Surgical treatment of Neer type II and type V lateral clavicular fractures: comparison of hook plate versus superior plate with lateral extension: a retrospective cohort study

Abstract Purpose Different fixation methods are used for treatment of unstable lateral clavicle fractures (LCF). Definitive consensus and guidelines for the surgical fixation of LCF have not been established. The aim of this study was to compare patient-reported functional outcome after open reduction and internal fixation with the clavicle hook plate (CHP) and the superior clavicle plate with lateral extension (SCPLE). Methods A dual-center retrospective cohort study was performed. All patients operatively treated for unstable Neer type II and type V LCF between 2011 and 2016, with the CHP (n = 23) or SCPLE (n = 53), were eligible for inclusion. The primary outcome was the QuickDASH score. Secondary outcomes were the numerical rating scale (NRS) pain score, complications, and implant removal. Results A total of 67 patients (88%) were available for the final follow-up. There was a significant difference in bicortical lateral fragment size, 15 mm (± 4, range 6–21) in the CPH group compared to 20 mm (± 8, range 8–43) in the SCPLE group (p ≤ 0.001). There was no significant difference in median QuickDASH score (CHP; 0.00 [IQR 0.0–0.0], SCPLE; 0.00 [IQR 0.0–4.5]; p = 0.073) or other functional outcome scores (NRS at rest; p = 0.373, NRS during activity; p = 0.559). There was no significant difference in median QuickDASH score or other functional outcome scores between Neer type II and type V fractures. There was no significant difference in complication rate, CHP 11% and SCPLE 8% (relative risk 1.26; [95% CI 0.25–6.33; p = 0.777]). The implant removal rate was 100% in the CHP group compared to 42% in the SCPLE group (relative risk 2.40; [95% CI 1.72–3.35; p ≤ 0.001]). Conclusion Both the CHP and SCPLE are effective fixation methods for the treatment of unstable LCF, resulting in excellent patient-reported functional outcome and similar complication rates. SCPLE fixation is an effective fixation method for the treatment of both Neer type II and type V LCF. The SCPLE has a lower implant removal rate. Therefore, if technically feasible, we recommend SCPLE fixation for the treatment of unstable LCF.

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Does acetabular coverage influence the clinical outcome of arthroscopically treated cam-type femoroacetabular impingement (FAI)?

The Bone & Joint Journal ◽

10.1302/0301-620x.100b7.bjj-2017-1340.r2 ◽

2018 ◽

Vol 100-B (7) ◽

pp. 831-838 ◽

Cited By ~ 13

Author(s):

M. M. Ibrahim ◽

S. Poitras ◽

A. C. Bunting ◽

E. Sandoval ◽

P. E. Beaulé

Keyword(s):

Functional Outcome ◽

Femoroacetabular Impingement ◽

Alpha Angle ◽

3D Analysis ◽

Acetabular Coverage ◽

Crossover Sign ◽

Significant Difference ◽

Patient Reported ◽

Outcome Scores

Aims What represents clinically significant acetabular undercoverage in patients with symptomatic cam-type femoroacetabular impingement (FAI) remains controversial. The aim of this study was to examine the influence of the degree of acetabular coverage on the functional outcome of patients treated arthroscopically for cam-type FAI. Patients and Methods Between October 2005 and June 2016, 88 patients (97 hips) underwent arthroscopic cam resection and concomitant labral debridement and/or refixation. There were 57 male and 31 female patients with a mean age of 31.0 years (17.0 to 48.5) and a mean body mass index (BMI) of 25.4 kg/m2 (18.9 to 34.9). We used the Hip2Norm, an object-oriented-platform program, to perform 3D analysis of hip joint morphology using 2D anteroposterior pelvic radiographs. The lateral centre-edge angle, anterior coverage, posterior coverage, total femoral coverage, and alpha angle were measured for each hip. The presence or absence of crossover sign, posterior wall sign, and the value of acetabular retroversion index were identified automatically by Hip2Norm. Patient-reported outcome scores were collected preoperatively and at final follow-up with the Hip Disability and Osteoarthritis Outcome Score (HOOS). Results At a mean follow-up of 2.7 years (1 to 8, sd 1.6), all functional outcome scores significantly improved overall. Radiographically, only preoperative anterior coverage had a negative correlation with the improvement of the HOOS symptom subscale (r = -0.28, p = 0.005). No significant difference in relative change in HOOS subscale scores was found according to the presence or absence of radiographic signs of retroversion. Discussion Our study demonstrated the anterior coverage as an important modifier influencing the functional outcome of arthroscopically treated cam-type FAI. Cite this article: Bone Joint J 2018;100-B:831–8.

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Treatment of End-Stage Hallux Rigidus and Impact of Arthrodesis versus Arthroplasty on Patient Reported Outcomes

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000129 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0001

Author(s):

Monique Chambers ◽

MaCalus Hogan ◽

Dukens LaBaze

Keyword(s):

Patient Reported Outcomes ◽

Surgical Intervention ◽

Metatarsophalangeal Joint ◽

Hallux Rigidus ◽

First Metatarsophalangeal Joint ◽

Significant Difference ◽

Patient Reported ◽

Outcome Scores ◽

Vas Scores ◽

End Stage

Category: Bunion, Midfoot/Forefoot Introduction/Purpose: Hallux rigidus is a degenerative disease of the first metatarsophalangeal joint. Severe, end-stage hallux rigidus can become debilitating with surgical intervention becoming necessary once conservative measures and shoe modifications have failed. Joint salvage procedures include metatarsal phalangeal (MTP) arthrodesis and MTP arthroplasty. The purpose of this study was to assess for differences in patient reported outcomes in two cohorts who underwent fusion or joint reconstruction. Methods: This study was a retrospective review of prospectively collected data of 385 patients from an academic medical institution. Patients who underwent surgical intervention from July 2015 to November 2016 were identified based on CPT codes for MTP arthrodesis (28750) and arthroplasty (28293). We extracted outcome scores including SF12-M, SF12-P, FAAM, and VAS scores. Exclusion criteria included poly-trauma, revision procedures, and lack of pre and post-operative outcome scores. Mann- Whitney t-test was performed using GraphPad Prism version 7.0b for Mac to compare procedure groups, with significance define by a p-value of 0.05. Results: A total of eighteen patients met the inclusion criteria, with 6 who underwent arthroplasty and 12 arthrodesis. The average age was 63.7 amongst the cohort, with a total of 16 female and 2 males. Patients who underwent arthrodesis had better outcomes across all parameters. When comparing preoperative and postoperative scores, arthrodesis patients showed greater improvement of SF12-M (arthrodesis 9 vs arthroplasty -2, p=0.05), and SF12-P (9 vs -16, respectively p=0.05) scores. Arthroplasty patients were more likely to have a decrease in their SF-12 scores. VAS scores and FAAM scores showed no statistical difference between the two cohorts. Postoperative VAS scores were worse in 33% of arthroplasty patients despite surgical intervention, compared to 10% of arthrodesis patients. Conclusion: Our results suggests that both procedures provide a statistically significant difference in pain with several patients having a Global Rate of Change that is “very much better”. However, fusion of the metatarsophalangeal joint results in improved pain and functional outcomes for patients with severe hallux rigidus. These findings are consistent with current reports in the literature, which are mostly case series reports. Larger studies are needed to provide appropriate power and better support the findings of this study.

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Clinical Outcomes and Complications Following Limited Open Achilles Repair Without an Instrumented Guide

Foot & Ankle International ◽

10.1177/1071100720962493 ◽

2020 ◽

pp. 107110072096249

Author(s):

Craig C. Akoh ◽

Amanda Fletcher ◽

Akhil Sharma ◽

Selene G. Parekh

Keyword(s):

Achilles Tendon ◽

Clinical Outcomes ◽

Tendon Repair ◽

Case Series ◽

Postoperative Outcome ◽

Foot And Ankle ◽

Achilles Tendon Repair ◽

Significant Difference ◽

Patient Reported ◽

Outcome Scores

Background: We report the clinical outcomes and complications following our limited open incision Achilles tendon repair technique without instrument guides. Methods: A total of 33 patients were included in this study. We recorded pre- and postoperative scores on the Foot and Ankle Disability Index (FADI), visual analog scale (VAS), and the Foot and Ankle Outcome Score (FAOS). Subgroup analyses were performed for acute (<2 weeks) and subacute (2-6 weeks) Achilles tendon repairs. A P value <.05 was considered significant for all statistical analyses. Results: The median time from injury to surgery was 10.0 days (range, 1-45 days). At a median follow-up of 3.7 years (range, 1.0-9.8 years), the average pre- and postoperative outcome scores improved significantly for the following: FADI index (49.1-98.4, P < .001), VAS (4.8-0.2, P < .001), FAOS Pain (54.8-99.2, P < .001), FAOS Symptoms (84.6-97.0, P < .001), FAOS activities of daily living (61.4-97.2, P < .001), FAOS Sports and Recreational Activity (39.5-98.5, P < .001), and FAOS quality of life (39.7-88.7, P < .001). There were no significant differences between pre- and postoperative outcome scores between the acute and subacute Achilles repair groups. There were no wound complication, reruptures, or reoperations in the entire cohort. Conclusion: Patients showed improvements in postoperative patient-reported outcome scores with minimal complications. There was no significant difference in outcomes for acute vs subacute repairs. Our limited open incision Achilles tendon repair, which required no additional targeting instrumentation, had favorable midterm results. Level of Evidence: Level IV, retrospective case series.

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Hook versus locking plate fixation for Neer type-II and type-V distal clavicle fractures: a retrospective cohort study

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-020-02658-7 ◽

2020 ◽

Vol 30 (6) ◽

pp. 1027-1031

Author(s):

Michael J. Chen ◽

Malcolm R. DeBaun ◽

Brett P. Salazar ◽

Cara Lai ◽

Julius A. Bishop ◽

...

Keyword(s):

Cohort Study ◽

Retrospective Cohort ◽

Locking Plate ◽

Plate Fixation ◽

Type Ii ◽

Distal Clavicle ◽

Locking Plate Fixation ◽

Clavicle Fractures ◽

Type V ◽

Distal Clavicle Fractures

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Factors predicting patient-reported functional outcome scores after humeral shaft fractures

Injury ◽

10.1016/j.injury.2015.01.027 ◽

2015 ◽

Vol 46 (4) ◽

pp. 693-698 ◽

Cited By ~ 13

Author(s):

Edward Shields ◽

Leigh Sundem ◽

Sean Childs ◽

Michael Maceroli ◽

Catherine Humphrey ◽

...

Keyword(s):

Functional Outcome ◽

Humeral Shaft ◽

Humeral Shaft Fractures ◽

Shaft Fractures ◽

Patient Reported ◽

Outcome Scores

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Return to Play in Adolescent Baseball Players after SLAP Repair (131)

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00274 ◽

2021 ◽

Vol 9 (10_suppl5) ◽

pp. 2325967121S0027

Author(s):

Somnath Rao ◽

Hareindra Jeyamohan ◽

Taylor D’Amore ◽

Robert Jack ◽

Pankti Acharya ◽

...

Keyword(s):

Functional Outcome ◽

Short Form ◽

Return To Play ◽

Shoulder Injuries ◽

Baseball Players ◽

Slap Repair ◽

Patient Reported ◽

Outcome Scores ◽

Future Return

Objectives: Superior labrum from anterior to posterior (SLAP) tears are increasingly common shoulder injuries in adolescent athletes who participate in repetitive overhead throwing. The purpose of this study is to evaluate adolescent baseball athletes who undergo SLAP repair in order to determine their long-term progression of play, surgical outcomes, and overall satisfaction with surgery. Methods: Patients between the ages of 10-19 who underwent a SLAP repair over a 10-year period from 2008-2018 with minimum two year follow-up were identified by a database query in the medical records of a single institution. From this cohort, non-baseball athletes and injuries to non-throwing shoulders were excluded. After identifying the cohort, patients were contacted via phone to complete functional outcome scores including Conway Score, Western Ontario Shoulder Instability (WOSI) Index, Kerlan-Jobe Orthopedic Clinic (KJOC) Shoulder and Elbow Score, Short Form 12 Mental (MCS)/Physical (PCS) survey and a custom return to play questionnaire. Results: During this time period, 59 baseball players met the inclusion criteria for this study and 76.3% (45/59) of patients were available to be contacted to complete final follow-up surveys at a minimum of 2 years. All patients were male with a mean age of 17.4 +/- 1.5 (14-19) years. The mean follow-up of this cohort was 5.3 +/- 2.6 (2.1-12.1) years. The overall return to play rate was 75.6% (34/45). The average time from surgery to initiation of throwing was 5.9 +/- 2.0 (2-12) months and the average time to return to full competition was 11.3 +/- 3.5 (6-22) months after the surgery. After the SLAP repair, those who returned to play continuing playing baseball competitively for 3.0 +/- 1.9 (0.5-8.0) years after surgery. At the time of final follow-up, 71.1% (32/45) of players had stopped playing baseball. Of those who had stopped playing competitive baseball, 12 (37.5%) reported it was because they were not recruited to the next level, 10 (31.3%) reported they lost the desire to play and 10 (31.3%) reported their shoulder prevented them from playing. The overall mean KOJC, WOSI, SF-12 MCS and SF-12 PCS scores were 60.0 +/- 27.4 (range, 0-100), 21.0+/-20.6% (0-73.8%), 55.2+/-3.9 (37.4-59.8) and 55.2+/-5.6 (range, 37.9-65.7) respectively. The overall satisfaction score was 83.2% with 86.7% (39/45) saying they given the opportunity they would undergo surgery again. Conclusions: The results of this study demonstrated a low return to play rate and low patient reported outcomes on baseball specific surveys among adolescent baseball players who underwent a SLAP repair. Mean functional outcome scores between pitchers and position players were not found to be significantly different. Based on these findings, orthopedic surgeons can better counsel their adolescent baseball players on expectations for future return to play and functional outcomes after SLAP repair.

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Early experience and patient-reported outcomes of 503 INFINITY total ankle arthroplasties

The Bone & Joint Journal ◽

10.1302/0301-620x.103b7.bjj-2020-2058.r2 ◽

2021 ◽

Vol 103-B (7) ◽

pp. 1270-1276

Author(s):

David N. Townshend ◽

Andrew J. F. Bing ◽

Timothy M. Clough ◽

Ian T. Sharpe ◽

Andy Goldberg ◽

...

Keyword(s):

Functional Outcome ◽

Early Experience ◽

Outcome Data ◽

Patient Specific ◽

Patient Specific Instrumentation ◽

Significant Difference ◽

Patient Reported ◽

The Mean ◽

One Year

Aims This is a multicentre, non-inventor, prospective observational study of 503 INFINITY fixed bearing total ankle arthroplasties (TAAs). We report our early experience, complications, and radiological and functional outcomes. Methods Patients were recruited from 11 specialist centres between June 2016 and November 2019. Demographic, radiological, and functional outcome data (Ankle Osteoarthritis Scale, Manchester Oxford Questionnaire, and EuroQol five-dimension five-level score) were collected preoperatively, at six months, one year, and two years. The Canadian Orthopaedic Foot and Ankle Society (COFAS) grading system was used to stratify deformity. Early and late complications and reoperations were recorded as adverse events. Radiographs were assessed for lucencies, cysts, and/or subsidence. Results In all, 500 patients reached six-month follow-up, 420 reached one-year follow-up, and 188 reached two-year follow-up. The mean age was 67.8 years (23.9 to 88.5). A total of 38 patients (7.5%) presented with inflammatory arthritis. A total of 101 (20.0%) of implantations used patient-specific instrumentation; 167 patients (33.1%) underwent an additional procedure at the time of surgery. A total of seven patients died of unrelated causes, two withdrew, and one was lost to follow-up. The mean follow-up was 16.2 months (6 to 36). There was a significant improvement from baseline across all functional outcome scores at six months, one, and two years. There was no significant difference in outcomes with the use of patient-specific instrumentation, type of arthritis, or COFAS type. Five (1.0%) implants were revised. The overall complication rate was 8.8%. The non-revision reoperation rate was 1.4%. The 30-day readmission rate was 1.2% and the one-year mortality 0.74%. Conclusion The early experience and complications reported in this study support the current use of the INFINITY TAA as a safe and effective implant in the treatment of end-stage ankle arthritis. Cite this article: Bone Joint J 2021;103-B(7):1270–1276.

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Nasal Septal Deviation and Incidental Paranasal Sinus Opacification: A Role of Computed Tomography

Journal of Rhinology ◽

10.18787/jr.2020.00334 ◽

2021 ◽

Vol 28 (1) ◽

pp. 50-56

Author(s):

Soo Young Choi ◽

So Young Jeon ◽

Hwa Sung Rim ◽

Sung Wan Kim ◽

Jin-Young Min

Keyword(s):

Computed Tomography ◽

Paranasal Sinus ◽

Septal Deviation ◽

Type I ◽

Type Ii ◽

Nasal Septal Deviation ◽

Type Iv ◽

Significant Difference ◽

Ct Evaluation ◽

Type V

Background and Objectives: The purpose of this study was to investigate the prevalence of incidental paranasal sinus (PNS) opacification in nasal septal deviation (NSD) using computed tomography (CT) and to identify contributing factors.Subjects and Method: We analyzed 216 patients who underwent septoplasty for the correction of NSD and who underwent preoperative PNS CT. We assessed the prevalence of incidental PNS opacification in these patients and determined the type of NSD according to Mladina classification. We also evaluated whether the direction of NSD affected the presence of PNS opacification on CT, and whether the presence of PNS opacification was associated with other rhinologic symptoms.Results: Of 216 patients with NSD, 86 showed opacified PNS on CT. According to Mladina classification, NSD patients were classified as type I (24.1%), type II (36.1%), type III (20.8%), type IV (5.6%), type V (9.7%), type VI (2.3%), or type VII (1.4%). Patients with type II NSD showed a significantly higher incidence of PNS opacification compared with other types of NSD (p=0.001). However, the direction of NSD did not significantly influence the presence of incidental PNS opacification. Furthermore, regardless of the presence of PNS opacification, there was no significant difference in rhinologic symptoms such as olfactory dysfunction, among others.Conclusion: We found that incidental PNS opacification on CT was common in NSD patients, especially in patients with type II NSD. Thus, we suggest that CT evaluation of patients with NSD may be helpful for assessing comorbid PNS pathologies as well as objectively identifying nasal septal deformities.

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Clinical and Functional Outcomes of Total Knee Arthroplasty in Sarcopenia: A Case–Control Retrospective Cohort Study

The Journal of Knee Surgery ◽

10.1055/s-0041-1740928 ◽

2021 ◽

Author(s):

Zili He ◽

Jie Cai ◽

Xingyu Wang ◽

Di Lu

Keyword(s):

Total Knee Arthroplasty ◽

Health Status ◽

Functional Outcome ◽

Knee Arthroplasty ◽

Multivariate Logistic Regression Analysis ◽

Control Group ◽

Complication Rates ◽

Patient Reported ◽

Outcome Scores ◽

Total Knee

Abstract Background The aim of the study was to investigate the relationship between sarcopenia and both clinical and functional outcome scores following total knee arthroplasty (TKA) performed for patients over 65 years of age. Methods We assessed patient demographics, preoperative health status, postoperative Knee Society Clinical (KSS-C) and Function (KSS-F) subscores, and perioperative complications for 180 patients with sarcopenia and 345 comparatively healthy patients at a mean of 12.0 months after surgery. Multivariate logistic regression analysis was performed to define whether sarcopenia was an independent risk factor for lower KSS-F and KSS-C subscores and peroperative complication rates. Patients with sarcopenia had lower mean body mass index, preoperative albumin, and preoperative hemoglobin levels (p < 0.01). Results Compared with the healthy control group, patients with sarcopenia had lower KSS-C (83.0 vs. 88.2, p < 0.01) and KSS-F (79.2 vs. 86.1, p < 0.01) subscores and increased postoperative complication rates (14.1% vs. 4.1%, p < 0.01). Conclusion Patients with sarcopenia present with generally poorer preoperative health and this appears to be associated with lower patient-reported clinical and functional outcome scores. Complication rates were higher among patients with sarcopenia who were still determined to have adequate health status to support TKA. Most complications were limited and could be managed with supportive treatment.

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