analyze changes in the force needed to raise the arm caused by using a single or a double-row configuration of cuff repair.

Cadaveric study performed using 5 fresh-frozen shoulders. Supraspinatus tear created in all specimens beginning 0.5 cm from biceps tendon. Repair of tear with single and double-row configuration of anchors placed 1cm apart each one. Sutures fixed to digital dynamometer. Continuous traction applied and registered to elevate humerus to 30° and 45°. Experiment repeated 3 times for each configuration and angle of elevation on each specimen. Paired Student t test was used to compare difference between single and double-row configuration at 30° and 45° of anterior elevation.

Significant differences between force needed to raise the arm to 30° with single-row (4,76 kg) configuration and double-row (6,94) (p< 0,001). Significant differences between force needed to raise the arm to 45° with single-row configuration (10,32 kg) and double-row (15,93) (p< 0,008). Significant differences when comparing mean increase of force needed to raise the arm from 30° to 45° between single and double-row configuration (p< 0,012).

The force needed to raise the arm to 30° and 45° is significantly higher for double than for single-row configuration. Quality of tendon margin should be taken into account when choosing between double and single-row configuration. If repair is done to a frayed and degenerated tendon, surgeon has to imbalance benefits of double-row repair with the fact that tendon suture will have to resist an increased force in active movement.

Purpose of study was to determine the value of the upper edge of the pectoralis major (UPM) insertion as landmark to determine proper height and version of hemiarthroplasties implanted for proximal humeral fractures.

UPM insertion was referenced with metallic device in 20 cadaveric humerus. Computed Tomography study was performed in all specimens. Total humeral length and distance between the UPM insertion and the tangent to humeral head was recorded. CT scan slice showing UPM superimposition in humeral head was drawn to determine prosthesis retroversion. Qualitative variables are presented in absolute and percentage values. Quantitative variables are presented with mean values and standard deviation.

Mean total humeral length 32,13 cm. Mean distance from the UPM to the tangent to the humeral head 5,64. Mean distance from UPM insertion to the tangent to the humeral head represents the 17,55 % of total humeral length. Mean distance of UPM insertion to the posterior fin of the prosthesis of 1,06 cm. Angle between UPM insertion and posterior fin of the prosthesis 24,65°.

Mean distance from the UPM insertion to the top of the humeral head of 5, 6 cm with a 95% confidence interval. Placement of the prosthesis in the proper retroversion can be achieved by placing the posterior fin 1,06 cm posterior to the UPM or by placing the posterior fin at 24,65° with respect to the upper insertion line. UPM constitutes a reliable reference to reproduce anatomy in hemiarthroplasties for proximal humeral fractures.

Introduction and purpose: One of the complications observed after meniscal transplant is allograft shrinkage. Amongst the proposed causes are both a subtle immunological rejection, and an alteration of meniscal permeability leading to nutritional deficit. The purpose of this study was to asses freezing, one of the most frequently used processes to preserve menisci, and provide evidence either in favor of those articles in the literature that claim that freezing does not affect the collagen network, or against it.

Materials and methods: Twenty-six lateral menisci were obtained during total knee replacement. Thirteen were frozen at −80° and the rest were used as a control group. The menisci were analyzed with Transmission Electronic Microscopy. According to the periodicity and degree of disruption of the collagen, loss of band pattern and intrafibrillar edema, each meniscus was scored from 0 to 7 points. Subsequently the menisci were classified by degrees from normal (grade I, 0 to 2 points) to severely altered (grade III, 5 to 7 points).

Results: Collagen fibers in longitudinal sections averaged 14.26 nm in previously frozen menisci and 17.28 in the control group (p=0.019), whereas in cross sections they averaged 13.14 nm. vs. 16.93 nm. respectively (p=0.003)..

Eight of the 13 frozen menisci were classified as grade III (61.54%) and 5 as grade II. In the control group 6 were classified as grade I (46.15%) and 7 as grade II (53.85%). Frozen menisci averaged 4.85 points and the control menisci 2.46 (p< 0.001).

Conclusions: The freezing process to −80°C seems to alter both each fiber of collagen as well as its spatial position. We have presented a new qualitative/quantitative assessment scale for meniscal status.

INTRODUCTION: Shrinkage is one of the complications observed after allograft meniscal transplantation. Subtle immune rejection and alterations in meniscal permeability leading to nutritional deficit have been suggested as causes of shrinkage. The purpose of this study was to ascertain how freezing, one of the most common procedures used to preserve allografts, alters the collagen’s architecture.

METHODS: 26 fresh human external menisci were harvested in sterile conditions during TKR procedures. 13 of them were immediately frozen to −80° C while the rest were used as controls. All the menisci were cut, processed and preserved in a 2.0% glutaraldehyde and then analyzed with transmission electron microscopy. Four hundred collagen fibrils were recorded and measured in longitudinal and transversal sections in each meniscus. According to the collagen’s periodicity and degree of disruption, loss of banding, degree of collagen packing, fibril size variability and its intrafibrilar oedema, each meniscus was pointed from 0 to 7. Subsequently they were classified in grades ranging from a normal state (grade I; 0 to 2 points) to severe disarray (grade III; 5 to 7 points).

RESULTS: The fibril collagen diameters of those menisci that had been previously frozen showed an average size in the longitudinal section of 14.256 nm, whereas 17.279 nm were seen in the menisci used as controls (p=0.019). In the transverse section, the frozen menisci averaged 13.145 nm and 16.935 nm the controls (p=0.003).

Samples of the 13 previously frozen menisci were classified as grade III in 8 cases (61,54 %), and grade II in 5 cases (38.46 %). They averaged 4.846 points. The control groups were classified as grade I in 6 cases (46.154%) and grade II in 7 cases (53.85 %). The frozen menisci averaged 4.85 points whereas the control group did so 2.46 (p< 0.001)

CONCLUSIONS: The fibril diameters in frozen menisci showed a thinner diameter and had a higher degree of disarray. Therefore, the results suggest that the freezing process alters the menisci’s collagen net. This could partially explain the pathological changes found in shrunken menisci. This is the first work that quantified and qualified methodologically the collagen meniscal architecture and its potential changes.

Introduction: Analysis of location of central peg and the fours screws of the glenoid component in inverted shoulder prostheses.

Materials and methods: 34 inverted prostheses. Mean age 74.10. 33 women, 1 man. Preoperative CT: glenoid version, presence and size of bone spurs. Postoperative CT: location of central peg and 4 screws.

Results: 27 retroverted glenoids (mean 6.5°), 7 anteverted glenoids (mean 5.3°); anterior bone spur in 17 cases, posterior in 12. In 52% of the cases the central peg was inside the glenoid; in 33% the anterior part was outside and in 14% the posterior part. If the anterior part of the central peg was outside, 85% was due to retroverted glenoids (mean 8.33°). If the posterior part was outside, 66% of these were due to anteverted glenoids (mean 9.5°). Lower inside screw in the scapula in 38% of cases, 3/4 inside in 19%, 2/4 in 23% and 1/4 in 19%. Upper screw: 47%, 23% 19% and 9%, respectively. Anterior screw: 66%, 23% and 9%, respectively. Posterior screw: 38%, 42%, 14% and 4%, respectively.

Conclusions:

- Lower screw completely within the lateral part of the scapula with less coverage by upper screw.

Introduction: Defects in rotational alignment of the femoral component in total knee replacements (TKR) may cause poor alignment of the extensor apparatus. There are numerous references concerning the correct alignment of the femoral component of a prosthesis: transepicondylar axis, anteroposterior axis, and posterior condylar axis.

Materials and methods: Computer-assisted measurement of the relative differences between the transepicondylar axis, anteroposterior axis and posterior condylar axis in 38 TKR patients, excluding those with varus or valgus deformity greater than 15 degrees.

Results: The difference between the anteroposterior axis and the transepicondylar axis was 3.13 degrees of external rotation in the former.

Between the posterior condylar axis and the transepicondylar axis it was 1.18 degrees of internal rotation in the former.

Between the anteroposterior axis and the posterior condylar axis it was 5.51 degrees of external rotation of the former.

Conclusions: Probably the transepicondylar axis is the best landmark to enable reproducing the biomechanics of the knee in a patient bearing a prosthesis, although it is often difficult to reproduce it precisely. Several studies have noted errors among observers that are too great to make us feel certain that we are doing the best thing.

Although it is accepted that the perpendicular to the anteroposterior axis is reliable and corresponds to 4° of external rotation in relation to the posterior condylar axis, we have observed significant differences from one patient to another.

It would seem preferable to use a combination of the different axes, which we can do with a surgical browser.

Introduction: Study of the influence of anatomical restoration on the outcome of the surgical treatment of proximal humerus fractures treated by sutures and Ender nails.

Materials and methods: 44 fractures. Mean age 64.45. 12 men and 32 women. Mean follow-up 55.83 months (12.83-97). 14 2p fractures, 27 3p and 3 4p. Functional study using the Constant Scale. Quality of life measured with EuroQol-5D. Imaging done one year after surgery: AP X-Ray, full bilateral humerus with external measurement and control CT.

Results: Mean Constant score for series: 78.98. Mean EuroQol-5D rating for the series: 0.7681. Constant scores for total humerus length: Diminished length: difference < 1 cm, 84.71; difference ≥1 cm, 56. Increased length: difference < 1 cm, 79.2; difference ≥ 1 cm, 78.67. Constant score according to distance between head and trochlea: difference +: 77,94; difference −: 82.92. Differences by age groups: < 70 years, 84.12; ≥70 years, 73.5.

Conclusions: No significant involvement of function with differences of less than 2 cm in total humerus length. No significant involvement of function for differences of less than 1 cm in head-trochlea distance. Functional differences by age groups. Best result < 70 years of age.

Introduction: The correct position of the knee arthroplasty components is associated with a better result of the prosthesis.

In the tibial component, both intramedullar and extramedullar instrumentations have been used for its fiability, but in the femoral component intramedullar guides are more precise than extramedullar ones.

The use of the intramedullar guide for the femoral component is not always possible, because a significant deformity of the femoral shaft or when a intramedullar device has been implanted in the femur.

We have studied the alineation of the components of computer assisted total knee arthroplasties in a group of patients with femoral deformities or implants.

Material and methods: We have used the surgical navigator Stryker-Howmedica for the implantation of a knee arthroplasty in a group of 10 patients in which a endomedullar femoral guide can not be used for femoral shaft severe deformities (6 cases): Paget disease (1 case), previous femoral osteomyelitis (2 cases) or previous femoral fractures (3 cases), or a shaft device was in the femoral shaft (4 cases): long hip femoral stem (3 cases) or a femoral nail (1 case) .

We have studied the alineation of femoral and tibial components with a whole-leg X-ray and Computer Tomography.

Results: All the femoral and tibial components have been implanted in a good position (90 +/– 2 degrees in the A-P plane and a femorotibial axe 180 +/– 3 degrees. The alineation in the sagital and axial planes have been inside the desired values in all cases also.

Discussion: It is generally accepted than intramedullary guides for the femoral component is the gold standard in arthroplasty of the knee.

In the last years, the development of computer assisted systems has allowed to obtain femoral and tibial cuts referred to the mechanical axes of the bone, without using mechanical guides for the alineation.

In some studies these navigation systems are better than mechanical instruments in terms of alineation of the components in cases without great deformities.

In this study, with some cases with severe femoral shaft deformities or with some intramedullary devices that does not allow the use of intramedullary femoral guides, we think that the indication to use a surgical navigator should be nearly absolute.

Study Design: Prospective study cohort describing lung function, exercise tolerance and strength inspiratory and expiratory muscles.

Objective: To analyze lung function and ventilatory response to exercise in adolescents with thoracic curves > 45, candidates to surgery.

Summary of background: Adolescents with symptomatic scoliosis have little or no impairment of resting lung volumes. We have limited information about moderates scoliosis. In some series not found abnormalities and in others ones report little restrictive pulmonary function and lower exercise tolerance. We have found no one study that it have valuated the strength of the respiratory muscles.

Methods: From 2002 until 2003. They were evaluated 19 patients with AIS (4 males and 15 females) who were indicated to surgical treatment. Mean age of 16 (13–26). The mean Cobb angle was 61 (45–105). Flow curves were obtained by maximal forced expirations. Incremental exercise was performed by cycloergometry using the protocol described by Neder et al. Muscle strength was measured by one system of valve with incremental weight.

Results: The mean values of spirometry were FEV 1 81 (+/−14% ref), %FEV 1/FVC 82 +/−6, TLC 86 +/− 11%ref, RV 106 +/− 20% ref. The strength of respiratory muscles was significant lower, Pimax. 67% (p=0’030), Pemax 65% (p< 0’0001). In the exercise capacity the VO2 max was significantly lower (54’5 % ref., p< 0’05) but without to be the VE max and the heart rate the restricted factor.

Conclusions:

The rest lung volumes are into the normal values but in the lower side.

Introduction and purpose: The treatment of proximal humerus fractures is still controversial in terms of the surgical approach to be used and even of whether surgery is indeed necessary or not. The purpose of this study is to assess the functional result and the patients’ perception of their general health condition after treatment of displaced humerus fractures by means of transosseous sutures with or without the support of modified Ender nails.

Materials and methods: The study comprised a series of 40 patients (mean age: 66.21 years); 82% females /18% males. The patients had the following fracture types: 27% had two-part fractures, 60% had three-part fractures and 12% had four-part fractures and fracture-dislocations. The mean follow-up was 55.83 months (12.83-97). The final functional evaluation was carried out using the Constant score and the health perception was measured on the EuroQol-5D scale. All patients were submitted to a final radiological exam (AP and profile radiographs on the scapular plane).

Results: The mean value obtained on the Constant Scale was 74.18 in the involved arm and 84.06 in the contralateral one. As regards pain, the mean obtained was 12.57, while the value for forward arm elevation was 8.24. When comparing two age groups (> 70 vis-á-vis < 70 year olds) a significant difference was obtained with respect to Constant Scale’s global value (p 0.022). Furthermore, a significant difference was detected between the result of the EuroQol-5D scale, the global result of the Constant Scale (p 0.061), abduction (p 0.05), internal rotation (p 0.05) and strength (p 0.007). The rate of postop complications was 6% (2 surgical wound haematomas). The final radiological control revealed losses in reduction and necrosis in 9.37% and 3.03% of patients respectively.

Conclusions: (1) Good global functional results on he Constant Scale. (2) Significant differences in functional results based on patients’ age. (3) Difference in quality of life perceptions on the basis of the amount of mobility and strength obtained postoperatively. (4) Low complications rate.

Introduction and purpose: The functional result of the functional repair of the rotator cuff is multifactorial. The purpose of this study was to assess the influence of supraspinatus and infraspinatus fatty degeneration prior to surgery on the functional result of open rotator cuff repair surgeries.

Materials and methods: The study comprised 32 patients (19 females and 13 males) operated on for a rotator cuff tear by means of open surgery. Mean age: 58.16. The right arm was involved in 20 cases, whereas the left one was involved in the remaining 12. The acromion was type II in 28 cases and type III in 4. In all cases a previous MRi was available. The analysis of fatty degeneration was made on the basis of Goutallier’s criteria. The assessment of the functional result was made according to Constant’s score. Minimum follow-up: 1 year.

Results: Mean Constant score: preop 51.41 (range: 30–69); postop (at the end of follow-up) 83 (range: 77–100). Fatty degeneration of the supraspinatus was deg. I in 32.25% of cases and deg. II in 45.16%. As regards the infraespinatus, 38,7% of cases had no fatty degeneration and 41.93% had deg. I. No significant differences were found regarding the post Constant score between patients with deg. 0-I supraspinatus fatty degeneration and patients with 0-I infraspinatus fatty degeneration (p 0.604) or between patients with deg. II-III-IV supraspinatus fatty degeneration and those with deg. 0-I infraspinatus fatty degeneration (p.654).

Conclusions: (1) Surgical repairs of rotator cuff tears lead to a satisfactory final functional result. (2) Considering the size of our sample, there do not seem to exist significant differences with respect to functional result between patients with supraspinatus (degrees 0–4) and patients with infraspinatus fatty degeneration (limited to deg. 0–1).