Comparison of the ALPS and PHILOS plating systems in proximal humeral fracture fixation - a retrospective study

BACKGROUND

Open reduction and plate osteosynthesis are considered as a successful technique for the treatment of proximal humerus fracture (PHF) despite high complication rates. The objective of our study was to review the clinical outcome and complications of the Anatomic Locking Plate System (ALPS) and compare it to the Proximal Humeral Internal Locking System (PHILOS). Our hypothesis was that ranges of motion (ROM) were superior and complication rates were lower with ALPS.

METHODS

Twenty patients treated with ALPS for PHF were retrospectively compared to 27 patients treated with PHILOS. Union, ROM and complications were clinically and radiologically assessed at 6 weeks, 3, 6, 12 and 18-24 months post-operatively.

RESULTS

Mean age was 52 ± 14 in the ALPS group and 58 ± 13 in the PHILOS group. Last follow-ups were conducted at a mean of 20.6 ± 4.8 months. Mean shoulder abduction was superior with ALPS by 14° (p-value = 0.036), 15° (p-value = 0.049), and 15° (p-value = 0.049) at 3, 6, and 12 months respectively. Mean shoulder external rotation was superior with ALPS by 11° (p-value = 0.032), 15° (p-value = 0.010) and 12° (p-value = 0.016) at 6 weeks, 3 and 6 months respectively. At the end of the follow-up, ROM remained better with ALPS, but not significantly. Complication rates over 21 months reached 20% with ALPS and 48% with PHILOS (p-value = 0.045). Implant removal rates reached 10% with ALPS and 37% with PHILOS (p-value = 0.036). Avascular necrosis was the only cause for hardware removal in the ALPS group.

CONCLUSION

The ALPS group showed better clinical outcomes with faster recovery in abduction and external rotation, although no difference in ROM remained after 21 months. Additionally, the complications rate was lower at last follow up. In our experience, the ALPS plating system is an effective management option in some PHF.

A semi-automated quantitative CT method for measuring rotator cuff muscle degeneration in shoulders with primary osteoarthritis

BACKGROUND

Rotator cuff muscle degeneration is an important parameter to consider when planning shoulder arthroplasty.

HYPOTHESIS

We hypothesized that rotator cuff muscle degeneration is correlated with scapulohumeral subluxation in patients planned for anatomical total shoulder arthroplasty (TSA).

MATERIALS AND METHODS

We developed a semi-automated quantitative CT method to measure rotator cuff muscle degeneration, and retrospectively analyzed 107 preoperative shoulder CT scans of patients with primary osteoarthritis. On a standardized sagittal-oblique CT slice perpendicular to the scapular axis, two observers measured the cross-sectional areas of residual rotator cuff muscle tissues, normalized by the estimated area of healthy muscles. Muscle degeneration was quantified in a semi-automated manner, and divided into atrophy and fatty infiltration. Scapulohumeral subluxation was determined in 3D as the distance between the humeral head center and the glenoid surface center, projected on the same CT slice, and normalized by the humeral head radius. We tested all potential correlations between muscle degeneration and scapulohumeral subluxation.

RESULTS

Muscle degeneration, primarily due to atrophy, predominated in the supraspinatus; it varied from 0.8% to 88.8%. Scapulohumeral subluxation varied from 2.5% to 72.9%, and was mainly in a posterior and postero-superior orientation. There was a significant but weak correlation between the amount of subluxation and both supraspinatus (R=0.207, P=0.032) and infraspinatus (R=0.225, P=0.020) degeneration. Inter- and intra-observer reproducibility of muscle degeneration measurements were both excellent (ICCs range=0.955-0.987 and 0.971-0.988, respectively).

CONCLUSION

This new semi-automated CT method allows to quantitatively and reproducibly measure rotator cuff muscle degeneration in shoulders with primary osteoarthritis. Muscle degeneration is weakly correlated with scapulohumeral subluxation in patients planned for anatomical TSA.

LEVEL OF EVIDENCE

Level IV.

TYPE OF STUDY

Diagnostic retrospective study.

A novel body weight support system extension: initial concept and simulation study

Body weight supported treadmill training is an approach to gait rehabilitation following a stroke or spinal cord injury. Although lateral control of balance is an important aspect of walking, many of the currently available body weight support systems have a fixed pulley configuration which can lead to lateral forces being developed in the supporting cables, interfering with the lateral balance task. In this paper, a novel extension for body weight support systems, used for treadmill walking, is presented which features a system of pulleys and trolleys. A model is developed for the device along with a basic feedback controller in order to enable simulation of the concept. The lateral forces induced by the novel system are greatly reduced in comparison to a fixed pulley system. This device has applications in balance training within gait rehabilitation programs.

[Cerebral venous thrombosis after lumbar puncture and intravenous steroids in two patients with multiple sclerosis]

Two patients affected with a multiple sclerosis developed cerebral venous thrombosis after lumbar puncture and treatment with intravenous methylprednisolone. In one case, the course was favorable. The second patient died in spite of intracerebral thrombolysis. The autopsy confirmed the diagnosis of cerebral venous thrombosis and multiple sclerosis. We discuss the relationship between lumbar puncture, steroid treatment and cerebral venous thrombosis.

[Antithrombotic agents and prevention of cerebrovascular accidents]

Prevention remains a major therapeutic approach of stroke. Inhibitors of platelet aggregation are the treatment of choice in the secondary prevention of an arterial embolism stroke. Aspirin (200-300 mg/d) is the most commonly used drug, ticlopidine (500 mg/d) is advised if aspirin is contraindicated or if a recurrent stroke of arterial embolism origin occurs in spite of treatment with aspirin. We are waiting with interest for the results of the clinical trial of clopidogrel, a derivative of ticlopidine. Till now, no studies have proved the benefit of antiplatelet treatment in the primary prevention of stroke. In non rheumatic atrial fibrillation, the unanimous results of recent studies confirmed the benefit of oral anticoagulation in the primary and secondary prevention of stroke. Although coumadin is superior to aspirin in non rheumatic atrial fibrillation, aspirin is an efficient alternative when anticoagulation is contraindicated.

[Muscle cramps: mechanism , etiology and current treatment]

Spasms of skeletal muscles occur in healthy individuals or in the course of functional disorders of the peripheral motor neuron or its axons. Like fasciculations, they are a motor manifestation, but a painful one. Cramps evoke the notion of ephapsis and of immature terminal axons. There are, however, also other responsible regulatory systems, mostly the sensible and spinal ones. Three personal observations are used to illustrate the various triggering mechanisms. A review of the literature on this subject is added. Symptomatic treatment has not changed over past decades: Quinidine remains the treatment of choice. Other stabilizers of cell membranes are actually available, whose usefulness varies as a function of the cause of cramps.