scholarly journals Failed Dermal Allograft Procedures for Irreparable Rotator Cuff Tears Can Still Improve Pain and Function: The “Biologic Tuberoplasty Effect”

2019 ◽  
Vol 7 (8) ◽  
pp. 232596711986343 ◽  
Author(s):  
Raffy Mirzayan ◽  
Michael A. Stone ◽  
Michael Batech ◽  
Daniel C. Acevedo ◽  
Anshuman Singh
Keyword(s):  
Rotator Cuff ◽  
Clinical Improvement ◽  
Rotator Cuff Tears ◽  
Type I ◽  
Type Ii ◽  
Bone Contact ◽  
Type Iii ◽  
Goutallier Classification ◽  
Functional Scores ◽  
The Mean

Background:Acellular dermal matrices (ADMs) have been used in the treatment of shoulders with massive rotator cuff tears (MRCTs). Despite clinical improvement, correlation of clinical findings with ADM integrity on imaging has not been investigated.Hypothesis:The pain in shoulders with MRCTs is partially due to bone-to-bone contact between the tuberosity and acromion. Coverage of the tuberosity with an intact graft or a graft that is torn in a way that the tuberosity remains covered will act as an interpositional tissue, preventing bone-to-bone contact and leading to clinical improvement.Study Design:Case series; Level of evidence, 4.Methods:Between 2006 and 2016, a total of 25 shoulders with MRCTs underwent a procedure with an ADM. Pre- and postoperative visual analog scale (VAS) results, American Shoulder and Elbow Surgeons (ASES) score, Hamada grade, and Goutallier classification were reviewed. A postoperative magnetic resonance imaging (MRI) was obtained in 22 (88%) shoulders. The status of the graft was divided into the following categories: type I, intact graft; type II, graft tear with tuberosity covered; and type III, graft tear with tuberosity uncovered (bare).Results:The mean patient age was 61 years (range, 49-73 years), and the mean follow-up was 25.6 months (range, 10-80 months). Mean length from surgery to postoperative MRI was 13.9 months (range, 6-80 months). The graft was torn in 59% (13/22 shoulders). Significant improvements were found in VAS and ASES scores (7 vs 0.7 and 32.6 vs 91.2, respectively; P < .01) for type I grafts and in VAS and ASES scores (8.1 vs 1.3 and 26.3 vs 84.6, respectively; P < .01) for type II grafts. No difference was found in postoperative VAS and ASES (0.7 vs 1.3 and 91.2 vs 84.6, respectively; P = .8) between type I and type II grafts. No improvement was seen in VAS (7.3 vs 5.7; P = .2) or ASES (30.6 vs 37.2; P = .5) for type III grafts.Conclusion:MRI appearance of the graft has a significant impact on functional outcomes. Patients with an intact graft or a graft tear leaving the tuberosity covered have lower pain and higher functional scores than those in whom the torn graft leaves the tuberosity uncovered.

scholarly journals Types of Lens Structure in Intumescent Cataract

2018 ◽  
Vol 15 (2S) ◽  
pp. 153-159
Author(s):  
E. S. Pirogova ◽  
O. L. Fabrikantov ◽  
S. I. Nikolashin
Keyword(s):  
Irrigation System ◽  
Anterior Segment ◽  
Type I ◽  
Type Ii ◽  
Large White ◽  
Type Iii ◽  
Associated Diseases ◽  
Type Iv ◽  
The Mean ◽  
Anatomical Parameters

Purpose: to study the structure of the swelling lens, the dependence of its anatomical parameters on the nucleus sizes and density, patients’ age.Patients and methods. 52 patients with intumescent mature cataract were examined. All patients underwent phacoemulsification with a two-stage continuous circular capsulorhexis. After the 2–2.5 mm capsulorhexis had been created, the liquid lenticular masses were removed from the anterior and posterior lens compartment with the aspiration/irrigation system. Visually we determined the size of the nucleus, its color and density according to Buratto’s classification.Results. When performing this work 4 types of the swelling lens structure were revealed. Type I — a small emerging white nucleus with large amount of liquid lenticular masses in the anterior and posterior lens compartment, II degree of density according to Buratto’s classification. The mean age was 49.09 ± 3.19 years old. The related ophthalmic diseases accounted for 36.4%. Type II — a large white nucleus with the presence of liquefied lenticular masses in the anterior and posterior lens compartment. III degree of density according to Buratto’s classification. The mean age was 71.00 ± 1.92 years old. Associated diseases — 84.6%. Type III — a large brown nucleus with the presence of liquefied lenticular masses in the anterior and posterior lens compartment. IV degree of density according to Buratto’s classification. The mean age was 75.84 ± 1.46 years old. Associated diseases — 100%. Type IV — a small, very dense, brown nucleus with liquid lenticular masses. V degree of density according to Buratto’s classification. The mean age was 77.33 ± 2.49 years old. Associated diseases — 100%.Conclusion. 4 types of lens structure in intumescent cataract were described depending on the nucleus size, density, the amount of the lenticular masses. By means of UBM method, it was shown that intumescent cataract is accompanied with the alterations of the ocular anterior segment parameters, which depend on the type of lens structure. It was revealed that the types of swelling lens structure are directly connected to the patients’ age: mean age of patients with type I — 49.09 ± 3.19 years old, with type II — 71.00 ± 1.92, with type III — 75.84 ± 1.46, with type IV — 77.33 ± 2.49 years old. 

scholarly journals Atelocollagen Injection Improves Tendon Integrity in Partial-Thickness Rotator Cuff Tears: A Prospective Comparative Study

2020 ◽  
Vol 8 (2) ◽  
pp. 232596712090401
Author(s):  
Jong-Ho Kim ◽  
Dong-Jin Kim ◽  
Hyo-Jin Lee ◽  
Baek-Kyu Kim ◽  
Yang-Soo Kim
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tears ◽  
Type I ◽  
Pain Scores ◽  
Partial Thickness ◽  
Functional Scores ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background: Ongoing controversy surrounds the best treatment modality for partial-thickness rotator cuff tears. Purpose: To investigate the effects of atelocollagen injection in patients with small, symptomatic, intratendinous rotator cuff tears. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: From January 2014 to December 2017, 94 patients who had small, symptomatic, intratendinous rotator cuff tears were enrolled and randomly allocated to 1 of 3 groups: intratendinous injection with 0.5 mL of type I atelocollagen (group 1, n = 32), intratendinous injection with 1 mL of type I atelocollagen (group 2, n = 30), and no injection of type I atelocollagen (group 3, n = 32). American Shoulder and Elbow Surgeons score, Constant Shoulder Score, visual analog scale pain score, and range of motion were evaluated before injection; at 3, 6, and 12 months after injection; and at final follow-up. Magnetic resonance imaging (MRI) was performed at least 6 months after injection to evaluate rotator cuff integrity. Results: Demographic data did not differ significantly among the 3 groups before injection ( P > .05). The mean follow-up period was 24.7 months. The functional and pain scores in groups 1 and 2 were significantly improved at final follow-up ( P < .05). No significant improvement was seen in functional or pain scores at final follow-up in group 3 ( P > .05). Groups 1 and 2 had significantly better functional scores compared with group 3 at final follow-up ( P < .05). The proportion of patients with a decrease in size of the torn tendon on follow-up MRI at least 6 months after atelocollagen injection was significantly higher in group 1 (28.1%; P = .02) and group 2 (36.7%; P = .003) compared with group 3 (6.3%). Conclusion: Atelocollagen injection can improve the functional outcome and integrity of the tendon in intratendinous rotator cuff tears.

The development of lampbrush chromosome-type transcription in the early diplotene oocytes of Xenopus laevis: an electron-microscope analysis

1980 ◽  
Vol 44 (1) ◽  
pp. 87-101
Author(s):  
R.S. Hill ◽  
H.C. Macgregor
Keyword(s):  
Linear Regression ◽  
Xenopus Laevis ◽  
Linear Regression Analysis ◽  
Transcription Unit ◽  
Type I ◽  
Type Ii ◽  
Type Iii ◽  
Significant Difference ◽  
Germinal Vesicles ◽  
The Mean

Oocytes of Xenopus laevis in pachytene and early diplotene of meiosis have been studied using the Miller spreading technique. Transcription first appears in germinal vesicles 25–40 micrometers in diameter, when the oocyte is in early diplotene. Transcription at this stage consists of arrays of short RNP transcripts, irregularly distributed along the DNP axis. Linear regression analysis has shown that many of these arrays are transcription units (Type I) with the transcripts having a common point of origin. The lengths of these early transcription units (mean = 7.06 +/− 5.06 micrometers), calculated from the linear regression data, are comparable to the lengths of transcription units from later stages, including Dumont stage 3. The polymerase granules of Type I transcription units are widely and irregularly spaced, having a mean spacing of 505 +/− 748 nm. More advanced transcription units (Type II, mean length = 8.72 +/− 3.77 micrometer) are usually found in the same chromosome set as the Type I units. Type II transcription units have closer and more regularly spaced polymerase granules than Type I transcription units (mean spacing = 92 +/− 49 nm). Both Type I and II transcription units have comparatively short RNP transcripts, the mean values for the slopes of their regression lines being 0.1336 and 0.1440 respectively. By the time the germinal vesicles are about 50–60 micrometers in diameter the transcription units have a quite different morphology (Type III). The lengths of the Type III transcription units are comparable to the Type I and II units, the mean length being 6.34 +/− 4.03 micrometers. The spacing of the polymerase granules in the Type III units is closer and more regular than the earlier stages (70 +/− 40 nm). Another significant difference between Type III and Types I and II transcription units is a decrease in the foreshortening of the Type III RNP transcripts. The mean slope of the regression lines for Type III transcription units is 0.2439. The morphological appearance of the Type III transcription unit is virtually identical to that of the transcription units from Dumont stage 3 oocytes, both with respect to the length and the spacing of the polymerase granules. However, the transcripts in Type III transcription units are still more foreshortened than those of Dumont stage 3 oocytes, having mean regression slopes of 0.4728. From the data obtained in the present study, it has been concluded that the pattern of lampbrush-type transcription is virtually fully established by the time most germinal vesicles are about 50 micrometers in diameter.

A Long Preoperative Duration of Symptoms Is Associated With Worse Functional Outcomes After 1-Stage Arthroscopic Treatment of Rotator Cuff Tears With Shoulder Stiffness

2017 ◽  
Vol 45 (10) ◽  
pp. 2336-2344 ◽  
Author(s):  
Yuzhou Chen ◽  
Shiyi Chen ◽  
Yang Qiao ◽  
Yunshen Ge ◽  
Hong Li ◽  
...  
Keyword(s):  
Cohort Study ◽  
Rotator Cuff ◽  
Functional Outcomes ◽  
External Rotation ◽  
Arthroscopic Treatment ◽  
Rotator Cuff Tears ◽  
Duration Of Symptoms ◽  
Shoulder Stiffness ◽  
Functional Scores ◽  
The Mean

Background: Rotator cuff tears with shoulder stiffness remain a difficult issue. Despite the reported satisfactory results of 1-stage surgery, little information is available regarding the factors that affect clinical outcomes. Purpose/Hypothesis: To evaluate the 1-stage arthroscopic treatment of rotator cuff tears with shoulder stiffness and to present the influence of duration of symptoms (DOS) on postoperative functional outcomes. The hypothesis was that a long preoperative DOS is related to worse functional outcomes. Hypothesis: A long preoperative DOS is related to worse functional outcomes. Study Design: Cohort study; Level of evidence, 2. Methods: A cohort study was performed with consecutive patients who underwent 1-stage surgery between January 2012 and July 2014. Forty-four patients were enrolled in the long DOS group (DOS ≥6 months or LDOS), and 38 were enrolled in the short DOS group (DOS <6 months or SDOS). There were no significant differences in the other variables between the groups. The patients were followed for a mean of 33.8 months, and the functional and radiographic outcomes were compared. Results: Both groups achieved apparent functional postoperative improvements in terms of range of motion, pain, strength, and functional scores ( P < .001 for all). Despite the overall improvements, the patients in the SDOS group had significantly better outcomes according to all functional instruments. The mean postoperative abduction and external rotation at the side in the SDOS group were higher than in the LDOS group (abduction: 162.2° vs 152.8°, respectively [ P = .002]; external rotation: 64.7° vs 56.9°, respectively [ P = .004]). The mean postoperative functional scores in the SDOS group were all higher than in the LDOS group (American Shoulder and Elbow Surgeons [ASES] score: 91.1 vs 81.9, respectively; Constant-Murley score: 76.9 vs 71.8, respectively; Fudan University Shoulder Score [FUSS], 90.6 vs 81.1, respectively), and the mean postoperative visual analog scale (VAS) score for pain in the SDOS group was lower (0.7 vs 1.8, respectively) ( P < .001 for all). The difference in the retear rates was not significant, with 7 retears in the SDOS group and 4 in the LDOS group ( P = .216). Conclusion: One-stage surgery effectively achieved overall improvements. A preoperative DOS of ≥6 months led to poorer functional outcomes, which suggests that surgeons should propose a surgical treatment for this condition before symptoms persist for 6 months.

Functional outcomes of tympanoplasty surgery

2016 ◽  
Vol 70 (6) ◽  
pp. 12-19 ◽  
Author(s):  
Izabela Matuszewska ◽  
Paweł Burduk ◽  
Wojciech Kaźmierczak ◽  
Joanna Janiak-Kiszka
Keyword(s):  
Functional Outcomes ◽  
Pure Tone Audiometry ◽  
Type I ◽  
Type Ii ◽  
Hearing Improvement ◽  
Type Iii ◽  
Type Iv ◽  
Ossicular Replacement ◽  
The Mean ◽  
Replacement Prosthesis

Objective: We reviewed functional outcomes of tympanoplasty. Study design: The results of tympanoplastic surgery are changing in time. We present late treatment outcomes among different types of tympanoplasty. Methods: Eighty-six patients who underwent tympanoplasty were enrolled in the study. The results of pure tone audiometry performed 7 days before, then at 3 months, 1 year, and 3 years after the surgery were assessed. Type II tympanoplasty involved implantation of a partial ossicular replacement prosthesis and type III tympanoplasty involved reconstruction with a total ossicular replacement prosthesis and the use of autogenous homogenous material. Statistical analysis was performed. Results: With all four types of tympanoplasty, hearing improvement was achieved at 3 months and 1 year after surgery based on the magnitude of the mean ABG reduction (p<0.001). In patients who underwent type I, type III, and type IV tympanoplasty, the ABG reduction at 3 years after surgery was maintained at the level reported at 3 months and 1 year after surgery (p<0.001). In patients who underwent type II tympanoplasty, however, the mean ABG value was increased at all tested frequencies (p<0.05). The mean ABG values reported 3 years after type II and type III tympanoplasty were similar. Conclusions: Based on the results over time, hearing improvement seems to be less durable after reconstruction with the partial ossicular replacement prosthesis procedure compared to the total ossicular replacement prosthesis procedure.

scholarly journals THE GLENOID NOTCH AND ITS CLINICAL IMPLICATIONS. La muesca glenoidea y sus implicaciones clínicas.

2017 ◽  
Vol 9 (1) ◽  
pp. 11-17 ◽  
Author(s):  
Abduelmenem Alashkham ◽  
Abdulrahman Alraddadi ◽  
Roger Soames
Keyword(s):  
Multivariate Analysis ◽  
Shoulder Dislocation ◽  
Glenohumeral Joint ◽  
Clinical Implications ◽  
Type I ◽  
Type Ii ◽  
Glenoid Fossa ◽  
Type Iii ◽  
The Mean ◽  
Las Mujeres

A notch is often observed on the anterosuperior aspect of the glenoid fossa, however its association with gender remains unexplored. The aims of this study were to: (i) investigate the incidence and type of glenoid notch, and (ii) its association with gender, age and side. A total of 140 shoulders from 30 male and 40 female cadavers were examined. All muscles and blood vessels surrounding the glenohumeral joint, as well as the fibrous capsule, were removed to expose the glenoid fossa: the presence of a notch was classified as type I (mild), type II (moderate) or type III (severe). The mean age of specimens was 81.5 years (±9.8 years). A type III notch was the most commonly observed (32 male, 21 female specimens), followed by type I (14 male, 34 female specimens) and finally type II (14 male, 25 female specimens). Multivariate analysis showed that the type of glenoid notch was significantly associated with gender (?2 (2, n=140) = 11.088, p = 0.004). Females are significantly more likely to have a type I or II glenoid notch, while males are significantly more likely to have a type III notch. This difference could explain the higher incidence of shoulder dislocation in males compared to females.  A menudo se observa una muesca en el lado anterosuperior de la fosa glenoidea, sin embargo su relación con el sexo sigue siendo inexplorada. Los objetivos de este estudio fueron: (i) investigar la incidencia y el tipo de muesca glenoidea, y (ii) su relación con el sexo, la edad y el lado en el que se observa. Se examinaron un total de 140 hombros de entre 30 cadáveres masculinos y 40 femeninos. Todos los músculos y vasos sanguíneos que rodean la articulación glenohumeral, así como la cápsula fibrosa, fueron retirados para permitir el acceso a la fosa glenoidea: la presencia de la muesca fue clasificada como tipo I (leve), tipo II (moderado) o tipo III (grave). La edad media de los especímenes examinados fue de 81,5 años (± 9,8 años). La muesca de tipo III fue la más comúnmente observada (32 varones, 21 hembras), seguida por la muesca de tipo I (14 varones, 34 hembras) y finalmente seguida de la de tipo II (14 varones, 25 hembras). El análisis multivariado mostró que el tipo de muesca glenoidea está significativamente relacionado con el sexo (?2 (2, n = 140) = 11.088, p = 0.004). Las mujeres son significativamente más propensas a presentar una muesca glenoidea de tipo I o II, mientras que los varones son significativamente más propensos a presentar una muesca de tipo III. Esta diferencia podría explicar la mayor incidencia de luxación de hombro que se produce en los varones en comparación con la que se produce en las mujeres. 

Effort and the Forced Expiratory Volume in One Second (FEV1)

1970 ◽  
Vol 39 (6) ◽  
pp. 747-755 ◽  
Author(s):  
J. R. Kemm ◽  
P. L. Kamburoff
Keyword(s):  
Healthy Subjects ◽  
Forced Expiratory Volume ◽  
The Body ◽  
Type I ◽  
Type Ii ◽  
Type Iii ◽  
Significant Difference ◽  
Maximum Effort ◽  
The Mean ◽  
The Relationship

1. The relationship between volumes expired and the maximum intrathoracic pressures developed within the first second of expiration was examined in a group of healthy subjects and patients with airways obstruction who exhaled with varying degrees of effort. 2. The body plethysmographic method was used to ensure that expirations started from total lung capacity. 3. Three different types of volume-effort curves could be distinguished: Type I; in this the volume expired increased with greater effort. Type II; after a phase in which the volume expired increased with effort, a plateau was reached after which increasing effort made no difference to the volume expired. Type III; this resembles Type II except that instead of a plateau being established at maximum expired volume, increasing effort resulted in diminishing expired volume. Correction for the degree of compression of the intrathoracic gas failed to account for this phenomenon. Type III curves were found in healthy subjects as well as in patients. 4. In most cases the maximum Forced Expiratory Volume in 1 s (FEV1) was not found to coincide with the maximum oesophageal pressure (Poes), nor was there a significant difference between the mean and the maximum FEV1 produced with an effort greater than 75% of maximum. 5. Blowing ‘half as hard’ is an unnatural procedure; all subjects tend to blow nearly as hard as possible or very gently. In the latter case, the resulting FEV1 tracing is easily recognizable as technically unsatisfactory. 6. We conclude that for practical purposes, measurements of FEV1 depend for their reliability upon ensuring that they are started from full inspiration; insistence upon maximum effort is less important because FEV1 is independent of effort for the greater part of the effort range.

scholarly journals Effectiveness of stereotaxic radiosurgery for supratentorial cavernous malformations

2019 ◽  
Vol 21 (4) ◽  
pp. 29-38
Author(s):  
L. Ya. Kravets ◽  
S. N. Gryaznov ◽  
S. Ya. Kalinina ◽  
P. I. Ivanov
Keyword(s):  
Informed Consent ◽  
Conflict Of Interest ◽  
Size Reduction ◽  
Type I ◽  
Type Ii ◽  
Study Objective ◽  
Cavernous Malformations ◽  
Type Iii ◽  
Epileptic Syndromes ◽  
The Mean

The study objective is an objective assessment of the treatment outcome with a gamma knife radiosurgery (GKRS) in different types of supratentorial cavernous malformations on the basis of their sizes and clinical symptoms dynamic changes after the treatment.Materials and methods. GKRS outcomes in 145 patients with hemisphere cavernous malformations (58 male, 87 female, the mean age 43,3 ± 11,9) were analyzed by comparing the initial and control data in all the patients and the telephone interview of 91 (37 male, 54 female, the mean age being 42,2 ± 11,9) patients.Results. On the basis of the “CM size reduction” criterion the efficacy of GKRS in the first magnetic resonance imaging control was 70 %. It was comparable in type I and type II CMs (76,3 and 72,5 % accordingly), but it was evidently worse in type III CMs (p = 0,0032). Repeated hemorrhages were noted in 3 observations in deep type I CM. Totally, statistically evident dependence on CM size reduction (p = 0,0413) was obtained on the clinical efficacy criterion with initially developed symptoms, which in turn means does not prove its effectiveness in type III CMs. In epileptic syndromes accompanying CMs, the efficacy of GKRS was selective, and did not correlate with CM size reduction, but mostly depended on the genesis and course of epileptic seizures.Conclusion. GKRS appears to be a justified method of treatment for clinically compensated mobile patients with type I and type II CMs. The clinical effectiveness of GKRS in such patients is in no way inferior to open surgery and does not exceed the number of its complications. CM type III should be excluded from the objects of treatment by GKRS.Conflict of interest. The authors declare no conflict of interest.Informed consent. All patients gave written informed consent to participate in the study and for the publication of their data.

scholarly journals STUDY OF ACROMIAL MORPHOLOGY IN INDIAN POPULATION. Estudio de la morfología acromial en la población India

2016 ◽  
Vol 3 (2) ◽  
pp. 84-88
Author(s):  
Susmita Saha ◽  
Neelam Vasudeva ◽  
Shipra Paul ◽  
Virender Kumar Gautam
Keyword(s):  
Indian Population ◽  
Rotator Cuff Tears ◽  
Subacromial Impingement Syndrome ◽  
New Delhi ◽  
Type I ◽  
Type Ii ◽  
Posterior Angle ◽  
Maulana Azad Medical College ◽  
Type Iii ◽  
Medical College

Objetivos: El propósito del estudio era evaluar la morfología de acromion adulto en la población India y correlacionar su asociación con varias patologías del hombro. Materiales y métodos: La evaluación morfológica fue realizada en 200 omóplatos secos adultos obtenidos del museo de osteología del Departamento de Anatomía, Maulana Azad Medical College, Nueva Delhi. Se calculó la altura del arco acromial, ángulo anterior y posterior del arco y su índice, usando el método objetivo de Getz et al  (1996) para demarcar forma acromial. La presencia o la ausencia de entesofitos fue observada en la superficie inferior de la cara anterior del acromion. Resultados: 28% de los omóplatos fueron el acromion de tipo I, 67% fueron el tipo II y el 5% fueron el tipoIII. La presencia de entesofitos en la superficie inferior de la cara anterior del acromion también fue estudiada; los enthesofitos fueron observados en 3.5% en el tipo acromial I, 15.67% en el tipo II y el 40% en el proceso acromial de tipoIII. Conclusiones: La asociación entre el síndrome subacromial de compresión y el tipo acromial está bien establecida. Les asistirá a los clínicos para decidir la modalidad del tratamiento: conservador o quirúrgico. Se debe tener en cuenta la asociación de entesofitos subacromiales con la morfología acromial y los desgarros del manguito rotador al interpretar opacidades en las radiografías.  Objectives: The purpose of the study was to asses the morphology of adult acromion  processes in Indian population and correlate its association with various shoulder pathologies. Materials and methods: Morphologic evaluation was conducted on 200 adult dry scapulae obtained from osteology museum of Department of Anatomy, Maulana Azad Medical College, New Delhi. The height of the acromial arch, anterior and posterior angle of arch and their ratio were measured by using objective method of Getz et al (1996) for determining acromial shape. Presence or absence of enthesophyte was noted on the undersurface of the anterior aspect of the acromion process. Results: 28% scapulae exhibited type I acromion, 67% exhibited type II and 5% exhibited type III. The presence of enthesophytes on the anterior undersurface of the acromion was also studied; enthesophytes were observed in 3.5% in type I acromion, 15.67% in type II and 40% in type III acromion process. Conclusions: Association between subacromial impingement syndrome and acromial type is well established. This will assist the clinicians in deciding the modality of treatment: conservative or operative. Association of subacromial enthesophytes with acromial morphology and rotator cuff tears should be borne in mind when interpreting opacities on radiographs.

Phalangeal Neck Fractures in Adults

2006 ◽  
Vol 31 (5) ◽  
pp. 484-488 ◽  
Author(s):  
M. M. AL-QATTAN
Keyword(s):  
Proximal Phalanx ◽  
Proximal Fragment ◽  
Type I ◽  
Distal Fragment ◽  
Type Ii ◽  
Middle Phalanx ◽  
Bone Contact ◽  
Pattern Of Injury ◽  
Wire Fixation ◽  
The Mean

The author investigated the pattern of injury and outcome of management in 11 adults with phalangeal neck fractures. The mean age was 40 years. The fracture occurred at the neck of the proximal phalanx of the thumb in seven cases and at the neck of the middle phalanx of the fingers in the remaining four cases. One patient had an undisplaced (Type I) fracture and was treated with splinting; the final result was graded as excellent. Nine patients had Type II fractures (the displaced distal fragment maintaining bone-to-bone contact with the proximal fragment) and all patients were treated with closed reduction and single K-wire fixation. The final outcome of Type II fractures was considered good in eight patients and fair in one patient. One patient had a Type III fracture (the displaced distal fragment was rotated 180° with no bone-to-bone contact with the proximal fragment). The fracture required open reduction and K-wire fixation and the final result was poor.

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