The Constant score (CS) is one of the most frequently applied tools for the assessment of the shoulder joint. However, evaluation of strength is not standardized leading to potential bias when comparing different studies. Seventy-six patients with fractures of the proximal humerus undergoing open reduction and internal fixation (ORIF) were assessed using standardized CS strength measurements at the deltoid muscle insertion and at the wrist in three different arm positions. Variation coefficients were evaluated for each patient and position. Forty women (57%) and 36 men (43%) were examined 96 months in mean after ORIF. We could state a maximum of 105.3 N difference if measurements were performed at the wrist or the insertion of the deltoid muscle in 90° forward flexion on the injured arm (167.9 ± 83.1 N; 62.6 ± 29.4 N). The lowest variation coefficient of the three performed measurements could be stated at the deltoid muscle insertion in a 90° abduction position in the scapula plane (6.94 ± 5.5). Following our study results, different positions of force measurement can change the total CS by a whole category (e.g. “very good” to “good”). We recommend performing the measurement at the insertion of the deltoid muscle in a 90° abduction position in the scapula plane. Otherwise, even in the non-injured, it is hard to reach a “normal” shoulder function, based on the CS. When using the CS as outcome parameter, authors must give detailed information about the force measuring and use an exact measuring device.

The current study describes several surgical techniques for the treatment of the reverse Hill - Sachs lesion after posterior shoulder dislocation; we also aimed to present long term results followed for a minimum of five years. This study is a prospective case series of 17 patients who were treated in our clinic between 2008 and 2011. Patients with a defect size smaller than 25% of the articular surface were treated conservatively. An endoprosthesis of the glenohumeral joint was implanted in patients with a defect size bigger than 40%. All remaining patients were treated by a variety of operative techniques, depending on the quality of the bone and size of the defect. Twelve of seventeen patients had a defect size of the humeral articular surface between 25% and 40% with a mean age of 39 years. Depending on the defect size these patients were treated with retrograde chondral elevation, antegrade cylindrical graft or a graft of the iliac bone crest with an open approach. All the procedures showed fair results, e.g. the open approach with a graft of the iliac bone crest (2010: Dash 3.89, Constant 90.33, Rowe 86.67; 2015: Dash 2.22, Constant 92.00, Rowe 93.33). The open approach is not a disadvantage for the functional outcome. The treatment algorithm should involve the superficial size of the defect as well as the depth of the defect and the time interval between the dislocation and the surgical treatment. 223/2012BO2 , 02 August 2010.

Ankle fractures are frequently occurring injuries. Despite the relatively simple operative technique, patients often suffer from postoperative complications. Little is known about postoperative treatment of implant-associated infections of the ankle. Therefore, this study shows and evaluates a treatment algorithm in long- and short-term outcomes compared to infection-free patients. Data from patients of over 20 years of a level 1 trauma center and university hospital was retrospectively analyzed including age, gender, comorbidities, smoking status, fracture classification, number of revisions, length of in-patient stay due to fracture and infection, and results of microbiological specimen with the length of antibiotic treatment. Moreover, present long-term outcome was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, the Ankle Osteoarthritis Score, and the Short Form 36 score and compared to a matched-pair infection-free patient cohort. Forty-four patients could be retrospectively evaluated (51% male, 49% women, mean age 46 ± 17 years). Most of the cases were Weber B fractures (38%) following an in-patient stay from 51 ± 4.3 days after primary treatment and 77 ± 10.0 days after secondary treatment in our hospital. Microbiological specimen showed in 77% Staphylococcus aureus with following intravenous antibiotic treatment for 13.9 ± 3.1 days in mean. Common comorbidities/risk factors were cardiovascular disease (28%), smoking (15%), and diabetes (18%). Cure of infection and clinical and radiographic osseous consolidation could be documented for all cases. Patients with implant-associated infections had significantly more risk factors than infection-free patients (1.1/0.33; p = .02 per patient). The matched-pair group showed significantly better long-term outcome in mean regarding the Ankle Osteoarthritis Score (2.0 ± 1.2/13.9 ± 4.7) and AOFAS hindfoot score (96.7 ± 1.9/87.3 ± 3.4). Immediate revision surgery with aggressive debridement, microbiological diagnostics, antibiotic therapy, and use of a drain until osseous consolidation is reached with following removal of the implant in patients with implant-associated infections after ankle fracture and open reduction internal fixation lead to cure of infection and fair long-term outcome in all cases. Special care must be taken of risk factors like diabetes and smoking. 24/2008BO2

Joint Diseases and Related Surgery (JDRS), the official journal of the Turkish Joint Diseases Foundation, is an international, peer-reviewed, immediate open access journal. All published articles in JDRS has been free for everyone, without embargo, since 1990.

Zusammenfassung: Hintergrund Die Rotatorenmanschettenläsion gehört zu den am häufigsten therapierten Krankheitsbildern der arthroskopischen Schulterchirurgie. Neben verschiedenen operativen Techniken gibt es Unterschiede in der postoperativen Nachbehandlung. In dieser Anwendungsbeobachtung wurde die Funktionalität zweier Schulterorthesen (ADVAGOshoulder vs. Standardabduktionsverband) verglichen und das postoperative Behandlungsergebnis ermittelt. Patienten und Methodik 53 Patienten mit Rotatorenmanschettenläsion (n = 25 ADVAGOshoulder, n = 28 Standardabduktionsverband) wurden vor und nach operativer Versorgung anhand des DASH-Scores, modifizierten Constant-Scores sowie des Handlings und des Komforts der Orthese untersucht und befragt. Ergebnisse Die Orthese ADVAGOshoulder zeigte bessere Ergebnisse hinsichtlich Einschränkungen im Alltag, Schlafqualität und Bewegungseinschränkungen. Auch bewerteten die Patienten im Gegensatz zum Abduktionsverband dieses Hilfsmittel besser im Hinblick auf seinen Beitrag zum Heilungserfolg. Der Standardabduktionsverband wurde doppelt so häufig mit gut oder sehr gut bewertet im Hinblick auf den Heilungserfolg der Therapie. Bei der Auswertung der DASH-Fragebögen ergaben sich keine signifikanten Unterschiede zwischen beiden Gruppen. Schlussfolgerung Beide Schulterorthesen erwiesen sich als geeignete postoperative Hilfsmittel zur Ruhigstellung der operierten Schulter und trugen nach Einschätzung der Patienten zum Heilungserfolg bei. Die Orthese ADVAGOshoulder zeigte in unserer Studie Vorteile im Hinblick auf Bewegungseinschränkungen, Stabilitätsempfinden und Schlafqualität.