We used an inverted shoulder arthroplasty in 43 consecutive patients with a mean age of 78 years (65 to 97) who had sustained a three- or four-part fracture of the upper humerus. All except two were reviewed with a mean follow-up of 22 months (6 to 58).

The clinical outcome was satisfactory with a mean active anterior elevation of 97° (35° to 160°) and a mean active external rotation in abduction of 30° (0° to 80°). The mean Constant and the mean modified Constant scores were respectively 44 (16 to 69) and 66% (25% to 97%). Complications included three patients with reflex sympathetic dystrophy, five with neurological complications, most of which resolved, and one with an anterior dislocation. Radiography showed peri-prosthetic calcification in 36 patients (90%), displacement of the tuberosities in 19 (53%) and a scapular notch in ten (25%). Compared with conventional hemiarthroplasty, satisfactory mobility was obtained despite frequent migration of the tuberosities. However, long-term results are required before reverse shoulder arthroplasty can be recommended as a routine procedure in complex fractures of the upper humerus in the elderly.

Aim: The operative management of proximal humerus fractures is still viewed as an unsolved question.

Surgical treatment aims at restoring anatomical elements to a condition stable enough, to allow early mobilization to avoid secondary displacement. The blood supply of the humeral head should not be damaged, so the risk of avascular necrosis will be minimal.

This work offers a new surgical technique that dramatically reduces the need for dissection of soft tissues while using a new locked plate.

Material and Method: This prospective study was carried out between August 2002 and March 2004. 47 fractures of the humerus proximal were operated on 47 patients aged 63 as an average. There were 9 four part fractures, 18 three part and 17 two part fractures.

The two arms of this Y shaped plate embrace the humeral head. The anterior arm overbridges the biceps longus tendon and fixes the lesser tuberosity, with a locked screw in the head. The posterior arm fixes the greater tuberosity with an another locked screw. These two screws cross each other at nearly right angle thus giving optimal fixation in the head.

Results: Fourty four patients (44 shoulders) were later re-examined with 10,3 months mean delay. Re-education was made immediate for 85% of the cases. The final evaluation was made with the functional Constant score and X ray control.

The main complications were 3 algodystrophies, 1 hematoma, 4 failures of fixation, 2 nonunions and only one necrosis.

Conclusion: This first clinical experience with this new implant is stimulating, since it provides a reliable fixation, even into the osteopenic bone.

Purpose: Bilateral hip disease is a common finding. For patients in good general health the question is whether total hip arthroplasty should be performed on both sides during the same operation or whether a deferred strategy would be better. We compared 24 patients (48 hips) to determine the relative advantages of these two treatment strategies.

Material and methods: Two treatment groups were formed: the first group (group A) was a prospective series of 12 patients who underwent total hip arthroplasty for both hips during the same operation between January 1992 and September 1999; the second group (group B) was composed of 12 patients who had total hip arthroplasty for both hips implanted during two different operations separated by at least one year and chosen by random selection among patients operated during the same period as group A patients. Group A was composed of five women and seven men, mean age 48.4 years (23–67). Group B was composed of five women and seven men, mean age 60 years (50–75). Pressfit cups were used in both groups (except one in group A). The femoral stem was cemented in seven patients in group A and in five in group B. Peroperative data (transfusion, complications, anaesthesia agents, duration of anaesthesia and operation) and post-operative data (transfusions, blood loss, haemoglobin, temperature curve, hospital stay, drugs, early and late complications, radiologic findings) were studied. LWMH was given prophylactically and all patients had a duplex Doppler exploration before discharge. All patients were reviewed regularly: mean follow-up was 5.75 years (2–9) in group A and 6.42 years (2.33–8.5) in group B.

Results: We added the two hospitalisations for group B patients. Mean duration of the operation was 6h in group A and 4h22m in group B. Anaestheia lasted 7h in group A and 6h16min in group B. Blood transfusions amounted to 5.27 packed cell units and 3.09 fresh frozen plasma units in group A, 4.75 and 2.83 respectively in group B. Blood loss was 1439 cc in group A and 1642 cc in group B. Haemoglobin and temperature curves were similar between the two groups. There were two cases of postoperative phlebitis in group A and one revision procedure on day 9 for haematoma in group B. There were no cases of infection. Mean hospital stay was 14.66 days in group A and 22.5 days in group B. Radiographs did not show evidence of loosening.

Discussion: The results obtained in our two series are similar to other reports in the literature (Eggle 1996, Shih 1985). Per- and postoperative complications were not more frequent for one or two procedures. Hospitalisation stays were much shorter in group A patients, providing an important cost savings (34.8% for simultaneous implantations).

Conclusion: Bilateral total hip arthroplasty during a single operation offers an advantage in terms of hospital stay and overall cost. Comparison with two different operations shows that complications are not more frequent. Inversely, work stoppage is shorter, making this strategy particularly interesting for younger patients.