Dany El-Najjar, Apoorva Mehta, Caroline Taber, Puneet Gupta, Joel R Peterson, Brandon Rogalski, Charles M Jobin, David P Trofa
Background: Although functional outcomes of total elbow arthroplasty (TEA) for distal humerus fractures are satisfactory, there is a high rate of complications. This study aims to characterize the 30-day complications, readmissions, and mortality of patients with TEA for distal humerus fractures in a large registry database.
Methods: Patients who underwent TEA for a distal humerus fracture were identified from the 2015 to 2020 ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Program) database. Baseline demographics, clinical characteristics, and complications including deep vein thrombosis/pulmonary embolus, infection, mortality, readmissions, and reoperations were recorded. Overall, 134 patients (mean age, 73.6 years; mean body mass index, 28.9 kg/m2 ; 88.8% females) were included.
Results: The total complication rate was 21.6% (n=29). The most common complications were unplanned readmission (6.0%), postoperative transfusion (5.2%), unplanned reoperation (3.0%), wound disruption (2.2%), and urinary tract infection (1.5%). The composite infection rate was 3.7%. There were no 30-day events of mortality, sepsis, or cerebral vascular accident. Patients 80 years or older had higher but not significant rates of unplanned readmission (10.2% vs. 3.5%, P=0.116) and reoperation (6.1% vs. 1.2%, P=0.105).
Conclusions: TEA for distal humerus fracture analyzed over 5 years had high rates of 30-day postoperative complications (21.6%), with unplanned readmission, reoperation, and infection being the most common. Level of evidence: IV.
背景:尽管全肘关节置换术(TEA)治疗肱骨远端骨折的功能效果令人满意,但并发症的发生率很高。本研究旨在通过大型登记数据库了解肱骨远端骨折 TEA 患者的 30 天并发症、再入院率和死亡率:从2015年至2020年的ACS-NSQIP(美国外科学院国家外科质量改进计划)数据库中确定了因肱骨远端骨折接受TEA治疗的患者。记录了基线人口统计学、临床特征和并发症,包括深静脉血栓/肺栓塞、感染、死亡率、再入院和再手术。共纳入 134 名患者(平均年龄 73.6 岁;平均体重指数 28.9 kg/m2;88.8% 为女性):结果:总并发症发生率为 21.6%(n=29)。最常见的并发症是计划外再入院(6.0%)、术后输血(5.2%)、计划外再次手术(3.0%)、伤口破坏(2.2%)和尿路感染(1.5%)。综合感染率为 3.7%。30 天内没有发生死亡、败血症或脑血管意外。80岁或以上患者的意外再入院率(10.2% vs. 3.5%,P=0.116)和再次手术率(6.1% vs. 1.2%,P=0.105)较高,但无显著性差异:肱骨远端骨折TEA术后30天并发症发生率较高(21.6%),其中最常见的是计划外再入院、再次手术和感染。证据级别:IV级。
{"title":"Descriptive analysis of total elbow arthroplasty for distal humerus fractures: 30-day complications.","authors":"Dany El-Najjar, Apoorva Mehta, Caroline Taber, Puneet Gupta, Joel R Peterson, Brandon Rogalski, Charles M Jobin, David P Trofa","doi":"10.5397/cise.2024.00500","DOIUrl":"10.5397/cise.2024.00500","url":null,"abstract":"<p><strong>Background: </strong>Although functional outcomes of total elbow arthroplasty (TEA) for distal humerus fractures are satisfactory, there is a high rate of complications. This study aims to characterize the 30-day complications, readmissions, and mortality of patients with TEA for distal humerus fractures in a large registry database.</p><p><strong>Methods: </strong>Patients who underwent TEA for a distal humerus fracture were identified from the 2015 to 2020 ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Program) database. Baseline demographics, clinical characteristics, and complications including deep vein thrombosis/pulmonary embolus, infection, mortality, readmissions, and reoperations were recorded. Overall, 134 patients (mean age, 73.6 years; mean body mass index, 28.9 kg/m2 ; 88.8% females) were included.</p><p><strong>Results: </strong>The total complication rate was 21.6% (n=29). The most common complications were unplanned readmission (6.0%), postoperative transfusion (5.2%), unplanned reoperation (3.0%), wound disruption (2.2%), and urinary tract infection (1.5%). The composite infection rate was 3.7%. There were no 30-day events of mortality, sepsis, or cerebral vascular accident. Patients 80 years or older had higher but not significant rates of unplanned readmission (10.2% vs. 3.5%, P=0.116) and reoperation (6.1% vs. 1.2%, P=0.105).</p><p><strong>Conclusions: </strong>TEA for distal humerus fracture analyzed over 5 years had high rates of 30-day postoperative complications (21.6%), with unplanned readmission, reoperation, and infection being the most common. Level of evidence: IV.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Su Cheol Kim, Seung Jin Yoo, Je Hyeong Jo, Jong Hyun Lee, Eugene Baek, Sang Min Lee, Jae Chul Yoo
Background: Aimed to report the prevalence and predisposing factors affecting subscapularis muscle atrophy and fatty infiltration (MAFI) in patients without a subscapularis tear, and to analyze the effect of this condition on surgical outcomes.
Methods: Between 2020 and 2022, 153 patients (mean age 58.1 ± 10.2 years; 84 men and 69 women) who underwent repair of posterosuperior cuff tears, with no subscapularis tears identified during arthroscopy were retrospectively analyzed. Baseline characteristics, preoperative and follow-up (6 months) magnetic resonance imaging findings, arthroscopic findings, and clinical outcomes (>1 year) were recorded.
Results: The prevalence of subscapularis MAFI (Goutallier grade 1 or 2) was 73.9% (113/153), of which the prevalence of Goutallier grade 2 was 23.5% (36/153). From multivariable logistic regression analysis, female sex (odds ratio [OR], 5.6; 95% CI, 1.7-18.6; P=0.005), older age (OR, 1.1; 95% CI, 1.0-1.1; P=0.052), advanced supraspinatus MAFI by Goutallier grade (OR, 3.2; 95% CI, 1.5-6.9; P=0.004), and synovitis (OR, 2.8; 95% CI, 1.1-7.9; P=0.030) were identified as independent predisposing factors for subscapularis MAFI. However, patients with preoperative subscapularis MAFI exhibited similar final range of motion, pain and function, and belly press strength compared to those without preoperative subscapularis MAFI.
Conclusions: Subscapularis MAFI is frequently observed conditions even in the absence of subscapularis tears, and this condition could be affected by supraspinatus MAFI, female sex, older age, and synovitis. However, because subscapularis MAFI does not affect the surgical outcome, surgeons need not be concerned about this condition when repairing posterosuperior rotator cuff tear. Level of evidence: IV.
{"title":"The impact of supraspinatus tear on subscapularis muscle atrophy and fatty infiltration.","authors":"Su Cheol Kim, Seung Jin Yoo, Je Hyeong Jo, Jong Hyun Lee, Eugene Baek, Sang Min Lee, Jae Chul Yoo","doi":"10.5397/cise.2024.00521","DOIUrl":"10.5397/cise.2024.00521","url":null,"abstract":"<p><strong>Background: </strong>Aimed to report the prevalence and predisposing factors affecting subscapularis muscle atrophy and fatty infiltration (MAFI) in patients without a subscapularis tear, and to analyze the effect of this condition on surgical outcomes.</p><p><strong>Methods: </strong>Between 2020 and 2022, 153 patients (mean age 58.1 ± 10.2 years; 84 men and 69 women) who underwent repair of posterosuperior cuff tears, with no subscapularis tears identified during arthroscopy were retrospectively analyzed. Baseline characteristics, preoperative and follow-up (6 months) magnetic resonance imaging findings, arthroscopic findings, and clinical outcomes (>1 year) were recorded.</p><p><strong>Results: </strong>The prevalence of subscapularis MAFI (Goutallier grade 1 or 2) was 73.9% (113/153), of which the prevalence of Goutallier grade 2 was 23.5% (36/153). From multivariable logistic regression analysis, female sex (odds ratio [OR], 5.6; 95% CI, 1.7-18.6; P=0.005), older age (OR, 1.1; 95% CI, 1.0-1.1; P=0.052), advanced supraspinatus MAFI by Goutallier grade (OR, 3.2; 95% CI, 1.5-6.9; P=0.004), and synovitis (OR, 2.8; 95% CI, 1.1-7.9; P=0.030) were identified as independent predisposing factors for subscapularis MAFI. However, patients with preoperative subscapularis MAFI exhibited similar final range of motion, pain and function, and belly press strength compared to those without preoperative subscapularis MAFI.</p><p><strong>Conclusions: </strong>Subscapularis MAFI is frequently observed conditions even in the absence of subscapularis tears, and this condition could be affected by supraspinatus MAFI, female sex, older age, and synovitis. However, because subscapularis MAFI does not affect the surgical outcome, surgeons need not be concerned about this condition when repairing posterosuperior rotator cuff tear. Level of evidence: IV.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Keegan M Hones, Caroline T Gutowski, Taylor R Rakauskas, Victoria E Bindi, Trevor Simcox, Jonathan O Wright, Bradley S Schoch, Thomas W Wright, Jean-David Werthel, Joseph J King, Kevin A Hao
Background: To compare clinical outcomes following lateralized reverse shoulder arthroplasty (RSA) versus RSA with latissimus dorsi transfer (LDT) in patients with poor preoperative active external rotation (ER).
Methods: We performed a systematic review per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We queried PubMed/Medline, Embase, Web of Science, and Cochrane databases to identify articles reporting clinical outcomes of RSA with LDT or lateralized RSA alone performed in patients with preoperative ER ≤0°. Our primary outcomes were active ER, active forward elevation (FE), Constant score, and the incidence of complications.
Results: We included 12 RSA with LDT studies with 188 shoulders and 4 lateralized RSA without transfer studies with 250 shoulders. Mean preoperative ER in RSA with LDT was -14°, while mean preoperative ER in lateralized RSA alone was -11°. Lateralized RSA alone was associated with superior postoperative ER (28° vs. 22°, P=0.010) and Constant score (69 vs. 65, P=0.014), but similar postoperative FE (P=0.590). Pre- to postoperative improvement in ER and FE was similar between cohorts. RSA with LDT had a higher incidence of nerve-related complications (2.1% vs. 0%) and dislocation (2.8% vs. 0.8%) compared to lateralized RSA alone.
Conclusions: Both RSA with LDT and lateralized RSA are reliable options to restore ER in patients with significantly limited preoperative ER. Our analysis suggests that lateralized RSA alone is superior to RSA with LDT in patients with either a medialized or lateralized implant design and confers a lower risk of complications, particularly nerve injury and dislocation. However, the addition of an LDT may still be indicated in certain patient populations with very severe ER loss. Level of Evidence: IV.
背景:目的:比较对术前主动外旋(ER)功能差的患者进行侧位反向肩关节置换术(RSA)与背阔肌转移术(LDT)后的临床效果:我们根据《系统综述和荟萃分析首选报告项目》(Preferred Reporting Items for Systematic Reviews and Meta-Analyses,PRISMA)指南进行了系统综述。我们查询了 PubMed/Medline、Embase、Web of Science 和 Cochrane 数据库,以确定报道术前 ER ≤0° 的患者接受 RSA 加 LDT 或单独侧向 RSA 的临床结果的文章。我们的主要结果是活动ER、活动前抬高(FE)、Constant评分和并发症的发生率:我们纳入了12项带LDT的RSA研究,共188个肩关节;以及4项无转移的侧位RSA研究,共250个肩关节。带LDT的RSA术前平均ER为-14°,而单纯侧位RSA术前平均ER为-11°。单纯侧位 RSA 术后 ER(28° vs. 22°,P=0.010)和 Constant 评分(69 vs. 65,P=0.014)更优,但术后 FE 相似(P=0.590)。各组患者术前至术后ER和FE的改善情况相似。与单侧RSA相比,带LDT的RSA发生神经相关并发症(2.1%对0%)和脱位(2.8%对0.8%)的几率更高:结论:对于术前ER明显受限的患者,带LDT的RSA和侧位RSA都是恢复ER的可靠选择。我们的分析表明,对于采用内侧化或外侧化植入物设计的患者,单纯外侧化RSA优于外侧化LDT RSA,并发症风险较低,尤其是神经损伤和脱位。然而,在某些ER缺失非常严重的患者群体中,可能仍然需要加用LDT。证据等级:IV级。
{"title":"Outcomes of lateralized reverse total shoulder arthroplasty versus latissimus dorsi transfer for external rotation deficit: a systematic review and meta-analysis.","authors":"Keegan M Hones, Caroline T Gutowski, Taylor R Rakauskas, Victoria E Bindi, Trevor Simcox, Jonathan O Wright, Bradley S Schoch, Thomas W Wright, Jean-David Werthel, Joseph J King, Kevin A Hao","doi":"10.5397/cise.2024.00304","DOIUrl":"10.5397/cise.2024.00304","url":null,"abstract":"<p><strong>Background: </strong>To compare clinical outcomes following lateralized reverse shoulder arthroplasty (RSA) versus RSA with latissimus dorsi transfer (LDT) in patients with poor preoperative active external rotation (ER).</p><p><strong>Methods: </strong>We performed a systematic review per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We queried PubMed/Medline, Embase, Web of Science, and Cochrane databases to identify articles reporting clinical outcomes of RSA with LDT or lateralized RSA alone performed in patients with preoperative ER ≤0°. Our primary outcomes were active ER, active forward elevation (FE), Constant score, and the incidence of complications.</p><p><strong>Results: </strong>We included 12 RSA with LDT studies with 188 shoulders and 4 lateralized RSA without transfer studies with 250 shoulders. Mean preoperative ER in RSA with LDT was -14°, while mean preoperative ER in lateralized RSA alone was -11°. Lateralized RSA alone was associated with superior postoperative ER (28° vs. 22°, P=0.010) and Constant score (69 vs. 65, P=0.014), but similar postoperative FE (P=0.590). Pre- to postoperative improvement in ER and FE was similar between cohorts. RSA with LDT had a higher incidence of nerve-related complications (2.1% vs. 0%) and dislocation (2.8% vs. 0.8%) compared to lateralized RSA alone.</p><p><strong>Conclusions: </strong>Both RSA with LDT and lateralized RSA are reliable options to restore ER in patients with significantly limited preoperative ER. Our analysis suggests that lateralized RSA alone is superior to RSA with LDT in patients with either a medialized or lateralized implant design and confers a lower risk of complications, particularly nerve injury and dislocation. However, the addition of an LDT may still be indicated in certain patient populations with very severe ER loss. Level of Evidence: IV.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aidan G Papalia, Paul V Romeo, Matthew G Alben, Andrew Cecora, Dashaun Ragland, Mandeep S Virk
Background: The popularity of the Latarjet procedure (LP) for the treatment of anterior shoulder instability continues to rise. However, LP is technically demanding and associated with complications. This study aims to determine the learning curve for the open LP (oLP) and the threshold for proficiency.
Methods: This was a retrospective study of all oLPs performed by a single surgeon in a single institution from 2016 to 2021. Operative time, defined as time from incision to closure, was the primary outcome of this study, and 1-year postoperative complications were the secondary outcome. After listing oLP cases in chronological order, they were classified into groups of 15, and the average operative time for each group was determined. Demographics, operative duration, and postoperative complications were compared across groups.
Results: Seventy-five oLPs were included in this study, and operative times decreased after the first 15 procedures. While operative times continued to decrease with increasing case number, the learning curve began to plateau after 30 procedures. After 75 procedures, there was a total decrease in average operative time of 31.5 minutes relative to that of the first 15 cases. There were no differences in complication or revision rates among procedure groups.
Conclusions: Establishing learning curves provides important insight into the complexity of surgical procedures. Our study demonstrates that the oLP has a steep learning curve with significant improvement in operative time after the first 15 cases. Operative time plateaus after 30 cases, indicating proficiency in this procedure. Level of evidence: IV.
{"title":"Learning curve for the open Latarjet procedure: a single-surgeon study.","authors":"Aidan G Papalia, Paul V Romeo, Matthew G Alben, Andrew Cecora, Dashaun Ragland, Mandeep S Virk","doi":"10.5397/cise.2024.00199","DOIUrl":"10.5397/cise.2024.00199","url":null,"abstract":"<p><strong>Background: </strong>The popularity of the Latarjet procedure (LP) for the treatment of anterior shoulder instability continues to rise. However, LP is technically demanding and associated with complications. This study aims to determine the learning curve for the open LP (oLP) and the threshold for proficiency.</p><p><strong>Methods: </strong>This was a retrospective study of all oLPs performed by a single surgeon in a single institution from 2016 to 2021. Operative time, defined as time from incision to closure, was the primary outcome of this study, and 1-year postoperative complications were the secondary outcome. After listing oLP cases in chronological order, they were classified into groups of 15, and the average operative time for each group was determined. Demographics, operative duration, and postoperative complications were compared across groups.</p><p><strong>Results: </strong>Seventy-five oLPs were included in this study, and operative times decreased after the first 15 procedures. While operative times continued to decrease with increasing case number, the learning curve began to plateau after 30 procedures. After 75 procedures, there was a total decrease in average operative time of 31.5 minutes relative to that of the first 15 cases. There were no differences in complication or revision rates among procedure groups.</p><p><strong>Conclusions: </strong>Establishing learning curves provides important insight into the complexity of surgical procedures. Our study demonstrates that the oLP has a steep learning curve with significant improvement in operative time after the first 15 cases. Operative time plateaus after 30 cases, indicating proficiency in this procedure. Level of evidence: IV.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Reconsidering the clinical outcomes of the stemless reverse total shoulder arthroplasty design implant.","authors":"Bo-Seoung Kim, Jong-Hun Ji","doi":"10.5397/cise.2024.00836","DOIUrl":"10.5397/cise.2024.00836","url":null,"abstract":"","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: This study aimed to investigate the impact of microfractures generated within the footprint of the greater tuberosity (GT) on postoperative cuff healing following arthroscopic rotator cuff repair (ARCR).
Methods: A retrospective analysis was conducted on patients who underwent ARCR for full-thickness rotator cuff tear (FTRCT) between April 2020 and October 2023 at our institution. A total of 73 patients was categorized into two groups based on the presence of microfractures: a microfracture group (group M, n=33) and a non-microfracture group (group N, n=40). Six months post-surgery, magnetic resonance imaging was performed to assess cuff healing and retear rates between the two groups. Furthermore, patients were stratified into retear and healing groups based on cuff integrity to analyze the factors influencing retear. Statistical analyses were performed to assess the associations between various demographic data (e.g., age) and radiologic parameters (tear size mediolateral [ML], anteroposterior [AP], and fatty infiltration [FI] of the rotator cuff muscle), including microfracture, with retear.
Results: There was no significant difference in retear rates between groups M and N (18.2% vs. 10.0%, P=0.332). Among demographic factors, age showed a significant difference between the retear and healing groups (67.4±8.5 vs. 61.6±6.1, P=0.044). ML tear size (3.1±1.7 vs. 2.0±1.1, P=0.015), AP tear size (2.4±1.2 vs. 1.6±1.0, P=0.332), FI of the supraspinatus (2.3±1.3 vs. 1.4±1.0, P=0.029), and FI of the infraspinatus (1.6±1.3 vs. 0.9±0.8, P=0.015) exhibited significant differences between the retear and healing groups. Multivariate logistic regression analysis identified age (odds ratio [OR], 1.153; 95% CI, 1.026-1.295; P=0.016) and tear size (OR, 1.988; 95% CI, 1.103-3.582; P=0.022) as independent risk factors for retear.
Conclusions: ARCR with concurrent microfracture of the GT footprint did not significantly impact cuff healing in patients with FTRCT. However, older age and larger ML tear size were associated with an increased risk of retear. Level of evidence: III.
背景:本研究旨在探讨大结节(GT)足底内产生的微骨折对关节镜下肩袖修复术(ARCR)术后肩袖愈合的影响:本院对2020年4月至2023年10月期间因全厚肩袖撕裂(FTRCT)接受关节镜下肩袖修复术(ARCR)的患者进行了回顾性分析。根据是否存在微骨折,73 名患者被分为两组:微骨折组(M 组,人数=33)和非微骨折组(N 组,人数=40)。手术后六个月,进行磁共振成像,以评估两组患者的袖带愈合情况和再撕裂率。此外,根据袖带完整性将患者分为再撕裂组和愈合组,以分析影响再撕裂的因素。统计分析评估了各种人口统计学数据(如年龄)和放射学参数(撕裂大小内外侧[ML]、前后[AP]和肩袖肌脂肪浸润[FI])(包括微骨折)与再撕裂之间的关联:M组和N组的再撕裂率无明显差异(18.2% vs. 10.0%,P=0.332)。在人口统计学因素中,年龄在再撕裂组和愈合组之间有显著差异(67.4±8.5 vs. 61.6±6.1,P=0.044)。ML撕裂大小(3.1±1.7 vs. 2.0±1.1,P=0.015)、AP撕裂大小(2.4±1.2 vs. 1.6±1.0,P=0.332)、冈上肌FI(2.3±1.3 vs. 1.4±1.0,P=0.029)和冈下肌FI(1.6±1.3 vs. 0.9±0.8,P=0.015)在再撕裂组和愈合组之间存在显著差异。多变量逻辑回归分析确定年龄(几率比[OR],1.153;95% CI,1.026-1.295;P=0.016)和撕裂大小(OR,1.988;95% CI,1.103-3.582;P=0.022)为再撕裂的独立风险因素:结论:ARCR同时进行GT足底微骨折不会对FTRCT患者的袖带愈合产生明显影响。然而,年龄越大、ML撕裂面积越大,发生再撕裂的风险就越高。证据等级:III级。
{"title":"Factors affecting healing of rotator cuff repairs: microfracture of the greater tuberosity.","authors":"Gwan Kyu Son, Myung Seo Kim","doi":"10.5397/cise.2024.00290","DOIUrl":"https://doi.org/10.5397/cise.2024.00290","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to investigate the impact of microfractures generated within the footprint of the greater tuberosity (GT) on postoperative cuff healing following arthroscopic rotator cuff repair (ARCR).</p><p><strong>Methods: </strong>A retrospective analysis was conducted on patients who underwent ARCR for full-thickness rotator cuff tear (FTRCT) between April 2020 and October 2023 at our institution. A total of 73 patients was categorized into two groups based on the presence of microfractures: a microfracture group (group M, n=33) and a non-microfracture group (group N, n=40). Six months post-surgery, magnetic resonance imaging was performed to assess cuff healing and retear rates between the two groups. Furthermore, patients were stratified into retear and healing groups based on cuff integrity to analyze the factors influencing retear. Statistical analyses were performed to assess the associations between various demographic data (e.g., age) and radiologic parameters (tear size mediolateral [ML], anteroposterior [AP], and fatty infiltration [FI] of the rotator cuff muscle), including microfracture, with retear.</p><p><strong>Results: </strong>There was no significant difference in retear rates between groups M and N (18.2% vs. 10.0%, P=0.332). Among demographic factors, age showed a significant difference between the retear and healing groups (67.4±8.5 vs. 61.6±6.1, P=0.044). ML tear size (3.1±1.7 vs. 2.0±1.1, P=0.015), AP tear size (2.4±1.2 vs. 1.6±1.0, P=0.332), FI of the supraspinatus (2.3±1.3 vs. 1.4±1.0, P=0.029), and FI of the infraspinatus (1.6±1.3 vs. 0.9±0.8, P=0.015) exhibited significant differences between the retear and healing groups. Multivariate logistic regression analysis identified age (odds ratio [OR], 1.153; 95% CI, 1.026-1.295; P=0.016) and tear size (OR, 1.988; 95% CI, 1.103-3.582; P=0.022) as independent risk factors for retear.</p><p><strong>Conclusions: </strong>ARCR with concurrent microfracture of the GT footprint did not significantly impact cuff healing in patients with FTRCT. However, older age and larger ML tear size were associated with an increased risk of retear. Level of evidence: III.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Adult humeral shaft fractures have traditionally been managed conservatively, but surgical intervention is considered for displaced fractures or when conservative treatment is unlikely to be successful. The optimal surgical approach remains controversial, with open reduction and internal fixation (ORIF) using plates and screws considered the gold standard. However, concerns about soft tissue damage have led to the development of less invasive techniques, such as anterior bridge plating using minimally invasive plate osteosynthesis (MIPO). This study aimed to evaluate the outcomes of MIPO for humeral shaft fractures.
Methods: A prospective cohort study included 43 patients who underwent anterior bridge plating with MIPO for closed, displaced humeral shaft fractures. Forty patients had full follow-up (functional and radiological) and three patients were lost to follow-up. Fractures were classified using the AO classification system. Surgical technique involved incision, reduction, and fixation with locking compression plates. Follow-up assessments were conducted at various intervals, and functional outcomes were evaluated.
Results: Fracture union was achieved in 38 of 40 patients (95%). Two patients required secondary bone grafts for non-union. The mean time to union was between 12 and 16 weeks. Excellent shoulder function was observed in 82.5% of patients, and excellent elbow function in 77.5%. The range of motion on the operated side differed statistically significantly from the non-operated side but was not clinically significant.
Conclusions: MIPO with anterior bridge plating is a viable option for the surgical management of humeral shaft fractures. It offers good fracture healing rates and satisfactory functional outcomes and avoids extensive soft tissue dissection associated with ORIF. Level of evidence: II.
{"title":"A prospective cohort study: promising results with minimally invasive plate osteosynthesis of anterior bridge plating in adult humeral shaft fractures.","authors":"Gur-Aziz Singh Sidhu, Deepak Jain, Harpal Singh Selhi, Harjot Kaur, Sergio Rowinski, Saphalya Pattnaik, Neil Ashwood","doi":"10.5397/cise.2024.00423","DOIUrl":"https://doi.org/10.5397/cise.2024.00423","url":null,"abstract":"<p><strong>Background: </strong>Adult humeral shaft fractures have traditionally been managed conservatively, but surgical intervention is considered for displaced fractures or when conservative treatment is unlikely to be successful. The optimal surgical approach remains controversial, with open reduction and internal fixation (ORIF) using plates and screws considered the gold standard. However, concerns about soft tissue damage have led to the development of less invasive techniques, such as anterior bridge plating using minimally invasive plate osteosynthesis (MIPO). This study aimed to evaluate the outcomes of MIPO for humeral shaft fractures.</p><p><strong>Methods: </strong>A prospective cohort study included 43 patients who underwent anterior bridge plating with MIPO for closed, displaced humeral shaft fractures. Forty patients had full follow-up (functional and radiological) and three patients were lost to follow-up. Fractures were classified using the AO classification system. Surgical technique involved incision, reduction, and fixation with locking compression plates. Follow-up assessments were conducted at various intervals, and functional outcomes were evaluated.</p><p><strong>Results: </strong>Fracture union was achieved in 38 of 40 patients (95%). Two patients required secondary bone grafts for non-union. The mean time to union was between 12 and 16 weeks. Excellent shoulder function was observed in 82.5% of patients, and excellent elbow function in 77.5%. The range of motion on the operated side differed statistically significantly from the non-operated side but was not clinically significant.</p><p><strong>Conclusions: </strong>MIPO with anterior bridge plating is a viable option for the surgical management of humeral shaft fractures. It offers good fracture healing rates and satisfactory functional outcomes and avoids extensive soft tissue dissection associated with ORIF. Level of evidence: II.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ji Un Kim, Ji Young Yoon, Hyung Jun Park, Jung Ho Park
Background: This study aimed to compare the outcomes and complications of active young adults undergoing open reduction and plate fixation (ORPF) and intramedullary nailing (IMN) for displaced midshaft clavicle fractures (MCFs).
Methods: A retrospective review was performed on all patients undergoing ORPF and IMN of complete MCFs at a single center between 2018 and 2022. Patients who were younger than 60 years with radiographic follow-up until union were included in the study. The mean age of the patients was 33.1 years. Outcome measures were achievement of union, time to healing, residual deformity, complications, and need for additional procedures.
Results: Of 39 patients, 29 underwent ORPF and 10 underwent IMN. Plate fixation provided faster functional recovery in the first 6 months, but no difference was observed after 1 year. All fractures in the IMN group healed (100%), compared to 90% in the ORPF group (P=0.08). Mean time to union was 21±8.9 weeks and was significantly different between the two groups (P<0.01), with the ORPF group averaging 23.1 weeks and the IMN group 20.8 weeks. Nonunion rates were higher in the ORPF group (10.3%) than in the IMN group (0.0%), but the difference was not significant (P=0.10).
Conclusions: Both methods restored patients to their pre-injury functional levels. However, IMN, with its higher healing rate, fewer required revision surgeries, and lower incisional numbness, appears to be the preferred method for treating MSFs without comminution in young adults. Level of evidence: III.
{"title":"Surgical treatment options of displaced midshaft fractures of the clavicle in young adults: plate fixation versus intramedullary nailing.","authors":"Ji Un Kim, Ji Young Yoon, Hyung Jun Park, Jung Ho Park","doi":"10.5397/cise.2024.00605","DOIUrl":"https://doi.org/10.5397/cise.2024.00605","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to compare the outcomes and complications of active young adults undergoing open reduction and plate fixation (ORPF) and intramedullary nailing (IMN) for displaced midshaft clavicle fractures (MCFs).</p><p><strong>Methods: </strong>A retrospective review was performed on all patients undergoing ORPF and IMN of complete MCFs at a single center between 2018 and 2022. Patients who were younger than 60 years with radiographic follow-up until union were included in the study. The mean age of the patients was 33.1 years. Outcome measures were achievement of union, time to healing, residual deformity, complications, and need for additional procedures.</p><p><strong>Results: </strong>Of 39 patients, 29 underwent ORPF and 10 underwent IMN. Plate fixation provided faster functional recovery in the first 6 months, but no difference was observed after 1 year. All fractures in the IMN group healed (100%), compared to 90% in the ORPF group (P=0.08). Mean time to union was 21±8.9 weeks and was significantly different between the two groups (P<0.01), with the ORPF group averaging 23.1 weeks and the IMN group 20.8 weeks. Nonunion rates were higher in the ORPF group (10.3%) than in the IMN group (0.0%), but the difference was not significant (P=0.10).</p><p><strong>Conclusions: </strong>Both methods restored patients to their pre-injury functional levels. However, IMN, with its higher healing rate, fewer required revision surgeries, and lower incisional numbness, appears to be the preferred method for treating MSFs without comminution in young adults. Level of evidence: III.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hyung Gyu Cho, Gyeong Hoon Lim, Min Su Joo, Jae Won Kim, Jun Ho Park, Jeong Woo Kim
Background: Our study aimed to evaluate the clinical and radiologic results of all-arthroscopic treatment of terrible triad injuries followed-up for a minimum of 5 years and investigate how arthroscopic partial excision for radial head fractures affects the results at the final follow-up.
Methods: We retrospectively reviewed consecutive patients with terrible triad injuries who underwent all-arthroscopic treatment between January 2011 and June 2018. In group I, we performed conservative or arthroscopic fixation of stable radial head fractures, while in group II, arthroscopic partial excision of unstable radial head fractures involving <30%-50% of the articular surface area was performed. Clinical outcomes were measured by visual analog scale score and assessment of instability, range of motion (ROM), and Mayo Elbow Performance Score. Radiological outcomes were evaluated using x-rays, and the integrity of the repaired lateral collateral ligament complex was confirmed through magnetic resonance imaging.
Results: Thirty-two patients with an average age of 49.5±16.2 years met the inclusion criteria and were followed-up for a mean of 82.7±22.2 months. Twenty patients were assigned to group I and 12 patients to group II. Clinical outcomes showed no significant differences between the two groups at the final follow-up (P>0.05). On radiological evaluation, more heterotopic ossifications were found in the radial head excision group (group II, 66.7% versus group I, 35%, P=0.02); however, there was no significant difference in ROM between the two groups (P>0.05).
Conclusions: In all-arthroscopic treatment of terrible triad injuries, arthroscopic partial excision of the radial head did not seem to have a significant impact on elbow joint stability. Level of evidence: III.
研究背景我们的研究旨在评估对可怕的三联症损伤进行至少 5 年随访的全关节镜治疗的临床和放射学结果,并探讨关节镜下桡骨头骨折部分切除术对最终随访结果的影响:我们回顾性研究了2011年1月至2018年6月期间接受全关节镜治疗的连续性可怕三联症损伤患者。在 I 组中,我们对稳定的桡骨头骨折进行了保守或关节镜固定,而在 II 组中,我们对涉及结果的不稳定桡骨头骨折进行了关节镜下部分切除:32 名患者符合纳入标准,平均年龄(49.5±16.2)岁,平均随访时间(82.7±22.2)个月。20 名患者被分配到第一组,12 名患者被分配到第二组。最终随访结果显示,两组患者的临床结果无明显差异(P>0.05)。在放射学评估中,桡骨头切除术组发现了更多的异位骨化(II组66.7%,I组35%,P=0.02);然而,两组患者的ROM无明显差异(P>0.05):结论:在对可怕的三联症损伤进行全关节镜治疗时,关节镜下桡骨头部分切除术似乎对肘关节稳定性没有显著影响。证据等级:证据等级:III。
{"title":"Is partial excision of the radial head safe and effective in all-arthroscopic treatment of terrible triad fractures?","authors":"Hyung Gyu Cho, Gyeong Hoon Lim, Min Su Joo, Jae Won Kim, Jun Ho Park, Jeong Woo Kim","doi":"10.5397/cise.2024.00703","DOIUrl":"https://doi.org/10.5397/cise.2024.00703","url":null,"abstract":"<p><strong>Background: </strong>Our study aimed to evaluate the clinical and radiologic results of all-arthroscopic treatment of terrible triad injuries followed-up for a minimum of 5 years and investigate how arthroscopic partial excision for radial head fractures affects the results at the final follow-up.</p><p><strong>Methods: </strong>We retrospectively reviewed consecutive patients with terrible triad injuries who underwent all-arthroscopic treatment between January 2011 and June 2018. In group I, we performed conservative or arthroscopic fixation of stable radial head fractures, while in group II, arthroscopic partial excision of unstable radial head fractures involving <30%-50% of the articular surface area was performed. Clinical outcomes were measured by visual analog scale score and assessment of instability, range of motion (ROM), and Mayo Elbow Performance Score. Radiological outcomes were evaluated using x-rays, and the integrity of the repaired lateral collateral ligament complex was confirmed through magnetic resonance imaging.</p><p><strong>Results: </strong>Thirty-two patients with an average age of 49.5±16.2 years met the inclusion criteria and were followed-up for a mean of 82.7±22.2 months. Twenty patients were assigned to group I and 12 patients to group II. Clinical outcomes showed no significant differences between the two groups at the final follow-up (P>0.05). On radiological evaluation, more heterotopic ossifications were found in the radial head excision group (group II, 66.7% versus group I, 35%, P=0.02); however, there was no significant difference in ROM between the two groups (P>0.05).</p><p><strong>Conclusions: </strong>In all-arthroscopic treatment of terrible triad injuries, arthroscopic partial excision of the radial head did not seem to have a significant impact on elbow joint stability. Level of evidence: III.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chang-Hyuk Choi, Ji Hoon Choi, Sug Hun Che, Jun-Young Kim
Background: The purpose of this study was to examine the radiographic and clinical outcomes of stemless reverse total shoulder arthroplasty (RTSA) after a minimum 2-year follow-up.
Methods: Between July 2018 and March 2023, 50 patients underwent 50 stemless RTSA with the Lima component. Twenty-eight patients with a follow-up of more than 2 years were reviewed. The average age was 71.9 years (range, 61-85 years), and the average follow-up period was 2.2 years (range, 2.0-5.1). Bone marrow density of the proximal humerus was measured before RTSA. We evaluated preoperative and postoperative range of motion, clinical score, radiographic change, and postoperative complications.
Results: Significant increases were observed postoperatively in forward flexion (112.0º-162.5º, P<0.01) and internal rotation (from L3 to T12 level; P<0.05). No changes were observed in external rotation (from 43.0º to 45.2º; P=0.762). The clinical scores improved for Korean Shoulder Scoring system (from 64 to 93, P<0.01) and American Shoulder and Elbow Surgeons score (from 17.5 to 27.3, P<0.01). Although radiolucent lines of less than 2 mm were observed in all cases, no osteolysis and loosening of the stemless humeral component was found. Scapular notching was observed in 18 cases (64.3%).
Conclusions: Stemless RTSA showed good radiographic and clinical results after a minimum 2-year follow-up. Level of evidence: IV.
{"title":"The radiographic and clinical outcomes of stemless reverse total shoulder arthroplasty: a minimum 2-year follow-up study.","authors":"Chang-Hyuk Choi, Ji Hoon Choi, Sug Hun Che, Jun-Young Kim","doi":"10.5397/cise.2024.00472","DOIUrl":"10.5397/cise.2024.00472","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to examine the radiographic and clinical outcomes of stemless reverse total shoulder arthroplasty (RTSA) after a minimum 2-year follow-up.</p><p><strong>Methods: </strong>Between July 2018 and March 2023, 50 patients underwent 50 stemless RTSA with the Lima component. Twenty-eight patients with a follow-up of more than 2 years were reviewed. The average age was 71.9 years (range, 61-85 years), and the average follow-up period was 2.2 years (range, 2.0-5.1). Bone marrow density of the proximal humerus was measured before RTSA. We evaluated preoperative and postoperative range of motion, clinical score, radiographic change, and postoperative complications.</p><p><strong>Results: </strong>Significant increases were observed postoperatively in forward flexion (112.0º-162.5º, P<0.01) and internal rotation (from L3 to T12 level; P<0.05). No changes were observed in external rotation (from 43.0º to 45.2º; P=0.762). The clinical scores improved for Korean Shoulder Scoring system (from 64 to 93, P<0.01) and American Shoulder and Elbow Surgeons score (from 17.5 to 27.3, P<0.01). Although radiolucent lines of less than 2 mm were observed in all cases, no osteolysis and loosening of the stemless humeral component was found. Scapular notching was observed in 18 cases (64.3%).</p><p><strong>Conclusions: </strong>Stemless RTSA showed good radiographic and clinical results after a minimum 2-year follow-up. Level of evidence: IV.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}