Clinics in Shoulder and Elbow最新文献

Background: To evaluate the outcomes of distal humerus hemiarthroplasty (DHH) in a series of eight consecutive patients with unreconstructible distal humeral fractures or failed open reduction and internal fixation (ORIF).

Methods: Retrospective data including demographics, postoperative outcomes, and complications were extracted from electronic records at a level 1 trauma center. Surgeries were performed by a single fellowship-trained upper extremity surgeon. The indications for DHH were unreconstructible distal humerus fracture or failed ORIF. Eventually, as accepted by current literature, no weight restrictions were applied. Range of motion (ROM), functional scores, and pain levels were evaluated during follow-up appointments. Minimum follow-up time was 12 months.

Results: Between 2014 and 2024, eight consecutive patients underwent DHH. The mean patient age at the time of surgery was 68.1 years, with an average follow-up of 46.6 months. Patients exhibited satisfactory ROM, with near-complete pronosupination and mean flexion and extension of 125° and 25°, respectively. Functional scores, including Quick Disabilities of the Arm, Shoulder and Hand score (35.2) and Mayo Elbow Performance Score (78.1), were good. Mean Numeric Pain Rating Scale was 3.9. Complications included two conversions to total elbow arthroplasty due to elbow instability and postoperative infection (staged conversion), one ligament reconstruction for postoperative elbow instability, two cases of ulnar periprosthetic fracture, and one case of ulnar nerve neuropathy.

Conclusions: DHH for unreconstructible distal humerus fractures and failed ORIF allows for unrestricted postoperative lifting and yields satisfactory functional outcomes but does have a relatively high complication rate. Level of evidence: IV.

Background: The glenoid components in total shoulder arthroplasty (TSA) are numerous and have both advantages and disadvantages. This study aimed to compare 5-year functional outcomes, patient-reported outcomes, and conversion rates between patients who underwent TSA using metal-backed glenoid (MBG), hybrid, and all-polyethylene glenoid components.

Methods: The patients who were eligible for this study were retrospectively identified using electronic health records. The subjects underwent TSA performed by a fellowship-trained attending physician from November 2017 to December 2018 at a single institution. The inclusion criteria from 5-year follow-up data were adult-age patients (≥18 years old) who underwent TSA using MBG, hybrid, or all-polyethylene glenoid components.

Results: A total of 77 patients was included: 44 patients with all-polyethylene glenoid components, 17 with hybrid glenoid components, and 16 with MBG components. The mean patient age was 66.9 years, with the all-polyethylene patients being significantly younger (P<0.001). The all-polyethylene glenoid patients experienced a significantly longer operative time at 120 minutes (P=0.005) compared to those with other components. At the 5-year follow-up, no significant difference was shown in American Shoulder and Elbow Surgeons (ASES) and visual analog scale scores. However, a trend was evident in which the all-polyethylene patients had lower ASES scores (all polyethylene 87.0 vs. hybrid 100.0 vs. 97.0 MBG, P=0.086). The hybrid components tended to require revision more often at 12% vs. 6.8% of polyethylene glenoid vs. 0% of MBGs (P=0.310). No dislocation was reported, and only two complications occurred, both in the all-polyethylene group (P=0.387).

Conclusions: At 5-year follow-up, patient-reported outcomes were similar when utilizing MBG, all-polyethylene, and hybrid glenoid components. Given the similar outcomes, MBGs and hybrid glenoid components could be considered favorable or preferred for potential surgical ease in a revision setting with conversion to reverse TSA. Level of evidence: III.

Background: Instability in distal clavicle fractures with impaired integrity of the coracoclavicular (CC) ligament poses a serious risk of nonunion, necessitating surgical intervention. Despite a consensus on the need for surgery in cases of unstable distal clavicle fractures, various surgical techniques are available. The aim of this study is to evaluate the radiological and functional outcomes of CC augmentation using the suture Endobutton technique for Neer type 2b clavicle fractures were evaluated.

Methods: In this retrospective study, 42 patients who met the criteria were divided into two groups: group 1 (locking plate with CC augmentation) and group 2 (locking plate without CC augmentation). Demographic data, Constant-Murley score (CMS), union time, range of motion, complications, and implant failures during the follow-up period were recorded.

Results: Among study patients, 13 (31.0%) were female and 29 (69.0%) were male. The mean age was 40.5±11.5 years. Significant differences were found in union time (week) (t(40)=-2.11, P=0.04) and the 6-month CMS (t(40)=4.19, P=0.01). Significant difference was not observed in postoperative complications between the groups (P>0.05).

Conclusions: CC augmentation with a suture Endobutton in type 2b distal clavicle fractures resulted in more favorable short-term functional and radiological outcomes. Level of evidence: III.

Background: Simple elbow dislocations exhibit residual flexion contracture after long-term immobilization. However, the factors affecting flexion contracture after fixation of distal humerus coronal shear (DHCS) fracture remain unclear.

Methods: This study enrolled 21 elbows in DHCS fracture (group A) from 2007 to 2017 and 30 elbows in elbow dislocation (group B) in 2020, all of whom attended a single trauma center. Group A was divided by immobilization period into less than 3 weeks (A1) and more than 3 weeks (A2). Injury patterns of the anterior capsule were divided into proximal stripping, middle displaced, and distal avulsion on magnetic resonance imaging (MRI) scans. Range of motion and functional outcomes were compared between groups A1 and A2.

Results: All patients in group A exhibited proximal stripping of the anterior capsule, while group B showed middle displaced (37%) and distal avulsion (63%) injuries (P<0.001). The mean flexion contracture was 2° in A1 and 8° in A2 (P=0.139), demonstrating no significant difference by immobilization duration. Similarly, the groups had no significant differences in Mayo Elbow Performance Score (MEPS) or Disabilities of the Arm, Shoulder and Hand (DASH) scores.

Conclusions: Flexion contracture following elbow trauma appears to be more closely related to the pattern of anterior capsule injury than the duration of immobilization. Early identification of anterior capsule injury patterns via MRI could inform treatment decisions, particularly in cases where stable surgical fixation is challenging. Prolonged immobilization may be a viable adjuvant treatment option in such cases. Level of evidence: III.

Machine learning (ML), a subset of artificial intelligence (AI), utilizes advanced algorithms to learn patterns from data, enabling accurate predictions and decision-making without explicit programming. In orthopedic surgery, ML is transforming clinical practice, particularly in shoulder arthroplasty and rotator cuff tears (RCTs) management. This review explores the fundamental paradigms of ML, including supervised, unsupervised, and reinforcement learning, alongside key algorithms such as XGBoost, neural networks, and generative adversarial networks. In shoulder arthroplasty, ML accurately predicts postoperative outcomes, complications, and implant selection, facilitating personalized surgical planning and cost optimization. Predictive models, including ensemble learning methods, achieve over 90% accuracy in forecasting complications, while neural networks enhance surgical precision through AI-assisted navigation. In RCTs treatment, ML enhances diagnostic accuracy using deep learning models on magnetic resonance imaging and ultrasound, achieving area under the curve values exceeding 0.90. ML models also predict tear reparability with 85% accuracy and postoperative functional outcomes, including range of motion and patient-reported outcomes. Despite remarkable advancements, challenges such as data variability, model interpretability, and integration into clinical workflows persist. Future directions involve federated learning for robust model generalization and explainable AI to enhance transparency. ML continues to revolutionize orthopedic care by providing data-driven, personalized treatment strategies and optimizing surgical outcomes.

Rotator cuff disease is a prevalent musculoskeletal condition associated with significant pain and functional impairment. Various injection therapies, ranging from corticosteroids to advanced biologic approaches, offer potential solutions for managing rotator cuff disease. This scoping review consolidates evidence on the efficacy, safety, and mechanisms of these treatments. Corticosteroid injections, while effective for short-term pain relief, pose risks of tendon degeneration with prolonged use. Platelet-rich plasma demonstrates promise in promoting tendon healing and improving long-term outcomes, but variability in preparation methods limits its clinical consistency. Hyaluronic acid and prolotherapy show potential in improving pain and tendon function, often serving as adjuncts in combined therapeutic strategies. Emerging regenerative options, such as polydeoxyribonucleotide and bone marrow aspirate concentrate, leverage growth factors and stem cells to enhance tendon repair and reduce degeneration, with preliminary evidence supporting their clinical efficacy. By synthesizing current knowledge on injection therapy for rotator cuff disease, this review provides valuable insights for clinicians and researchers seeking to enhance the management of rotator cuff disease through injection therapy.

Background: Although arthroscopically assisted lower trapezius tendon transfer (aLTT) is an effective treatment option for posterosuperior irreparable rotator cuff tear (PSIRCT), interpositional grafts should be used because of the length limitations of the LTT. This study compared the radiologic and clinical results of an Achilles tendon allograft (ATA) versus a fascia lata autograft (FLA) as the interpositional graft.

Methods: This study included 64 and 26 patients treated with aLTT using an ATA or FLA, respectively. Clinical outcomes were compared using the visual analog scale score, University of California Los Angeles shoulder score, American Shoulder and Elbow Surgeons score, Constant shoulder score, activities of daily living that require active external rotation score, and range of motion. Arthritic changes of the glenohumeral joint were evaluated by acromiohumeral distance (AHD) and Hamada grade. Extent of arthritis was evaluated by magnetic resonance imaging.

Results: Both groups showed significant improvement after the surgery in intra-group analysis, and no significant difference in clinical outcomes were observed between the two groups. AHD and Hamada grades were also comparable. The rate of graft retear was higher in the ATA group than in the FLA group, but without statistical significance.

Conclusions: aLTT may lead to significant improvement in clinical and radiologic outcomes in PSIRCT, regardless of whether an ATA or FLA is used as the interpositional graft. The retear rate of the interpositional bridging graft was not associated with graft status. However, measures to promote graft healing should be considered. Level of evidence: III.

Background: This study investigated whether the coracoid apex position relative to the glenoid is associated with anterior shoulder instability (ASI). We hypothesized that the coracoid apex is positioned superiorly and medially in patients with ASI.

Methods: This study included 72 patients who underwent surgery for ASI and 72 age- and sex-matched controls. The sagittal central glenoid- coracoid angle (scGCA) and axial central glenoid-coracoid angle (acGCA), which assess the coracoid apex position relative to the glenoid center, the glenoid version (GV), and glenoid inclination (GI) were evaluated using magnetic resonance imaging. The critical shoulder angle (CSA) was measured using true anterior-posterior radiographs.

Results: The ASI group had significantly lower scGCA and GV values than the control group (scGCA: 32.0°±4.3° vs. 39.2°±7°, P=0.004; GV: 2.2°±5.4° vs. 6.4°±5.4°, P=0.033, respectively). There was no significant difference in acGCA, GI, and CSA between the groups (P=0.377, P=0.524, P=0.847, respectively). Logistic regression analysis conducted with the scGCA, acGCA, GV, GI, and CSA parameters revealed a significant association only for scGCA (P=0.039, odds ratio: 1.28).

Conclusions: Lower scGCA values, which indicate a more superior position of the coracoid apex relative to the glenoid center, are associated with ASI independently of other parameters. scGCA values below 34.5°, indicating a superiorly positioned coracoid apex, showed an 85.7% sensitivity and 73.3% specificity for ASI. Level of evidence: III.

Background: Nonsurgical ulnar nerve release was developed for conservative treatment of cubital tunnel syndrome. Our objective in this study was to investigate the amount of ulnar nerve gliding and elongation during passive wrist, forearm, or elbow movements to determine the most effective nonsurgical ulnar nerve release technique.

Methods: Seven fresh-frozen cadaveric upper limbs were tested in an elbow-testing system. Ulnar nerve gliding (mobility) and elongation (stretching) were measured around the elbow joint using a three-dimensional digitizing system. Data were compared between arm positions (elbow extension vs. 90° flexion, wrist extension vs. flexion, or forearm pronation vs. supination).

Results: Passive wrist movement from flexion to extension caused the ulnar nerve to glide. The largest amount of glide during passive wrist movement was found at 90° elbow flexion and maximum forearm supination position (5.4±1.1 mm). Ulnar nerve gliding during passive forearm movement was subtle. The ulnar nerve tightened with elbow flexion. Maximum elongation of the ulnar nerve was 5.6±0.6 mm from extension to 90° flexion in the elbow.

Conclusions: Ulnar nerve gliding was most severe during passive wrist movement in elbow flexion and forearm supination. This result suggests that passive wrist movement from flexion to extension with the elbow flexed and forearm supinated may be the most effective nonsurgical ulnar nerve release position to treat cubital tunnel syndrome. Attention should be paid to the elbow flexion angle during nonsurgical ulnar nerve release to not exacerbate cubital tunnel symptoms. Level of evidence: III.