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Purpose: The current indication for comminuted radial head fractures is radial head arthroplasty (RHA). The main purpose of this study was to investigate any statistical differences in terms of prosthesis revision or removal and radiographic degenerative changes by comparing patients who underwent RHA and ligaments repair to those who underwent only RHA implant at minimum two years follow-up. The secondary aim was to delineate a trend profile of RHA implants. Methods: All patients who underwent RHA surgery for traumatic pathology between January 2012 and December 2017 were eligible. Two researchers independently and retrospectively reviewed the patients' charts and collected the following data: type of prosthesis, associated surgical procedures and revision surgery. They also looked for any radiographic sign of prosthesis loosening, overstuffing, capitellar osteopenia, heterotopic ossification and degenerative changes. No clinical evaluation was performed. Results: In 6 years, 124 RHA were implanted (74 female, 50 male, mean age 56). The main diagnoses were: terrible triad, trans-olecranon fracture and isolated radial head fracture. It was found no significant statistical difference between the 2 groups; nevertheless, the cohort of patients that underwent ligaments repair had a lower revision rate in comparison with the other. Suture of the annular ligament seems to be critical. The overall revision rate was 10.5%. Conclusion: This multi-center study found no evidence that ligaments repair, as an associated surgical procedure, improves RHA longevity, except for annular ligament. Nevertheless, it seems to prevent degenerative changes at midterm follow-up. [ABSTRACT FROM AUTHOR]

Despite the relatively common occurence of fractures of the proximal humerus in the elderly, the subgroup of isolated fractures of the greater and lesser tuberosity is still less well understood. Isolated tuberosity fractures are commonly associated with gleno-humeral dislocation or direct impact to the shoulder region. The diagnosis of greater tuberosity fracture is fairly commonly missed or ignored and this can result in an unaccettable treatment outcome. A standard radiographic trauma series of the shoulder must be obtained, including a true AP view in intrarotation and extrarotation. CT scans with coronal, sagittal and 3D reconstruction are useful for planning the surgical approach. Conservative treatment is recommended in non displaced and minimally displaced cases (5 mm in a high-demanding patient, 10 mm in a low-demanding patient). The treatment of displaced fractures includes both arthroscopically assisted fixation and open reduction and internal fixation with screws or tension banding sutures. The choice of approach depends not only on fracture type but also on patient-related factors and the surgeon’s experience. [ABSTRACT FROM AUTHOR]