Pub Date : 2025-02-01DOI: 10.1016/j.jse.2024.07.038
Amin Razi MD, David Ring MD, PhD
<div><h3>Background</h3><div>After shoulder surgery, infection is often diagnosed in the absence of an inflammatory host response (purulence, sepsis). In the absence of inflammation, the more appropriate diagnoses may be colonization or contamination. We reviewed the available data regarding culture of <em>Cutibacterium acnes</em> during primary and revision shoulder surgery and asked; 1) what is the prevalence of air, skin, and deep tissue colonization? 2) How often is an inflammatory host response associated with diagnosis of postoperative shoulder infection diagnosed on the basis of culture of <em>C</em>. <em>acnes</em>? 3) Is there any relation between culture of <em>C</em>. <em>acnes</em> and outcomes of shoulder surgery?</div></div><div><h3>Methods</h3><div>Three databases were searched for studies that address <em>C</em>. <em>acnes</em> and colonization or infection related to shoulder surgery. We analyzed data from 80 studies addressing the rates of <em>C</em>. <em>acnes</em> colonization/infection in patients undergoing shoulder surgery, evidence of an inflammatory host response, and relationship of <em>C</em>. <em>acnes</em> culture to surgery outcomes.</div></div><div><h3>Results</h3><div><em>C</em>. <em>acnes</em> is often cultured in the air in the operating room (mean 10%), the skin before preparation (mean 47%), and deep tissue in primary shoulder arthroplasty (mean 29%), arthroscopy (mean 27%), and other shoulder surgery (mean 21%). <em>C</em>. <em>acnes</em> was cultured from a mean of 39% of deep tissue samples during revision arthroplasty. <em>C</em>. <em>acnes</em> was believed to be the causative organism of a high percentage of the infections diagnosed after surgery, 39% in primary shoulder arthroplasties, 53% in revisions, 55% in arthroscopic surgeries, and 44% in a mixture of shoulder surgeries. Infection was nearly always diagnosed in the absence of an inflammatory host response. Documented purulence and sepsis were not specifically ascribed to <em>C</em>. <em>acnes</em> (rather than more virulent organisms such as <em>S</em>. <em>aureus</em>). Diagnosis of infection, or unexpected positive culture, with <em>C</em>. <em>acnes</em> during shoulder surgery is associated with outcomes comparable to shoulders with no bacterial growth.</div></div><div><h3>Conclusions</h3><div>The evidence to date supports conceptualization of <em>C</em>. <em>acnes</em> as a common commensal (colonization), and perhaps a frequent contaminant, and an uncommon cause of an inflammatory host response (infection). This is supported by the observations that 1) unexpected positive culture for <em>C</em>. <em>acnes</em> is not associated with adverse outcomes after shoulder surgery, and 2) diagnosed infection with <em>C</em>. <em>acnes</em> is associated with outcomes comparable to noninfected revision shoulder arthroplasty. We speculate that diagnosis of <em>C</em>. <em>acnes</em> infection might represent an attempt to account for unexplained discomf
{"title":"A systematic review of distinction of colonization and infection in studies that address Cutibacterium acnes and shoulder surgery","authors":"Amin Razi MD, David Ring MD, PhD","doi":"10.1016/j.jse.2024.07.038","DOIUrl":"10.1016/j.jse.2024.07.038","url":null,"abstract":"<div><h3>Background</h3><div>After shoulder surgery, infection is often diagnosed in the absence of an inflammatory host response (purulence, sepsis). In the absence of inflammation, the more appropriate diagnoses may be colonization or contamination. We reviewed the available data regarding culture of <em>Cutibacterium acnes</em> during primary and revision shoulder surgery and asked; 1) what is the prevalence of air, skin, and deep tissue colonization? 2) How often is an inflammatory host response associated with diagnosis of postoperative shoulder infection diagnosed on the basis of culture of <em>C</em>. <em>acnes</em>? 3) Is there any relation between culture of <em>C</em>. <em>acnes</em> and outcomes of shoulder surgery?</div></div><div><h3>Methods</h3><div>Three databases were searched for studies that address <em>C</em>. <em>acnes</em> and colonization or infection related to shoulder surgery. We analyzed data from 80 studies addressing the rates of <em>C</em>. <em>acnes</em> colonization/infection in patients undergoing shoulder surgery, evidence of an inflammatory host response, and relationship of <em>C</em>. <em>acnes</em> culture to surgery outcomes.</div></div><div><h3>Results</h3><div><em>C</em>. <em>acnes</em> is often cultured in the air in the operating room (mean 10%), the skin before preparation (mean 47%), and deep tissue in primary shoulder arthroplasty (mean 29%), arthroscopy (mean 27%), and other shoulder surgery (mean 21%). <em>C</em>. <em>acnes</em> was cultured from a mean of 39% of deep tissue samples during revision arthroplasty. <em>C</em>. <em>acnes</em> was believed to be the causative organism of a high percentage of the infections diagnosed after surgery, 39% in primary shoulder arthroplasties, 53% in revisions, 55% in arthroscopic surgeries, and 44% in a mixture of shoulder surgeries. Infection was nearly always diagnosed in the absence of an inflammatory host response. Documented purulence and sepsis were not specifically ascribed to <em>C</em>. <em>acnes</em> (rather than more virulent organisms such as <em>S</em>. <em>aureus</em>). Diagnosis of infection, or unexpected positive culture, with <em>C</em>. <em>acnes</em> during shoulder surgery is associated with outcomes comparable to shoulders with no bacterial growth.</div></div><div><h3>Conclusions</h3><div>The evidence to date supports conceptualization of <em>C</em>. <em>acnes</em> as a common commensal (colonization), and perhaps a frequent contaminant, and an uncommon cause of an inflammatory host response (infection). This is supported by the observations that 1) unexpected positive culture for <em>C</em>. <em>acnes</em> is not associated with adverse outcomes after shoulder surgery, and 2) diagnosed infection with <em>C</em>. <em>acnes</em> is associated with outcomes comparable to noninfected revision shoulder arthroplasty. We speculate that diagnosis of <em>C</em>. <em>acnes</em> infection might represent an attempt to account for unexplained discomf","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"34 2","pages":"Pages 617-625"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jse.2024.04.007
Shivan N. Chokshi BBA , Jeremy S. Somerson MD
Background
Total shoulder arthroplasty (TSA) is an effective treatment for a wide range of shoulder pathologies. Literature investigating the impact of COVID-19 diagnosis on outcomes following TSA is limited. The objective of this study was to perform a retrospective multi-institutional database analysis to investigate the association between preoperative COVID-19 diagnosis and 60-day complications following TSA.
Methods
We queried the TriNetX database using Current Procedural Terminology and the International Classification of Diseases, Tenth Revision codes for patients who underwent a TSA from January 1, 2018 to July 1, 2023. Patients were categorized by those who had and those who did not have a diagnosis of COVID-19 within 30 days prior to surgery. The cohorts were matched based on age, gender, ethnicity, race, and past medical history. Chi-square analysis was performed to determine the relationship between COVID-19 diagnosis and 60-day postoperative complications including pneumonia, sepsis, emergency department (ED) visit, hospital admission, mortality, periprosthetic fracture, superficial wound infection, deep vein thrombosis (DVT), pulmonary embolism (PE), acute myocardial infarction, and revision surgery. The search results identified a total 63,768 patients who met study criteria. Of these patients, 7118 (11.08%) were diagnosed with COVID-19 within 30 days prior to their TSA procedure. Propensity score matching resulted in 6982 patients in each of the 2 cohorts.
Results
Patients with a recent COVID-19 diagnosis prior to surgery had 1.96 (P = .0005) times the odds of sepsis, 1.42 (P = .0032) times the odds of superficial wound infections, 1.42 (P < .0001) times the odds of DVT, 1.52 (P = .0001) times the odds of PE, 1.10 (P = .0249) and 1.79 (P < .0001) times the odds of ED visits and hospital admissions, respectively, and 3.10 (P < .0001) and 2.87 (P < .0001) times the odds of periprosthetic fracture and revision surgery within 60 days of TSA.
Conclusions
Our study suggests an increased risk of sepsis, ED visits, hospital admissions, periprosthetic fracture, superficial wound infection, DVT, PE, and revision surgery in TSA patients with a recent COVID-19 diagnosis. There may be significant benefit to closer monitoring and greater preventive measures to reduce the occurrence of postoperative complications in this setting. In addition, patients may benefit from postponing elective TSA procedures in the setting of a recent COVID-19 infection.
{"title":"Preoperative COVID-19 infection increases risk for 60-day complications following total shoulder arthroplasty: a propensity-matched analysis","authors":"Shivan N. Chokshi BBA , Jeremy S. Somerson MD","doi":"10.1016/j.jse.2024.04.007","DOIUrl":"10.1016/j.jse.2024.04.007","url":null,"abstract":"<div><h3>Background</h3><div>Total shoulder arthroplasty (TSA) is an effective treatment for a wide range of shoulder pathologies. Literature investigating the impact of COVID-19 diagnosis on outcomes following TSA is limited. The objective of this study was to perform a retrospective multi-institutional database analysis to investigate the association between preoperative COVID-19 diagnosis and 60-day complications following TSA.</div></div><div><h3>Methods</h3><div>We queried the TriNetX database using Current Procedural Terminology and the International Classification of Diseases, Tenth Revision codes for patients who underwent a TSA from January 1, 2018 to July 1, 2023. Patients were categorized by those who had and those who did not have a diagnosis of COVID-19 within 30 days prior to surgery. The cohorts were matched based on age, gender, ethnicity, race, and past medical history. Chi-square analysis was performed to determine the relationship between COVID-19 diagnosis and 60-day postoperative complications including pneumonia, sepsis, emergency department (ED) visit, hospital admission, mortality, periprosthetic fracture, superficial wound infection, deep vein thrombosis (DVT), pulmonary embolism (PE), acute myocardial infarction, and revision surgery. The search results identified a total 63,768 patients who met study criteria. Of these patients, 7118 (11.08%) were diagnosed with COVID-19 within 30 days prior to their TSA procedure. Propensity score matching resulted in 6982 patients in each of the 2 cohorts.</div></div><div><h3>Results</h3><div>Patients with a recent COVID-19 diagnosis prior to surgery had 1.96 (<em>P</em> = .0005) times the odds of sepsis, 1.42 (<em>P</em> = .0032) times the odds of superficial wound infections, 1.42 (<em>P</em> < .0001) times the odds of DVT, 1.52 (<em>P</em> = .0001) times the odds of PE, 1.10 (<em>P</em> = .0249) and 1.79 (<em>P</em> < .0001) times the odds of ED visits and hospital admissions, respectively, and 3.10 (<em>P</em> < .0001) and 2.87 (<em>P</em> < .0001) times the odds of periprosthetic fracture and revision surgery within 60 days of TSA.</div></div><div><h3>Conclusions</h3><div>Our study suggests an increased risk of sepsis, ED visits, hospital admissions, periprosthetic fracture, superficial wound infection, DVT, PE, and revision surgery in TSA patients with a recent COVID-19 diagnosis. There may be significant benefit to closer monitoring and greater preventive measures to reduce the occurrence of postoperative complications in this setting. In addition, patients may benefit from postponing elective TSA procedures in the setting of a recent COVID-19 infection.</div></div>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"34 2","pages":"Pages 449-453"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141262888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jse.2024.05.007
Sebastian Lappen MD , Sebastian Siebenlist MD , Tim Leschinger MD , Pavel Kadantsev MD , Stephanie Geyer MD , Kilian Wegmann MD , Lars-Peter Müller MD , Michael Hackl MD
Background
Coronal shear fractures of the capitellum are rare injuries which can be challenging to treat. The aim of this study was to compare the biomechanical properties of different internal screw fixation techniques for Dubberley type IA fractures of the capitellum.
Methods
In this biomechanical study, Dubberley type IA fractures of the capitellum were created in 30 human fresh-frozen humeri. The specimens were then divided into 3 groups: fixation was either performed with 3 × 3.0 mm headless cannulated compression screws (HCCSs) in anteroposterior (AP) orientation (AP group), 3 × 3.0 mm HCCSs in posteroanterior (PA) orientation (PA group) or with 2 × 3.0 mm HCCSs in PA orientation and 1 × 3.0 mm HCCS in lateral orientation (LAT) group. Displacement under cyclic loading and ultimate load-to-failure were evaluated in all specimens.
Results
There was no significant difference in fragment displacement after 2000 cycles between AP and PA groups (0.8 ± 0.5 mm vs. 0.8 ± 0.6 mm; P = .987) or PA and LAT groups (0.8 ± 0.6 mm vs. 0.8 ± 0.3 mm; P = .966). LAT group showed the highest load-to-failure (548 ± 250 N) without reaching statistically significant difference to AP group (388 ± 173 N; P = .101). There was also no significant difference between AP and PA groups (388 ± 173 N vs. 422 ± 114 N; P = .649).
Conclusions
Variations in screw placement had no statistically significant influence on cyclic displacement or load-to-failure in Dubberley Type IA fractures. However, fracture fixation in 2 planes—both the coronal and the sagittal plane—by adding a screw in a lateral to medial direction may be beneficial to increase primary stability.
目的：帽状腱膜冠状剪切骨折是一种罕见的损伤，治疗难度很大。本研究旨在比较不同内螺丝固定技术治疗帽状腱膜 Dubberley IA 型骨折的生物力学特性：在这项生物力学研究中，我们在 30 个人体新鲜冷冻肱骨上创建了岬部 Dubberley IA 型骨折。然后将标本分为三组：使用 3 x 3.0 mm 无头套管加压螺钉（HCCS）在前胸（AP）方向进行固定（AP 组），使用 3 x 3.0 mm HCCS 在后前方（PA）方向进行固定（PA 组），或者使用 2 x 3.0 mm HCCS 在 PA 方向进行固定，使用 1 x 3.0 mm HCCS 在侧方进行固定（LAT 组）。对所有试样进行了循环加载下的位移和极限破坏荷载评估：AP组和PA组（0.8 ± 0.5 mm vs. 0.8 ± 0.6 mm; p = 0.987）或PA组和LAT组（0.8 ± 0.6 mm vs. 0.8 ± 0.3 mm; p = 0.966）在2000次循环后的碎片位移无明显差异。LAT 组显示出最高的失效载荷（548 ± 250 N），与 AP 组（388 ± 173 N；p = 0.101）相比无显著统计学差异。AP 组和 PA 组之间也无明显差异（388 ± 173 N vs. 422 ± 114 N；p = 0.649）：结论：螺钉位置的变化对 Dubberley IA 型骨折的循环位移或加载到破坏的影响没有统计学意义。然而，在两个平面（冠状面和矢状面）上进行骨折固定，在外侧到内侧的方向上增加一颗螺钉，可能有利于增加原发性稳定性。
{"title":"Optimal screw orientation for fixation of coronal shear fractures: a biomechanical comparison","authors":"Sebastian Lappen MD , Sebastian Siebenlist MD , Tim Leschinger MD , Pavel Kadantsev MD , Stephanie Geyer MD , Kilian Wegmann MD , Lars-Peter Müller MD , Michael Hackl MD","doi":"10.1016/j.jse.2024.05.007","DOIUrl":"10.1016/j.jse.2024.05.007","url":null,"abstract":"<div><h3>Background</h3><div>Coronal shear fractures of the capitellum are rare injuries which can be challenging to treat. The aim of this study was to compare the biomechanical properties of different internal screw fixation techniques for Dubberley type IA fractures of the capitellum.</div></div><div><h3>Methods</h3><div>In this biomechanical study, Dubberley type IA fractures of the capitellum were created in 30 human fresh-frozen humeri. The specimens were then divided into 3 groups: fixation was either performed with 3 × 3.0 mm headless cannulated compression screws (HCCSs) in anteroposterior (AP) orientation (AP group), 3 × 3.0 mm HCCSs in posteroanterior (PA) orientation (PA group) or with 2 × 3.0 mm HCCSs in PA orientation and 1 × 3.0 mm HCCS in lateral orientation (LAT) group. Displacement under cyclic loading and ultimate load-to-failure were evaluated in all specimens.</div></div><div><h3>Results</h3><div>There was no significant difference in fragment displacement after 2000 cycles between AP and PA groups (0.8 ± 0.5 mm vs. 0.8 ± 0.6 mm; <em>P</em> = .987) or PA and LAT groups (0.8 ± 0.6 mm vs. 0.8 ± 0.3 mm; <em>P</em> = .966). LAT group showed the highest load-to-failure (548 ± 250 N) without reaching statistically significant difference to AP group (388 ± 173 N; <em>P</em> = .101). There was also no significant difference between AP and PA groups (388 ± 173 N vs. 422 ± 114 N; <em>P</em> = .649).</div></div><div><h3>Conclusions</h3><div>Variations in screw placement had no statistically significant influence on cyclic displacement or load-to-failure in Dubberley Type IA fractures. However, fracture fixation in 2 planes—both the coronal and the sagittal plane—by adding a screw in a lateral to medial direction may be beneficial to increase primary stability.</div></div>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"34 2","pages":"Pages 543-549"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141472112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jse.2024.07.010
Justin T. Childers MS , Christopher W. Haff BS , Benjamin T. Lack BS , Jessica M. Forbes MS , Garrett R. Jackson MD , Vani J. Sabesan MD
Background
As orthopedic surgery becomes increasingly competitive, orthopedic surgeons are now pursuing advanced degrees more frequently to enhance their resumes or gain additional expertise. The specific impact of this additional training and education on a surgeon's career trajectory is not well defined. The purpose of this study was to understand the impact of an advanced degree on the academic career of orthopedic shoulder and elbow surgeons.
Methods
Orthopedic shoulder and elbow fellowship-trained surgeons were identified using the directory listed on the American Shoulder and Elbow Surgeons website. Demographics, education, and current professional roles were obtained. Research productivity was obtained using SCOPUS and Google Scholar. Advanced degrees were defined as those additional to the primary medical degree (Doctor of Medicine or Doctor of Osteopathic Medicine). Outcome measures collected included timing of advanced degree obtainment, current academic and leadership roles, leadership on journal editorial boards, and research productivity. Statistical analysis was performed using the chi-square test and Mann-Whitney U test to determine the association of advanced degrees on outcome measures.
Results
In total, 893 orthopedic shoulder and elbow surgeons were identified, of whom 129 had advanced degrees. Most common advanced degrees included Master of Science (43%), Master of Business Administration (23%), and Doctor of Philosophy (13%). The most common period of degree obtainment was before medical school (35%) with the least common times being after medical school/before residency (0.9%) and between residency and fellowship training (0.9%). Surgeons who held advanced degrees demonstrated greater research productivity, with a higher h-index (P < .001), a greater number of citations (P < .001), and more publications (P < .001). Of the 523 shoulder and elbow surgeons who worked at an academic institution, those holding advanced degrees were more likely to serve as orthopedic department chair (P < .001) and serve an editorial board position (<0.001).
Conclusion
This study found that having an advanced degree as an orthopedic shoulder and elbow surgeon was linked to higher research impact and productivity and an increased likelihood of becoming a department chair and holding an editorial position. These significant findings can help future trainees and department leadership in understanding the importance and impact of additional training on career trajectories for academic faculty.
{"title":"Does an additional advanced degree influence career trajectory as a shoulder and elbow surgeon?","authors":"Justin T. Childers MS , Christopher W. Haff BS , Benjamin T. Lack BS , Jessica M. Forbes MS , Garrett R. Jackson MD , Vani J. Sabesan MD","doi":"10.1016/j.jse.2024.07.010","DOIUrl":"10.1016/j.jse.2024.07.010","url":null,"abstract":"<div><h3>Background</h3><div>As orthopedic surgery becomes increasingly competitive, orthopedic surgeons are now pursuing advanced degrees more frequently to enhance their resumes or gain additional expertise. The specific impact of this additional training and education on a surgeon's career trajectory is not well defined. The purpose of this study was to understand the impact of an advanced degree on the academic career of orthopedic shoulder and elbow surgeons.</div></div><div><h3>Methods</h3><div>Orthopedic shoulder and elbow fellowship-trained surgeons were identified using the directory listed on the American Shoulder and Elbow Surgeons website. Demographics, education, and current professional roles were obtained. Research productivity was obtained using SCOPUS and Google Scholar. Advanced degrees were defined as those additional to the primary medical degree (Doctor of Medicine or Doctor of Osteopathic Medicine). Outcome measures collected included timing of advanced degree obtainment, current academic and leadership roles, leadership on journal editorial boards, and research productivity. Statistical analysis was performed using the chi-square test and Mann-Whitney <em>U</em> test to determine the association of advanced degrees on outcome measures.</div></div><div><h3>Results</h3><div>In total, 893 orthopedic shoulder and elbow surgeons were identified, of whom 129 had advanced degrees. Most common advanced degrees included Master of Science (43%), Master of Business Administration (23%), and Doctor of Philosophy (13%). The most common period of degree obtainment was before medical school (35%) with the least common times being after medical school/before residency (0.9%) and between residency and fellowship training (0.9%). Surgeons who held advanced degrees demonstrated greater research productivity, with a higher h-index (<em>P</em> < .001), a greater number of citations (<em>P</em> < .001), and more publications (<em>P</em> < .001). Of the 523 shoulder and elbow surgeons who worked at an academic institution, those holding advanced degrees were more likely to serve as orthopedic department chair (<em>P</em> < .001) and serve an editorial board position (<0.001).</div></div><div><h3>Conclusion</h3><div>This study found that having an advanced degree as an orthopedic shoulder and elbow surgeon was linked to higher research impact and productivity and an increased likelihood of becoming a department chair and holding an editorial position. These significant findings can help future trainees and department leadership in understanding the importance and impact of additional training on career trajectories for academic faculty.</div></div>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"34 2","pages":"Pages e112-e118"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jse.2024.07.022
Kathrin Kaeppler MD , Annabel R. Geissbuhler BS , Joan C. Rutledge BS , Grant J. Dornan MS , Conor A. Wallace BS , Randall W. Viola MD
Background
The treatment of complex radial head fractures remains controversial with open reduction and internal fixation (ORIF), radial head arthroplasty, and radial head excision being the most common treatment options. While ORIF is the preferred treatment strategy for Mason type II fractures, the optimal treatment of Mason type III fractures is debated. The purpose of this study was to report minimum 10-year outcomes after ORIF of Mason type II and type III radial head fractures. We hypothesized that both Mason Type II and Type III fracture patients would demonstrate satisfactory clinical outcomes at minimum 10-year follow-up.
Methods
All patients with Mason type II or III radial head fractures who were treated with ORIF by a single surgeon between 2005 and 2010 were included. Fractures with significant bone defects were treated with bone grafts and elbow ligament injuries were treated with either primary ligament repair or reconstruction. Patient reported outcome questionnaires were administered at the time of last clinical follow-up and at a minimum of 10 years postoperatively.
Results
Twenty-four patients, including 13 male and 11 female patients with an average age of 39 (range 19-60) at the time of surgery met inclusion criteria. Thirteen patients suffered from Mason type II and 11 patients from Mason type III fractures. At initial follow-up, 21 out of 24 fractures (88%) demonstrated radiographic union. Three nonunions, 2 of which were Mason type III fractures, were treated with revision ORIF and iliac crest bone grafting. 11 patients developed postoperative elbow stiffness and required capsular release surgery. At last clinical follow-up, average flexion was 139°, average extension was 4°, average supination was 77°, and average pronation was 81°. The median Disabilities of the Arm, Shoulder and Hand score was 7 (ranging from 0 to 32). Minimum 10-year follow-up (mean: 14.6 years) was collected on 18 of 24 (75%) of the patients. At a minimum of 10 years postoperatively, the median QuickDASH score was 4.5 (range: 0 to 25) and the median SANE score was 96.5 (range: 75-100). Median satisfaction with the surgical outcome was 10 of 10 (range: 3-10).
Conclusion
ORIF of Mason type II and III radial head fractures results in high union rates with good functional outcomes at a mean of 14.6 years postoperatively. The study results suggest that ORIF of Mason type II and III radial head fractures leads to long-term positive functional outcomes.
{"title":"Minimum 10-year follow-up after open reduction and internal fixation of radial head fractures Mason type II and III","authors":"Kathrin Kaeppler MD , Annabel R. Geissbuhler BS , Joan C. Rutledge BS , Grant J. Dornan MS , Conor A. Wallace BS , Randall W. Viola MD","doi":"10.1016/j.jse.2024.07.022","DOIUrl":"10.1016/j.jse.2024.07.022","url":null,"abstract":"<div><h3>Background</h3><div>The treatment of complex radial head fractures remains controversial with open reduction and internal fixation (ORIF), radial head arthroplasty, and radial head excision being the most common treatment options. While ORIF is the preferred treatment strategy for Mason type II fractures, the optimal treatment of Mason type III fractures is debated. The purpose of this study was to report minimum 10-year outcomes after ORIF of Mason type II and type III radial head fractures. We hypothesized that both Mason Type II and Type III fracture patients would demonstrate satisfactory clinical outcomes at minimum 10-year follow-up.</div></div><div><h3>Methods</h3><div>All patients with Mason type II or III radial head fractures who were treated with ORIF by a single surgeon between 2005 and 2010 were included. Fractures with significant bone defects were treated with bone grafts and elbow ligament injuries were treated with either primary ligament repair or reconstruction. Patient reported outcome questionnaires were administered at the time of last clinical follow-up and at a minimum of 10 years postoperatively.</div></div><div><h3>Results</h3><div>Twenty-four patients, including 13 male and 11 female patients with an average age of 39 (range 19-60) at the time of surgery met inclusion criteria. Thirteen patients suffered from Mason type II and 11 patients from Mason type III fractures. At initial follow-up, 21 out of 24 fractures (88%) demonstrated radiographic union. Three nonunions, 2 of which were Mason type III fractures, were treated with revision ORIF and iliac crest bone grafting. 11 patients developed postoperative elbow stiffness and required capsular release surgery. At last clinical follow-up, average flexion was 139°, average extension was 4°, average supination was 77°, and average pronation was 81°. The median Disabilities of the Arm, Shoulder and Hand score was 7 (ranging from 0 to 32). Minimum 10-year follow-up (mean: 14.6 years) was collected on 18 of 24 (75%) of the patients. At a minimum of 10 years postoperatively, the median QuickDASH score was 4.5 (range: 0 to 25) and the median SANE score was 96.5 (range: 75-100). Median satisfaction with the surgical outcome was 10 of 10 (range: 3-10).</div></div><div><h3>Conclusion</h3><div>ORIF of Mason type II and III radial head fractures results in high union rates with good functional outcomes at a mean of 14.6 years postoperatively. The study results suggest that ORIF of Mason type II and III radial head fractures leads to long-term positive functional outcomes.</div></div>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"34 2","pages":"Pages 531-542"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142121006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jse.2024.08.019
Grace Bennfors MD, John W. Moore BS, Alexander S. Guareschi MD, Brandon L. Rogalski MD, Josef K. Eichinger MD, Richard J. Friedman MD, FRCSC
Background
The Hospital Frailty Risk Score (HFRS) has demonstrated strong correlation with adverse outcomes in various joint replacement surgeries, yet its applicability in total elbow arthroplasty (TEA) remains unexplored. The purpose of this study is to assess the association between HFRS and postoperative complications following elective primary TEA.
Methods
The Nationwide Readmissions Database was queried to identify patients undergoing primary TEA from 2016-2020. The HFRS was used to compare medical, surgical, and clinical outcomes of frail vs. nonfrail patients. Mean and relative costs, total hospital length of stay, and discharge disposition for frail and nonfrail patients were also compared.
Results
We identified 2049 primary TEA in frail patients and 3693 in nonfrail patients. Frail patients had increased complication rates including acute respiratory failure (13.6% vs. 1.1%; P < .001), urinary tract infections (12.3% vs. 0.0%; P < .001), transfusions (3.9% vs. 1.1%; P < .001), pneumonia (1.1% vs. 0.2%; P < .001), acute respiratory distress syndrome (3.2% vs. 0.6%; P < .001), sepsis (0.7% vs. 0.1%; P < .001), and hardware failure (1.2% vs. 0.1%; P < .001). Frail patients also experienced higher rates of readmission (37% vs. 25%; P < .001) and death (1.7% vs. 0.2%; P < .001), while being less likely to undergo revision (6.5% vs. 17%; P < .001). Frail patients incurred higher health-care costs ($28,497 vs. $23,377; P < .001) and longer length of stay (5.3 days vs. 2.6 days; P < .001), with reduced likelihood of routine hospital stays (36% vs. 71%; P < .001) and increased utilization of short-term hospitalization (P < .001), care facilities (P < .001), and home health-care services (P < .001).
Conclusion
HFRS is a validated indicator of frailty and is strongly associated with increased rates of complications in patients undergoing elective primary TEA. These findings should be considered by orthopedic surgeons when assessing surgical candidacy and discussing treatment options in this at-risk patient population.
背景：医院虚弱风险评分（HFRS）已被证明与各种关节置换手术的不良预后密切相关，但其在全肘关节置换术（TEA）中的适用性仍有待探索。本研究旨在评估 HFRS 与选择性初级 TEA 术后并发症之间的关系：方法：查询全国再入院数据库，以确定 2016 年至 2020 年期间接受初级 TEA 的患者。HFRS 用于比较体弱与非体弱患者的内科、外科和临床结果。此外，还比较了体弱和非体弱患者的平均和相对费用、总住院时间（LOS）和出院处置：我们在体弱患者中发现了 2,049 例原发性 TEA，在非体弱患者中发现了 3,693 例原发性 TEA。体弱患者的并发症发生率增加，包括急性呼吸衰竭（13.6% vs. 1.1%；p < 0.001）、尿路感染（12.3% vs. 0.0%；p < 0.001）、输血（3.9% vs. 1.1%；P < 0.001）、肺炎（1.1% vs. 0.2%；P < 0.001）、急性呼吸窘迫综合征（3.2% vs. 0.6%；P < 0.001）、败血症（0.7% vs. 0.1%；P < 0.001）和硬件衰竭（1.2% vs. 0.1%；P < 0.001）。体弱患者的再入院率（37% vs. 25%; p < 0.001）和死亡率（1.7% vs. 0.2%; p < 0.001）也较高，但进行翻修的可能性较低（6.5% vs. 17%; p < 0.001）。体弱患者的医疗费用更高（28,497美元对23,377美元；p < 0.001），住院时间更长（5.3天对2.6天；p < 0.001），常规住院的可能性更低（36%对71%；p < 0.001），短期住院（p < 0.001）、护理机构（p < 0.001）和家庭医疗服务（p < 0.001）的使用率更高：结论：HFRS是一项有效的虚弱指标，与接受择期原发性TEA手术的患者并发症发生率增加密切相关。骨科医生在评估手术候选资格和讨论这类高危患者的治疗方案时应考虑这些发现。
{"title":"Impact of the hospital frailty risk score on outcomes following primary total elbow arthroplasty","authors":"Grace Bennfors MD, John W. Moore BS, Alexander S. Guareschi MD, Brandon L. Rogalski MD, Josef K. Eichinger MD, Richard J. Friedman MD, FRCSC","doi":"10.1016/j.jse.2024.08.019","DOIUrl":"10.1016/j.jse.2024.08.019","url":null,"abstract":"<div><h3>Background</h3><div>The Hospital Frailty Risk Score (HFRS) has demonstrated strong correlation with adverse outcomes in various joint replacement surgeries, yet its applicability in total elbow arthroplasty (TEA) remains unexplored. The purpose of this study is to assess the association between HFRS and postoperative complications following elective primary TEA.</div></div><div><h3>Methods</h3><div>The Nationwide Readmissions Database was queried to identify patients undergoing primary TEA from 2016-2020. The HFRS was used to compare medical, surgical, and clinical outcomes of frail vs. nonfrail patients. Mean and relative costs, total hospital length of stay, and discharge disposition for frail and nonfrail patients were also compared.</div></div><div><h3>Results</h3><div>We identified 2049 primary TEA in frail patients and 3693 in nonfrail patients. Frail patients had increased complication rates including acute respiratory failure (13.6% vs. 1.1%; <em>P</em> < .001), urinary tract infections (12.3% vs. 0.0%; <em>P</em> < .001), transfusions (3.9% vs. 1.1%; <em>P</em> < .001), pneumonia (1.1% vs. 0.2%; <em>P</em> < .001), acute respiratory distress syndrome (3.2% vs. 0.6%; <em>P</em> < .001), sepsis (0.7% vs. 0.1%; <em>P</em> < .001), and hardware failure (1.2% vs. 0.1%; <em>P</em> < .001). Frail patients also experienced higher rates of readmission (37% vs. 25%; <em>P</em> < .001) and death (1.7% vs. 0.2%; <em>P</em> < .001), while being less likely to undergo revision (6.5% vs. 17%; <em>P</em> < .001). Frail patients incurred higher health-care costs ($28,497 vs. $23,377; <em>P</em> < .001) and longer length of stay (5.3 days vs. 2.6 days; <em>P</em> < .001), with reduced likelihood of routine hospital stays (36% vs. 71%; <em>P</em> < .001) and increased utilization of short-term hospitalization (<em>P</em> < .001), care facilities (<em>P</em> < .001), and home health-care services (<em>P</em> < .001).</div></div><div><h3>Conclusion</h3><div>HFRS is a validated indicator of frailty and is strongly associated with increased rates of complications in patients undergoing elective primary TEA. These findings should be considered by orthopedic surgeons when assessing surgical candidacy and discussing treatment options in this at-risk patient population.</div></div>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"34 2","pages":"Pages 525-530"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shoulder arthroplasty revision is associated with a high prevalence of prosthetic infection, and diagnosis remains difficult. The primary aim of the study was to determine the diagnostic accuracy of percutaneous synovial biopsy (PSB) and joint aspiration compared with open culture results in detecting infection in revision shoulder arthroplasty. The second aim was to determine whether biopsy location within the shoulder was associated with culture status.
Methods
This was a multicenter prospective cohort study involving 4 sites and 69 patients undergoing revision shoulder arthroplasty. The cohort was 57% female with a mean age of 64 years. Preoperative fluoroscopic-guided PSBs and aspirations were carried out by a musculoskeletal radiologist before revision shoulder arthroplasty. The original prostheses consisted of hemiarthroplasties, total shoulder arthroplasties (TSAs), resurfacing TSA, reverse shoulder arthroplasties (RSAs), and antibiotic spacers. Six synovial tissue biopsies from separate regions in the shoulder were obtained both preoperatively and intraoperatively. The shoulder joint was aspirated, and synovial fluid collected, if available. Infection was considered positive in the setting of 2 or more matching positive cultures. The PSB cultures were considered “true positive” if the PSB cultures matched the open biopsy cultures.
Results
Nineteen percent had positive infection based on PSB, and 23% had confirmed culture-positive infections based on intraoperative biopsy. The diagnostic accuracy of PSB compared with open biopsy was as follows: sensitivity 0.37 (95% confidence interval [CI] 0.13-0.61), specificity 0.81 (95% CI 0.7-0.91), positive predictive value 0.37 (95% CI 0.13-0.61), negative predictive value 0.81 (95% CI 0.70-0.91), positive likelihood ratio 1.98, and negative likelihood ratio 0.77. Of the 71 patients from whom aspirates were collected, aspiration yielded synovial fluid in 33 patients. Preoperative aspiration detected no infections confirmed positive by open biopsy and correctly identified 81% of absent infections. The diagnostic accuracy of aspiration compared with open biopsy was as follows: sensitivity 0%, specificity 0.81 (95% CI 0.66-0.96), positive predictive value 0%, and negative predictive value 0.78 (95% CI 0.63-0.93). Biopsy location within the shoulder was not associated with infection status.
Discussion
Preoperative aspiration detected none of the infections proven positive via open biopsy. Although PSB was superior to synovial fluid aspirate, poor likelihood ratios suggest that PSB is not useful as an isolated test in the preoperative workup of the potentially infected patient. Biopsy location was not associated with culture status suggesting that the capsule is uniformly infected, and the location of tissue biopsies does not appear to matter.
背景：肩关节置换术翻修与假体感染的高发病率有关，但诊断仍然很困难。本研究的主要目的是确定经皮滑膜活检（PSB）和关节抽吸与开放培养结果相比，在检测肩关节翻修术感染方面的诊断准确性。第二个目的是确定肩部活检位置是否与培养结果有关：这是一项多中心前瞻性队列研究，涉及四个研究机构和 69 名接受翻修肩关节置换术的患者。57%的患者为女性，平均年龄为64岁。翻修肩关节置换术前，由一名肌肉骨骼放射科医生在透视引导下进行PSB检查和抽吸。原始假体包括半关节置换术、全肩关节置换术（TSA）、肩关节再植术（TSA）、反向肩关节置换术（RSA）和抗生素垫片。术前和术中分别从肩关节的不同区域获取了六份滑膜组织活检样本。对肩关节进行抽吸，并收集滑液（如有）。如果出现两个或两个以上匹配的阳性培养物，则认为感染呈阳性。如果PSB培养结果与开放活检培养结果一致，则认为PSB培养结果为 "真阳性"：结果：根据 PSB 结果，19% 的患者感染呈阳性，23% 的患者根据术中活检结果确认感染培养呈阳性。与开放活检相比，PSB 的诊断准确性如下：敏感性 0.37（95% CI 0.13-0.61），特异性 0.81（95% CI 0.7-0.91），阳性预测值 0.37（95% CI 0.13-0.61），阴性预测值 0.81（95% CI 0.70-0.91），阳性似然比 1.98，阴性似然比 0.77。在 71 例患者中，33 例患者抽出了滑膜液。术前抽液未发现经开放活检证实为阳性的感染，正确识别了81%的缺失感染。与开放活检相比，抽吸术的诊断准确性如下：敏感性 0%，特异性 0.81（95% CI 0.66-0.96），阳性预测值 0%，阴性预测值 0.78（95% CI 0.63-0.93）。肩部活检位置与感染状况无关：讨论：术前抽吸没有发现任何经开放活检证实为阳性的感染。尽管PSB优于滑膜液抽吸，但较低的似然比表明，PSB作为一种单独的检测方法在潜在感染患者的术前检查中并不实用。活检位置与培养状态无关，这表明关节囊受到的感染是一致的，组织活检的位置似乎也无关紧要。
{"title":"Diagnostic accuracy of preoperative percutaneous synovial biopsy and aspirate compared with open biopsy for prosthetic shoulder infections","authors":"Peter Lapner MD, FRCSC , Diane Nam MSc, MD, FRCSC , Amar Cheema MD, FRCSC , Adnan Sheikh MD , Taryn Hodgdon MD, FRCPC , J Whitcomb Pollock MSc, MD, FRCSC , Tim Ramsay PhD , Elham Sabri MSc , Darren Drosdowech MD, FRCSC , Katie McIlquham MSc , Baldwin Toye MD, FRCPC , Dominique Rouleau MD, FRCSC","doi":"10.1016/j.jse.2024.08.016","DOIUrl":"10.1016/j.jse.2024.08.016","url":null,"abstract":"<div><h3>Background</h3><div>Shoulder arthroplasty revision is associated with a high prevalence of prosthetic infection, and diagnosis remains difficult. The primary aim of the study was to determine the diagnostic accuracy of percutaneous synovial biopsy (PSB) and joint aspiration compared with open culture results in detecting infection in revision shoulder arthroplasty. The second aim was to determine whether biopsy location within the shoulder was associated with culture status.</div></div><div><h3>Methods</h3><div>This was a multicenter prospective cohort study involving 4 sites and 69 patients undergoing revision shoulder arthroplasty. The cohort was 57% female with a mean age of 64 years. Preoperative fluoroscopic-guided PSBs and aspirations were carried out by a musculoskeletal radiologist before revision shoulder arthroplasty. The original prostheses consisted of hemiarthroplasties, total shoulder arthroplasties (TSAs), resurfacing TSA, reverse shoulder arthroplasties (RSAs), and antibiotic spacers. Six synovial tissue biopsies from separate regions in the shoulder were obtained both preoperatively and intraoperatively. The shoulder joint was aspirated, and synovial fluid collected, if available. Infection was considered positive in the setting of 2 or more matching positive cultures. The PSB cultures were considered “true positive” if the PSB cultures matched the open biopsy cultures.</div></div><div><h3>Results</h3><div>Nineteen percent had positive infection based on PSB, and 23% had confirmed culture-positive infections based on intraoperative biopsy. The diagnostic accuracy of PSB compared with open biopsy was as follows: sensitivity 0.37 (95% confidence interval [CI] 0.13-0.61), specificity 0.81 (95% CI 0.7-0.91), positive predictive value 0.37 (95% CI 0.13-0.61), negative predictive value 0.81 (95% CI 0.70-0.91), positive likelihood ratio 1.98, and negative likelihood ratio 0.77. Of the 71 patients from whom aspirates were collected, aspiration yielded synovial fluid in 33 patients. Preoperative aspiration detected no infections confirmed positive by open biopsy and correctly identified 81% of absent infections. The diagnostic accuracy of aspiration compared with open biopsy was as follows: sensitivity 0%, specificity 0.81 (95% CI 0.66-0.96), positive predictive value 0%, and negative predictive value 0.78 (95% CI 0.63-0.93). Biopsy location within the shoulder was not associated with infection status.</div></div><div><h3>Discussion</h3><div>Preoperative aspiration detected none of the infections proven positive via open biopsy. Although PSB was superior to synovial fluid aspirate, poor likelihood ratios suggest that PSB is not useful as an isolated test in the preoperative workup of the potentially infected patient. Biopsy location was not associated with culture status suggesting that the capsule is uniformly infected, and the location of tissue biopsies does not appear to matter.</div></div>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"34 2","pages":"Pages 441-448"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jse.2024.07.049
Kiera Lunn BS , Eoghan T. Hurley MB, MCh, PhD , Kwabena Adu-Kwarteng BA , Jessica M. Welch BS , Jay M. Levin MD, MBA , Oke Anakwenze MD, MBA , Yaw Boachie-Adjei MD , Christopher S. Klifto MD
Hypothesis
The purpose of this study was to systematically review complications arising from intramedullary nailing (IMN) of proximal and humeral shaft fractures. This study hypothesized that there would be a low rate of complications and revision among patients treated with IMN for humerus fractures.
Methods
Two independent reviewers performed a literature search in the PubMed database based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were included if they reported on outcomes following the use of intramedullary nails for proximal humerus fractures or humeral shaft fractures. Variables that were collected included complications, visual analog scale pain scores and revision operations.
Results
Overall, 179 studies met the inclusion criteria, with 7984 shoulders. The average age of patients in this study was 55.2 years and 60.7% of patients were female. The mean follow-up was 16.6 months. The overall complication rate for all fractures treated with intramedullary nails was 18.9%, and the overall revision rate was 6.8%. Among the complications were fracture complications (7.5%), hardware complications (7.2%), soft tissue complications (1.8%), neurovascular complications (1.6%), and infection (0.8%). Four-part proximal humerus fractures (52.9%) and open fractures (36.7%) had the highest rates of complication. Among the reasons for revision were hardware removal or replacement (5.0%), conversion to arthroplasty (0.6%), and other (1.2%). The mean visual analog scale pain score at last follow-up was 1.6.
Conclusion
Overall, there was a moderate rate of complications but low rate of revision following IMN of humerus fractures. Open fractures and 4-part proximal humerus fractures had the highest complication rates.
假设：本研究旨在系统回顾髓内钉（IMN）治疗肱骨近端和肱骨轴骨折引起的并发症。本研究假设肱骨骨折髓内钉治疗患者的并发症和翻修率较低：两位独立审稿人根据《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）指南在 PubMed 数据库中进行了文献检索。如果研究报告了使用髓内钉治疗肱骨近端骨折或肱骨轴骨折后的结果，则纳入该研究。收集的变量包括并发症、视觉模拟量表（VAS）疼痛评分和翻修手术：共有 179 项研究符合纳入标准，涉及 7984 个肩部。研究中患者的平均年龄为 55.2 岁，60.7% 的患者为女性。平均随访时间为 16.6 个月。使用髓内钉治疗的所有骨折的总并发症发生率为 18.9%，总翻修率为 6.8%。并发症包括骨折并发症（7.5%）、硬件并发症（7.2%）、软组织并发症（1.8%）、神经血管并发症（1.6%）和感染（0.8%）。肱骨近端四部分骨折（52.9%）和开放性骨折（36.7%）的并发症发生率最高。翻修的原因包括硬件移除或更换（5.0%）、改用关节成形术（0.6%）和其他（1.2%）。最后一次随访时的平均 VAS 疼痛评分为 1.6：总体而言，肱骨骨折IMN术后并发症发生率适中，但翻修率较低。开放性骨折和肱骨近端4部分骨折的并发症发生率最高。
{"title":"Complications following intramedullary nailing of proximal humerus and humeral shaft fractures: a systematic review","authors":"Kiera Lunn BS , Eoghan T. Hurley MB, MCh, PhD , Kwabena Adu-Kwarteng BA , Jessica M. Welch BS , Jay M. Levin MD, MBA , Oke Anakwenze MD, MBA , Yaw Boachie-Adjei MD , Christopher S. Klifto MD","doi":"10.1016/j.jse.2024.07.049","DOIUrl":"10.1016/j.jse.2024.07.049","url":null,"abstract":"<div><h3>Hypothesis</h3><div>The purpose of this study was to systematically review complications arising from intramedullary nailing (IMN) of proximal and humeral shaft fractures. This study hypothesized that there would be a low rate of complications and revision among patients treated with IMN for humerus fractures.</div></div><div><h3>Methods</h3><div>Two independent reviewers performed a literature search in the PubMed database based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were included if they reported on outcomes following the use of intramedullary nails for proximal humerus fractures or humeral shaft fractures. Variables that were collected included complications, visual analog scale pain scores and revision operations.</div></div><div><h3>Results</h3><div>Overall, 179 studies met the inclusion criteria, with 7984 shoulders. The average age of patients in this study was 55.2 years and 60.7% of patients were female. The mean follow-up was 16.6 months. The overall complication rate for all fractures treated with intramedullary nails was 18.9%, and the overall revision rate was 6.8%. Among the complications were fracture complications (7.5%), hardware complications (7.2%), soft tissue complications (1.8%), neurovascular complications (1.6%), and infection (0.8%). Four-part proximal humerus fractures (52.9%) and open fractures (36.7%) had the highest rates of complication. Among the reasons for revision were hardware removal or replacement (5.0%), conversion to arthroplasty (0.6%), and other (1.2%). The mean visual analog scale pain score at last follow-up was 1.6.</div></div><div><h3>Conclusion</h3><div>Overall, there was a moderate rate of complications but low rate of revision following IMN of humerus fractures. Open fractures and 4-part proximal humerus fractures had the highest complication rates.</div></div>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"34 2","pages":"Pages 626-638"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jse.2024.08.020
Nathan H. Varady MD, MBA , Joshua T. Bram MD , Jarred Chow BA , Samuel A. Taylor MD , Joshua S. Dines MD , Michael C. Fu MD, MHS , Gabriella E. Ode MD , David M. Dines MD , Lawrence V. Gulotta MD , Christopher M. Brusalis MD
Background
Glenoid version is a critical anatomic parameter relied upon by many surgeons to inform preoperative planning for shoulder arthroplasty. Advancements in imaging technology have prompted measurements of glenoid version on various imaging modalities with different techniques. However, discrepancies in how glenoid version is measured within the literature have not been well characterized.
Methods
A literature search was performed by querying PubMed, EMBASE, CINAHL, and Cochrane computerized databases from their inception through December 2023 to identify studies that assessed the relationship between preoperative glenoid version and at least one clinical or radiologic outcome following shoulder arthroplasty. Study quality was assessed via the Methodologic Index for Nonrandomized Studies criteria. Imaging modalities and techniques for measuring glenoid version, along with their association with clinical outcomes, were aggregated.
Results
Among 61 studies encompassing 17,070 shoulder arthroplasties, 27 studies (44.3%) described explicitly how glenoid version was measured. The most common imaging modality to assess preoperative glenoid version was computed tomography (CT) (63.9%), followed by radiography (23%); 11.5% of studies used a combination of imaging modalities within their study cohort. Among the studies using CT, 56.5% utilized two-dimensional (2D) CT, 41.3% utilized three-dimensional (3D) CT, and 2.2% used a combination of 2D and 3D CT. The use of 3D CT increased from 12.5% of studies in 2012-2014 to 25% of studies in 2018-2020 to 52% of studies in 2021-2023 (ptrend = 0.02). Forty-three (70.5%) studies measured postoperative version, most commonly on axillary radiograph (22 [51.2%]); 34.9% of these studies used different imaging modalities to assess pre- and postoperative version.
Conclusions
This systematic review revealed marked discrepancies in how glenoid version was measured and reported in studies pertaining to shoulder arthroplasty. A temporal trend of increased utilization of 3D CT scans and commercial preoperative planning software was identified. Improved standardization of the imaging modality and technique for measuring glenoid version will enable more rigorous evaluation of its impact on clinical outcomes.
{"title":"Inconsistencies in measuring glenoid version in shoulder arthroplasty: a systematic review","authors":"Nathan H. Varady MD, MBA , Joshua T. Bram MD , Jarred Chow BA , Samuel A. Taylor MD , Joshua S. Dines MD , Michael C. Fu MD, MHS , Gabriella E. Ode MD , David M. Dines MD , Lawrence V. Gulotta MD , Christopher M. Brusalis MD","doi":"10.1016/j.jse.2024.08.020","DOIUrl":"10.1016/j.jse.2024.08.020","url":null,"abstract":"<div><h3>Background</h3><div>Glenoid version is a critical anatomic parameter relied upon by many surgeons to inform preoperative planning for shoulder arthroplasty. Advancements in imaging technology have prompted measurements of glenoid version on various imaging modalities with different techniques. However, discrepancies in how glenoid version is measured within the literature have not been well characterized.</div></div><div><h3>Methods</h3><div>A literature search was performed by querying PubMed, EMBASE, CINAHL, and Cochrane computerized databases from their inception through December 2023 to identify studies that assessed the relationship between preoperative glenoid version and at least one clinical or radiologic outcome following shoulder arthroplasty. Study quality was assessed via the Methodologic Index for Nonrandomized Studies criteria. Imaging modalities and techniques for measuring glenoid version, along with their association with clinical outcomes, were aggregated.</div></div><div><h3>Results</h3><div>Among 61 studies encompassing 17,070 shoulder arthroplasties, 27 studies (44.3%) described explicitly how glenoid version was measured. The most common imaging modality to assess preoperative glenoid version was computed tomography (CT) (63.9%), followed by radiography (23%); 11.5% of studies used a combination of imaging modalities within their study cohort. Among the studies using CT, 56.5% utilized two-dimensional (2D) CT, 41.3% utilized three-dimensional (3D) CT, and 2.2% used a combination of 2D and 3D CT. The use of 3D CT increased from 12.5% of studies in 2012-2014 to 25% of studies in 2018-2020 to 52% of studies in 2021-2023 (p<sub>trend</sub> = 0.02). Forty-three (70.5%) studies measured postoperative version, most commonly on axillary radiograph (22 [51.2%]); 34.9% of these studies used different imaging modalities to assess pre- and postoperative version.</div></div><div><h3>Conclusions</h3><div>This systematic review revealed marked discrepancies in how glenoid version was measured and reported in studies pertaining to shoulder arthroplasty. A temporal trend of increased utilization of 3D CT scans and commercial preoperative planning software was identified. Improved standardization of the imaging modality and technique for measuring glenoid version will enable more rigorous evaluation of its impact on clinical outcomes.</div></div>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"34 2","pages":"Pages 639-649"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jse.2024.04.022
Erick M. Marigi MD , Jacob F. Oeding MS , Micah Nieboer MD , Ian M. Marigi BA , Brian Wahlig MD , Jonathan D. Barlow MD , Joaquin Sanchez-Sotelo MD, PhD , John W. Sperling MD, MBA
Background
Technological advancements in implant design and surgical technique have focused on diminishing complications and optimizing performance of reverse shoulder arthroplasty (rTSA). Despite this, there remains a paucity of literature correlating prosthetic features and clinical outcomes. This investigation utilized a machine learning approach to evaluate the effect of select implant design features and patient-related factors on surgical complications after rTSA.
Methods
Over a 16-year period (2004-2020), all primary rTSA performed at a single institution for elective and traumatic indications with a minimum follow-up of 2 years were identified. Parameters related to implant design evaluated in this study included inlay vs. onlay humeral bearing design, glenoid lateralization (medialized or lateralized), humeral lateralization (medialized, minimally lateralized, or lateralized), global lateralization (medialized, minimally lateralized, lateralized, highly lateralized, or very highly lateralized), stem to metallic bearing neck shaft angle, and polyethylene neck shaft angle. Machine learning models predicting surgical complications were constructed for each patient and Shapley additive explanation values were calculated to quantify feature importance.
Results
A total of 3837 rTSA were identified, of which 472 (12.3%) experienced a surgical complication. Those experiencing a surgical complication were more likely to be current smokers (Odds ratio [OR] = 1.71; P = .003), have prior surgery (OR = 1.60; P < .001), have an underlying diagnosis of sequalae of instability (OR = 4.59; P < .001) or nonunion (OR = 3.09; P < .001), and required longer OR times (98 vs. 86 minutes; P < .001). Notable implant design features at an increased odds for complications included an inlay humeral component (OR = 1.67; P < .001), medialized glenoid (OR = 1.43; P = .001), medialized humerus (OR = 1.48; P = .004), a minimally lateralized global construct (OR = 1.51; P < .001), and glenohumeral constructs consisting of a medialized glenoid and minimally lateralized humerus (OR = 1.59; P < .001), and a lateralized glenoid and medialized humerus (OR = 2.68; P < .001). Based on patient- and implant-specific features, the machine learning model predicted complications after rTSA with an area under the receiver operating characteristic curve of 0.61.
Conclusions
This study demonstrated that patient-specific risk factors had a more substantial effect than implant design configurations on the predictive ability of a machine learning model on surgical complications after rTSA. However, certain implant features appeared to be associated with a higher odd of surgical complications.
{"title":"The relationship between design-based lateralization, humeral bearing design, polyethylene angle, and patient-related factors on surgical complications after reverse shoulder arthroplasty: a machine learning analysis","authors":"Erick M. Marigi MD , Jacob F. Oeding MS , Micah Nieboer MD , Ian M. Marigi BA , Brian Wahlig MD , Jonathan D. Barlow MD , Joaquin Sanchez-Sotelo MD, PhD , John W. Sperling MD, MBA","doi":"10.1016/j.jse.2024.04.022","DOIUrl":"10.1016/j.jse.2024.04.022","url":null,"abstract":"<div><h3>Background</h3><div>Technological advancements in implant design and surgical technique have focused on diminishing complications and optimizing performance of reverse shoulder arthroplasty (rTSA). Despite this, there remains a paucity of literature correlating prosthetic features and clinical outcomes. This investigation utilized a machine learning approach to evaluate the effect of select implant design features and patient-related factors on surgical complications after rTSA.</div></div><div><h3>Methods</h3><div>Over a 16-year period (2004-2020), all primary rTSA performed at a single institution for elective and traumatic indications with a minimum follow-up of 2 years were identified. Parameters related to implant design evaluated in this study included inlay vs. onlay humeral bearing design, glenoid lateralization (medialized or lateralized), humeral lateralization (medialized, minimally lateralized, or lateralized), global lateralization (medialized, minimally lateralized, lateralized, highly lateralized, or very highly lateralized), stem to metallic bearing neck shaft angle, and polyethylene neck shaft angle. Machine learning models predicting surgical complications were constructed for each patient and Shapley additive explanation values were calculated to quantify feature importance.</div></div><div><h3>Results</h3><div>A total of 3837 rTSA were identified, of which 472 (12.3%) experienced a surgical complication. Those experiencing a surgical complication were more likely to be current smokers (Odds ratio [OR] = 1.71; <em>P</em> = .003), have prior surgery (OR = 1.60; <em>P</em> < .001), have an underlying diagnosis of sequalae of instability (OR = 4.59; <em>P</em> < .001) or nonunion (OR = 3.09; <em>P</em> < .001), and required longer OR times (98 vs. 86 minutes; <em>P</em> < .001). Notable implant design features at an increased odds for complications included an inlay humeral component (OR = 1.67; <em>P</em> < .001), medialized glenoid (OR = 1.43; <em>P</em> = .001), medialized humerus (OR = 1.48; <em>P</em> = .004), a minimally lateralized global construct (OR = 1.51; <em>P</em> < .001), and glenohumeral constructs consisting of a medialized glenoid and minimally lateralized humerus (OR = 1.59; <em>P</em> < .001), and a lateralized glenoid and medialized humerus (OR = 2.68; <em>P</em> < .001). Based on patient- and implant-specific features, the machine learning model predicted complications after rTSA with an area under the receiver operating characteristic curve of 0.61.</div></div><div><h3>Conclusions</h3><div>This study demonstrated that patient-specific risk factors had a more substantial effect than implant design configurations on the predictive ability of a machine learning model on surgical complications after rTSA. However, certain implant features appeared to be associated with a higher odd of surgical complications.</div></div>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"34 2","pages":"Pages 462-472"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141297110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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