Sempre el tractament no Q d'entrada ha sigut el que hem utilitzat

Treatment of non-traumatic rotator cuff tears: A RANDOMISED CONTROLLED TRIAL WITH ONE-YEAR CLINICAL RESULTS..The Journal of Bone and Joint Surgery,69 B; pág. 75-81DOI: 10.1302/0301-620X.96B1.32168Kukkonen, J.; Joukainen, A.; Lehtinen, J.; Mattila, K. T.; Tuominen, E. K. J.; Kauko, T.; Aarimaa, V.

AB : We have compared three different methods of treating symptomatic non-traumatic tears of the supraspinatus tendon in patients above 55 years of age. A total of 180 shoulders (173 patients) with supraspinatus tendon tears were randomly allocated into one of three groups (each of 60 shoulders); physiotherapy (group 1), acromioplasty and physiotherapy (group 2) and rotator cuff repair, acromioplasty and physiotherapy (group 3). The Constant score was assessed and followed up by an independent observer pre-operatively and at three, six and twelve months after the intervention. Of these, 167 shoulders were available for assessment at one year (follow-up rate of 92.8%). There were 55 shoulders in group 1 (24 in males and 31 in females, mean age 65 years (55 to 79)), 57 in group 2 (29 male and 28 female, mean age 65 years (55 to 79)) and 55 shoulders in group 3 (26 male and 29 female, mean age 65 years (55 to 81)). There were no between-group differences in the Constant score at final follow-up: 74.1 (sd 14.2), 77.2 (sd 13.0) and 77.9 (sd 12.1) in groups 1, 2 and 3, respectively (p = 0.34). The mean change in the Constant score was 17.0, 17.5, and 19.8, respectively (p = 0.34). These results suggest that at one-year follow-up, operative treatment is no better than conservative treatment with regard to non-traumatic supraspinatus tears, and that conservative treatment should be considered as the primary method of treatment for this condition.

CLAVICLE FRACTURE treatment and repair - Everything You Need To Know - ...

La pròtesi de tija enforrellada

En el cas de les Hemiartroplàsties per fractures en gent gran la tija protetica enforrellada ( Medcomtech i Acumed ) pot ser de utilitat i possiblement un standard en el futur.

    

Medcomtech / te tijes de 8-10-12 mm de diàmetre i molta versatilitat hemi-inversa bilboquet... mentre que 

Acumed te tijes en diametres de 7 a 15 mm i llargada estandard de 130 mm amb opcio llarga de 200 1 230 mm en 8 mm de diàmetre que la fa util en situacions complexes.  

Informes C de la CV

Informes clinics per Op i postop a la CV : Fets

Al final els millors resultats motiu de tract quirurgic de les fractures de clavícula

Open Reduction and Plate Fixation Versus Nonoperative Treatment for Displaced Midshaft Clavicular Fractures: A Multicenter, Randomized, Controlled Trial

C.M. Robinson, et alt.

J Bone Joint Surg Am, 2013 Sep 4;95(17):1576-1584. doi: 10.2106/JBJS.L.00307

Acute proximal humeral fractures. Hemi vs RSA

Functional outcomes of reverse shoulder arthroplasty compared with hemiarthroplasty for acute proximal humeral fractures 

Matthew J. Boyle, MBChB, Department of Orthopaedic Surgery, Auckland City Hospital. NZ

Journal of Shoulder and Elbow Surgery
Volume 22, Issue 1 , Pages 32-37, January 2013

ConclusionsPatients with acute proximal humeral fractures who undergo RSA appear to achieve superior 5-year functional outcomes compared with patients who undergo hemiarthroplasty.

Sembla que tothom ho te força clar la superioritat de la RSA versus hemi en fractures en gent gran o molt gran. Quina es la edat-funció limits per aquest tractament?

Hemiarthroplasty for Humeral Four-part

Hemiarthroplasty for Humeral Four-part Fractures for Patients 65 Years and Older: A Randomized Controlled Trial 
Harm W. Boons MD, 

No differences could be found in Constant and Simple Shoulder Test scores at three and twelve months. Patients who had nonoperative treatment had better abduction strength at three and twelve months and worse pain scores at three months.There was no clear benefit in association with the use of hemiarthroplasty as compared with nonoperative treatment for patients over the age of sixty-five years with four-part proximal humeral fractures.

 

Aixo pot ser nou i cal veure com han dissenyat el treball ( Diuen Level I terapeutic). De tota manera una funcio limitada amb poques molesties es la norma en moltes fractures desplaçades del cap. Calen mes treballs...