Aims

Failure of healing is a well-known problem after repair of the rotator cuff. This study aimed to investigate if early repair of trauma-related full-thickness rotator cuff tears (FTRCTs) could prevent this failure.

Background: The Hansson Twin Hook (HTH) is an alternative to the sliding hip screw in the treatment of trochanteric fractures. In osteoporotic bone, biomechanical tests indicate better fixation properties of the HTH than of the lag screw. Our aim was to evaluate the technical results of the HTH in a larger series of osteoporotic patients with intertrochanteric fractures. Many surgeons were involved to assess, if the device was user-friendly.

Patients and Methods: In a prospective bicentric study, 55 surgeons used the HTH and a standard plate in 157 consecutive patients with intertrochanteric fractures, of which 83% were unstable. The mean age of the patients was 83 years. The patients were followed regularly clinically and radiographically for at least 4 months with a final control at 2 years.

Results: Technical intraoperative errors were done in 7 of the patients. The reduction of the fracture was inaccurate in these cases; hence the HTH had not been placed centrally in the femoral head. Two of the 7 intraoperative errors developed into failures of fixation (1.3%) during the 2-year period.

Interpretation: The HTH achieves adequate fixation purchase in osteoporotic bone, has a low failure rate and is easy to use.

Background: Whether pelvic fracture instability is correlated to mortality in blunt multi-trauma patients is debatable. This is the first prospective study on patients with pelvic fractures aiming at finding whether pelvic fracture type affects mortality.

Methods: 100 consecutive patients (77 males, mean age of 31 (3–73) years) were studied between September 2003 and October 2004. Data were collected regarding mechanism of injury, associated injuries, injury severity score (ISS), blood transfusions and mortality. The fractures were classified according to instability where type O is stable, type R rotationally unstable and type RV both rotationally and vertically unstable. Since a pure acetabular fracture is a single break in the pelvic ring, we classified it as type O. Computer tomography was used for fracture classification in 73 patients and plain X-rays in 27 patients.

Results: 77 fractures were caused by road traffic collisions. Type O fractures (n 63) had lower median ISS (13(4–48)) than type R (n 19) (18(9–75)) and type RV (n 18) (18(6–66)) (p=0.019, Kruskal Wallis). There was no significant in ISS between type R and RV fractures. A logistic regression model has shown that ISS was the only significant factor that predicts mortality.

Conclusion: ISS is the most importnt predictor in defining mortality in patients with pelvic fracture and not the type of pelvic instability.

Background: We aimed to study the relationship between the number of fractured scapular regions, and the severity and distribution of associated injuries in blunt trauma patients.

Methods: 107 consecutive patients with fractured scapulae (100 males) with a mean age of 35 (8–65) years were prospectively studied between January 2003 and December 2005. Mechanism of injury, associated injuries, injury severity scale (ISS) and the number of anatomical scapular regions involved in each fracture were studied. Patients were divided into single-region, two-region fracture, and more than two-region fracture groups. Computer tomography was used for fracture classification in 99 patients and plain X-rays in the remaining 8.

Results: Road traffic collisions were the most common cause of scapular fracture. 95 patients (89%) sustained associated injuries. The most frequent was chest injury (68 (64%)). The median ISS was 9 (4–57) for the single-region fracture group (n 55), 20 (4–59) for the two-region fracture group (n 30), and 22.5 (4–54) for more than two-region fracture group (n 22) (p=0.02, Kruskal Wallis test). The median values of abbreviated injury scale (AIS) for chest injuries for the three groups were 1 (0–4), 3 (0–5) and 3 (0–5), respectively (p=0.001, Kruskal Wallis test). The single-region fracture group had significantly less posterior structure injury (9/55) compared with the multiple-region fracture group (46/52) (p=0, Fisher’s exact test).

Conclusion: Associated injuries are common in patients having scapular fractures. ISS and AIS for chest injuries are higher and posterior structure injuries more frequent in patients with fractures involving multiple scapular regions.

The Medoff sliding plate (MSP) is a new device used to treat intertrochanteric and subtrochanteric fractures. There are three options for sliding; either along the shaft or the neck of the femur, or a combination of both.

In a prospective series of 108 consecutive displaced intertrochanteric fractures we used combined dynamic compression. The patients were followed clinically and radiologically for one year. All fractures healed during the follow-up period. The only postoperative technical failure was one lag-screw penetration.

Combined compression of the MSP gives increased dynamic capacity which reduces the risk of complications. The low rate of technical failure in our series compares favourably with that of the sliding hip screw or the Gamma nail but randomised trials comparing the MSP with other hip screw systems are necessary to find the true role of the MSP with its various sliding modes.