INTRODUCTION: In a comparative study, mid-term findings after posttraumatic and degenerative hemi-prosthetic shoulder joint replacement were analyzed and compared with current reports in the literature. METHODS: The patient sample in the retrospective study consisted of 20 patients with proximal fractures of the humeral head (x = 64 years) and 6 patients (x = 61 years) with degenerative shoulder joint disease. In 14 patients the humeral head was replaced as a primary procedure at < 4 weeks after the trauma and in 6 patients as a secondary treatment at > 4 weeks. The follow-up period was 38-41 months on average. Evaluation was based on the Constant Score, subjective assessment by the patient, and conventional radiographs. RESULTS: After posttraumatic shoulder replacement, the patients achieved a Constant Score of 65 (+/- 19) and after degenerative replacement 74 (+/- 34) points. In the posttraumatic group, the Constant Score after primary implantation was better than after secondary implantation (68 +/- 16 versus 59 +/- 15 points). After posttraumatic replacement, the only improvement over time was in pain levels (p < 0.05). 92% of all patients were satisfied with the result and would accept the same treatment again. Radiologically, a clinical correlate could be found for the arrosions at the acromion and occasionally for the secondary upwards displacement of the humerus. The results correlated well with data from the literature. CONCLUSIONS: For posttraumatic conditions, hemiarthroplasty led to better results within four weeks and seemed to be a suitable alternative to other procedures, especially in older patients. Patients with primary osteoarthritis and idiopathic humeral head necrosis can expect good to excellent results after hemiarthroplasty. In both groups, the overall results depend mainly upon patient compliance and the state of the rotator cuff.

Aged↗

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Achieving cost-effective practice in a prepaid plan.

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Cost-Benefit Analysis↗

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[Oxygen transport economy and circulatory capacity in relation to blood pressure in middle aged men].

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Adult↗

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Comparison of a stiff and a spring-type ankle-foot orthosis to improve gait in spastic hemiplegic children.

The effect of two different types of functional ankle-foot orthosis on the gait of patients with spastic hemiplegia was studied. A gap was cut into the conventional stiff orthosis to allow a limited dorsiflexion of 10-15 degrees, while plantarflexion was blocked (spring type). This gap was bridged by an aluminum bar to stiffen the orthosis for the experiment. Fourteen patients of different ages (6.5-20.1 years) walked barefoot and with the orthosis, once springy and once stiff. Kinetics and kinematics were analyzed. Gait was significantly improved into normal pattern by using any type of ankle-foot orthosis. While walking barefoot with a toe-heel-toe gait, the physiological heel-toe gait was restored with any type of orthosis. The spring type of orthosis was significantly superior to the stiff orthosis. This was most clearly expressed in the general parameters of gait-like cadence, velocity, and step length. Kinetic data gave a significant improvement by using any ankle-foot orthosis. Whereas break force was similar with both types, push-off was further improved with the spring type. Kinematics revealed little statistical difference between the two types, although gait was more dynamic and physiological with the spring type of orthosis. Any functional ankle-foot orthosis ameliorates the gait pattern in patients with spastic hemiplegia, but a spring type of orthosis renders the gait more dynamic and best corrects the pathology of gait.

Adolescent↗