Background: The purpose of this study was to evaluate the role of medial support and clinical factors responsible on outcomes and major complications associated with treatment of unstable proximal humerus fractures using a locking plate and suture augmentation.Methods: Sixty-three cases in 62 patients (42 female, 20 male) were evaluated between September 2004 and October 2008. Cases were divided into either a medial support group (36 cases) or non-medial support group (27 cases). Clinical and radiographic evaluations included Neer’s evaluation criteria, the neck-shaft angle using the Paavolainen method, and complications. We analyzed the correlation between bone- and fracture- related complications and three independent clinical variables, such as the presence of medial support, fracture type, and osteoporosis by way of multivariate logistic regression.Results: There were statistically significant differences in the overall incidence of complications based on the presence of medial support (p = 0.014) and preoperative fracture type (p = 0.018), but no differences based on the presence of osteoporosis (p = 0.157). According to multivariate logistic regression analysis, the restoration of medial support was the most reliable factor to prevent bone- and fracture- related complications. In addition, when we compared the incidence of bone- and fracture-related complications in the presence or absence of medial support among 30 patients with osteoporosis, the group with restoration of medial support had only one complication of humeral head osteonecrosis despite the presence of osteoporosis (5.9% vs. 46.2%, p = 0.025). According to Neer’s criteria, excellent or satisfactory clinical results accounted for seventy-three percent of the total cases (46 of 63 cases). Seventy-eight percent (49 of 55 cases) showed good radiographic results by the Paavolainen method. There were 14 complications in 13 of 63 cases (20.6%).Conclusions: In the treatment of unstable proximal humerus fractures with locking plate technology and suture augmentation, we suggest that obtaining medial support is an important factor in preventing major bone- and fracture-related postoperative complications such as reduction loss or nonunion.

Chung JY, et al. Asian Spine J. 2016 Jun;10(3):582-592. http://dx.doi.org/10.4184/asj.2016.10.3.582

Background: There are two surgical approaches for distal soft-tissue procedures for the correction of hallux valgus—the dorsal first web-space approach, and the medial transarticular approach. The purpose of this study was to compare the outcomes achieved after use of either of these approaches combined with a distal chevron osteotomy in patients with moderate to severe hallux valgus. Methods: One hundred and twenty-two female patients (122 feet) who underwent a distal chevron osteotomy as part of a distal soft-tissue procedure for the treatment of symptomatic unilateral moderate to severe hallux valgus constituted the study cohort. The 122 feet were randomly divided into two groups: namely, a dorsal first web-space approach (group D; sixty feet) and a medial transarticular approach (group M; sixty-two feet). The clinical and radiographic results of the two groups were compared at a mean follow-up time of thirty-eight months. Results: The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot scale hallux metatarsophalangeal-interphalangeal scores improved from a mean and standard deviation of 55.5 ± 12.8 points preoperatively to 93.5 ± 6.3 points at the final follow-up in group D and from 54.9 ± 12.6 points preoperatively to 93.6 ± 6.2 points at the final follow-up in group M. The mean hallux valgus angle in groups D and M was reduced from 32.2° ± 6.3° and 33.1° ± 8.4° preoperatively to 10.5° ± 5.5° and 9.9° ± 5.5°, respectively, at the time of final follow-up. The mean first intermetatarsal angle in groups D and M was reduced from 15.0° ± 2.8° and 15.3° ± 2.7° preoperatively to 6.5° ± 2.2° and 6.3° ± 2.4°, respectively, at the final follow-up. The clinical and radiographic outcomes were not significantly different between the two groups. Conclusions: The final clinical and radiographic outcomes between the two approaches for distal soft-tissue procedures were comparable and equally successful. Accordingly, the results of this study suggest that the medial transarticular approach is an effective and reliable means of lateral soft-tissue release compared with the dorsal first web-space approach. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.