scholarly journals Differences in Patients’ and Surgeons’ Expectations before Shoulder Stabilization Surgery

2021 ◽  
Vol 10 (20) ◽  
pp. 4661
Author(s):  
Katrin Karpinski ◽  
Fabian Plachel ◽  
Christian Gerhardt ◽  
Tim Saier ◽  
Mark Tauber ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Range Of Motion ◽  
Shoulder Instability ◽  
Important Goal ◽  
Shoulder Stabilization ◽  
Multicentric Study ◽  
Significant Difference ◽  
Special Surgery ◽  
The Cost ◽  
Hospital For Special Surgery

Purpose: The primary goal of shoulder stabilization procedures is to re-establish stability and many surgeons measure the success after shoulder stabilization surgery only by the absence of re-dislocation. However, patients might also suffer from pain, loss of range of motion and strength as well as anxiety and stigmatization and therefore have other expectations from a stabilization surgery than just a stable shoulder. Purpose of this study was to analyze if surgeons know what their patients typically expect from a shoulder stabilization surgery. Furthermore, the aim was to analyze the influence of various factors on patients’ expectations. Materials and Methods: 204 patients with a diagnosis of shoulder instability scheduled for surgical treatment were included in this prospective multicentric study. Preoperatively, objective and subjective scores were obtained and patients were asked about their postoperative expectations. Additionally, 25 surgeons were interviewed with regard to what they think their patients expect from the surgery using standardized questions. Results: With regard to postoperative expectations surveyed by the Hospital for Special Surgery questionnaire (HSS), the most important goal to achieve for the patients was ‘stopping the shoulder from dislocation’, followed by ‘to improve the ability to exercise or participate in sports’ and ‘being the shoulder to be back the way it was before the issue started’. The ranking of factors for patients was ‘stability’ as the most important to achieve, followed by ‘movement’, ‘strength’, ‘pain’ and ‘cosmetics’. For surgeons, the order was ‘stability’ (p = 0.004 **), ‘movement’ (p = 0.225), ‘pain’ (p = 0.509), ‘strength’ (p = 0.007 **) and ‘cosmetics’ (p = 0.181). There was a significant difference between patients and surgeons with regard to gaining stability at the cost of movement (p = 0.001 **). Conclusion: Patients and surgeons expectations regarding outcome after surgical shoulder stabilization procedures are quite similar with limited topics of disagreement. Generally, surgeons tend to overrate the importance of stability at the costs of other factors.

The Comparison of Postoperative Outcomes Open and Closed Reduction for Patellar Fractures

2018 ◽  
Vol 33 (01) ◽  
pp. 073-077
Author(s):  
Si Young Lee ◽  
Jun Young Choi ◽  
Hyun Il Lee ◽  
Jung Min Lee ◽  
Jin Ho Cho
Keyword(s):  
Surgical Treatment ◽  
Closed Reduction ◽  
Open Reduction ◽  
Visual Analog Scale Score ◽  
Significant Difference ◽  
Special Surgery ◽  
The Mean ◽  
Patellar Fractures ◽  
Postoperative Knee ◽  
Hospital For Special Surgery

AbstractPatellar fractures account for approximately 1% of all human body fractures. This study aimed to compare the surgical outcomes of open reduction and closed reduction for patellar fractures. This retrospective study included 62 patients (63 cases) who underwent surgical treatment of patellar fractures from 2008 to 2013. Of the 63 cases, open and closed reductions were performed in 42 and 21 cases, respectively. Plain radiography was used to assess fracture healing. Comminuted patellar fracture was the most common fracture type in both groups. Tension band wiring and cannulated screw fixation were mainly used in the open and closed reduction groups, respectively. There was no significant difference in the modified hospital for special surgery score, visual analog scale score for pain, and range of motion between the two groups. The mean union time was 3.2 and 3.0 months in open and closed reductions, respectively. Postoperative knee stiffness was noted in five cases of open reduction and in three cases of closed reduction. One patient in the open reduction group had a refracture. There were no notable differences in treatment outcomes between open and closed reductions. Thus, closed reduction may not be inferior to open reduction as a surgical treatment for patellar fractures.

scholarly journals Management of intercondylar femur fracture with distal femur locking compression plate: outcome analysis of 72 cases

2020 ◽  
Vol 6 (5) ◽  
pp. 1022
Author(s):  
Nadeem Ashraf Khan ◽  
A. M. Atif ◽  
Abhinandan Chatterjee
Keyword(s):  
Range Of Motion ◽  
Distal Femur ◽  
Femur Fracture ◽  
Locking Compression Plate ◽  
Open Fractures ◽  
Knee Score ◽  
Compression Plate ◽  
Special Surgery ◽  
Closed Fractures ◽  
Hospital For Special Surgery

<p class="abstract"><strong>Background:</strong> Supra-condylar and inter-condylar fractures of the distal femur account for 7% of all femoral fractures and have always been difficult to treat and regaining full knee function is often difficult. The purpose of this study is to evaluate the functional outcome, fracture healing, complications of distal femoral intercondylar fractures managed by locking compression plate.</p><p class="abstract"><strong>Methods:</strong> Total 72 patients of intercondylar femur fracture were operated by ORIF with distal femur-locking compression plate via the standard swashbuckler approach.<strong> </strong>The functional outcomes were analyzed using modified hospital for special surgery scoring system.<strong></strong></p><p class="abstract"><strong>Results:</strong> Muller type C2 fracture was the most common fracture type with 50 out of 72 patients. The average range of motion achieved was about 99.03°±24.73° (Closed fractures =105.83°±19.41°and open fractures = 89.50°±28.36°). There was also a significant difference in the duration of operative time, 84.28±18.32 minutes for closed fractures and 98.46±22.47 minutes for open fractures. The average duration for radiological union was 14.52±2.21 weeks for closed and 17.20±2.44 weeks for open fractures. The average knee score was 80.13±13.38 using modified Hospital for Special Surgery score.</p><p class="abstract"><strong>Conclusions:</strong> Closed fractures have a higher range of motion and a better knee score compared to open fractures, supporting the fact that soft tissue compromise also affects range of motion and post-op rehabilitation of the limb. The outcome seems to correlate with the nature of injury i.e. high vs low velocity, type of fracture, anatomic reduction, associated injuries, time elapsed since injury to fixation and the stability of fixation.</p>

scholarly journals Functional outcome of retrograde nailing versus locked plating of extra-articular distal femoral fractures in adults: A randomized controlled trial

2020 ◽  
Vol 9 (3) ◽  
pp. 122-129
Author(s):  
Chandra Bhusan Yadav ◽  
Asish Rajak ◽  
Bikram Prasad Shrestha ◽  
Raju Rijal ◽  
Rajiv Maharjan ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Functional Outcome ◽  
Femoral Fracture ◽  
Distal Femur ◽  
Controlled Trial ◽  
Distal Femoral Fracture ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Special Surgery ◽  
Hospital For Special Surgery

Background: Distal femoral fracture constitutes the supracondylar and intercondylar fractures of femur. These are treated by locking plates as well as with nails. Despite the widespread use of both techniques, there are only few comparative studies. The two clinical techniques used to stabilize distal femur fractures are compared in this study. Objectives:  The aim of this study was to compare plating and nailing in terms of functional outcome using the Hospital for Special Surgery (HSS) Knee Score of operative fixation of extra-articular femur fracture. Methodology: A randomized controlled trial was conducted with a total of 30 patients presenting to BP Koirala Institute of Health Sciences in a period of twelve months. All skeletally mature (>16 years) adult patients with isolated traumatic closed extra-articular fracture of distal femur without distal neurovascular deficit and giving written and informed consent were included. Patients with re-fractures, poly-trauma, fracture dislocations, pathological fracture and compartment syndrome were excluded. They were operated and followed up at 2, 6, 12 and 24 weeks.  Results: The demographic profiles of the two groups were comparable. There was no significant difference in functional outcome (Hospital for Special Surgery score), union or complications between them. Conclusion: This study showed that there was no significant difference in terms of functional outcome (Hospital for Special Surgery score), union, fracture alignment, range of motion (knee, hip joint), infection, other outcome measures between plating and nailing in the treatment of distal femoral fracture in adults. Hence, further study is required to come to firm conclusions.

scholarly journals Anterior Shoulder Instability in the Professional Athlete: Return to Competition, Time to Return, and Career Length

2020 ◽  
Vol 8 (11) ◽  
pp. 232596712095972
Author(s):  
Travis J. Dekker ◽  
Brandon Goldenberg ◽  
Lucca Lacheta ◽  
Marilee P. Horan ◽  
Peter J. Millett
Keyword(s):  
Surgical Treatment ◽  
Shoulder Instability ◽  
Bankart Repair ◽  
Professional Athletes ◽  
Successful Outcome ◽  
Anterior Shoulder Instability ◽  
Shoulder Stabilization ◽  
Arthroscopic Bankart Repair ◽  
The Mean ◽  
Return To Competition

Background: Anterior shoulder instability is a common condition in professional athletes, yet little is known about the success of surgery. Return to competition (RTC) is a metric indicative of a successful outcome for professional athletes who undergo anterior shoulder stabilization surgery. Purpose: To determine the rate of RTC, time to RTC, recurrence rate, and length of career after surgery in professional athletes who had undergone surgical treatment for anterior shoulder instability. Study Design: Case series; Level of evidence, 4. Methods: We evaluated professional athletes who underwent surgical treatment for anterior shoulder instability by a single surgeon between 2007 and 2018. Data from patients’ medical records, a patient data registry, basic search engines, sports websites, and individual team websites were used to determine length of professional play before injury, duration of career after surgery, and RTC level. Results: Overall, 23 professional athletes (25 shoulders from 12 contact and 13 noncontact athletes) were identified. The mean age at the time of surgery was 24.3 ± 4.9 years (range, 16-35 years). Primary procedures included arthroscopic Bankart repair (76%; 19/25), open Latarjet (20%; 5/25), and bony Bankart repair (4%; 1/25). Of the 23 athletes, 22 returned to their previous level of competition (96%; 95% CI, 78%-100%). The mean time between surgery and RTC was 4.5 months (range, 3-8 months). There was no difference in time to RTC between contact and noncontact athletes (4.1 vs 4.4 months). There was no difference in RTC rates and time to return for players who received a Bankart repair versus a Latarjet procedure (4.6 vs 4.2 months). A total of 12 participants were still actively engaged in their respective sport at an average of 4.3 years since surgery, while 11 athletes went on to retire at an average of 4.8 years. Duration of play after surgery was 3.8 years for contact athletes and 5.8 years for noncontact athletes ( P > .05). Conclusion: In this series, professional athletes who underwent surgical shoulder stabilization for the treatment of anterior glenohumeral instability returned to their presurgical levels of competition at a high rate. No differences in RTC rate or time to RTC were observed for contact versus noncontact athletes or for those who received arthroscopic Bankart repair versus open Latarjet. However, contact athletes had shorter careers after surgery than did noncontact athletes.

scholarly journals Percutaneous cheilectomy combined with Watermann and Moberg osteotomies for the treatment of hallux rigidus

2019 ◽  
Vol 13 (2) ◽  
pp. 135-139
Author(s):  
Júlio Ferreira de Arruda ◽  
André Donato Baptista
Keyword(s):  
Surgical Treatment ◽  
Range Of Motion ◽  
Functional Outcomes ◽  
Plantar Flexion ◽  
Case Series ◽  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
Functional Improvement ◽  
Percutaneous Technique ◽  
Significant Difference

Objective: To evaluate the clinical and functional outcomes of patients subjected to surgical treatment of hallux rigidus by the percutaneous cheilectomy combined with Watermann and Moberg osteotomies. Methods: Between May 2017 and August 2018, the clinical outcomes of 7 patients with a diagnosis of hallux rigidus (HR) treated using the percutaneous technique were assessed using the American Orthopedic Foot and Ankle Society (AOFAS) scale, the visual analogue scale (VAS) for pain and hallux metatarsophalangeal joint range of motion measurements during the pre- and postoperative periods. Clinical and functional outcomes were followed up for a minimum of 6 months (mean of 8 months). Results: The range of motion of the metatarsophalangeal joint during the pre- and postoperative periods showed the following results: dorsiflexion increased on average from 28.00º (± 15.63) to 44.43º (± 17.33) (p = 0.006), demonstrating an effective gain in dorsal articular movement. Plantar flexion ranged on average from 27.43º (± 2.22) to 24.43º (± 5.28) (p = 0.228), with no significant difference between the evaluated periods. The AOFAS score increased on average from 52.71 (± 9.63) to 88.00 (± 8.10) (p < 0.01), representing important functional improvement. The VAS score decreased on average from 7.00 (± 1.52) to 2.14 (± 2.19) (p = 0.002), indicating a significant improvement in patient pain. No patient presented postoperative complications. Conclusion: The results of the present study demonstrated that cheilectomy combined with percutaneous Watermann and Moberg osteotomies is an effective surgical treatment for hallux rigidus, with satisfactory clinical and functional outcomes. Level of Evidence IV; Therapeutic Studies; Case Series.

scholarly journals Medical treatment of hernia of abdomen wall with the use of different plastic materials

2019 ◽  
Vol 23 (2) ◽  
pp. 263-266
Author(s):  
S. D. Khimich ◽  
M. D. Zheliba ◽  
A. I. Reva ◽  
A. V. Funikov ◽  
A. P. Prevar ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Skin Flap ◽  
Postoperative Wound ◽  
Satisfactory Condition ◽  
Results Of Treatment ◽  
Plastic Materials ◽  
Significant Difference ◽  
Antimicrobial Film ◽  
Bed Days ◽  
The Cost

The purpose of the work is to analyze the results of surgical treatment of hernias using different methods of hernioplasty. The results of treatment of 176 patients with abdominal hernias, which were monitored from 1995 to 2008, were analyzed. Patients were divided into 2 groups. The first group (85 patients) included patients who underwent surgical treatment with autodermal plasty. Second group (91 patients) consisted of patients who underwent hernioplasty using mesh allografts. All patients were comprehensively examined. In obese patients, an antimicrobial film was used to glue the skin under the mammary glands and “folds of the abdomen” to prevent microbial contamination of the wound. All operated patients had a normal postoperative condition, and the postoperative period in both groups was almost the same. We did not observe complications from the side of the postoperative wound in patients of the 1st group. The wounds healed by primary intention. All patients were discharged on the 8–10 day in satisfactory condition. 2 relapses were noted: in one patient 1 month after surgery, in the second — 10 years after surgery. In the 2nd group, suppuration of the postoperative wound was observed in a patient with a II degree of obesity. The average number of bed-days in the 2nd group was approximately the same as in the 1st group. The number of bed-days statistically significantly increased with an increase in the degree of obesity in these patients. Thus, the use of mesh allografts is an effective method of treating hernias and they should be used strictly according to indications. Autodermal plastic surgery using a skin flap is also a reliable surgical method for the treatment of hernias. A significant difference in the indices in the treatment of patients of both groups (with the exception of the cost of mesh allografts) was not found.

scholarly journals Patients Undergoing Shoulder Stabilization Procedures Do Not Accurately Recall Their Preoperative Symptoms at Short- to Midterm Follow-up

2019 ◽  
Vol 7 (6) ◽  
pp. 232596711985108
Author(s):  
Danielle Hope ◽  
Jacqui French ◽  
Tania Pizzari ◽  
Greg Hoy ◽  
Shane Barwood
Keyword(s):  
Shoulder Instability ◽  
Intraclass Correlation ◽  
Absolute Difference ◽  
Minimal Detectable Change ◽  
Shoulder Stabilization ◽  
Specific Patient ◽  
Younger Patients ◽  
Significant Difference ◽  
Patient Reported ◽  
The Mean

Background: A patient’s ability to recall symptoms is poor in some elderly populations, but we considered that the recall of younger patients may be more accurate. The accuracy of recall in younger patients after surgery has not been reported to date. Purpose: To assess younger patients’ abilities to recall their preoperative symptoms after having undergone shoulder stabilization surgery. We used 2 disease-specific, patient-reported outcome measures (PROMs)—the Western Ontario Shoulder Instability Index (WOSI) and the Melbourne Instability Shoulder Score (MISS)—at a period of up to 2 years postoperatively. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Participants (N = 119) were stratified into 2 groups: early recall (at 6-8 months postoperatively; n = 58) and late recall (at 9-24 months postoperatively; n = 61). All patients completed the PROMs with instructions to recall preoperative function. The mean and absolute differences between the preoperative scores and recalled scores for each PROM were compared using paired t tests. Correlations between the actual and recalled scores of the subsections for each PROM were calculated using an intraclass correlation coefficient (ICC). The number of individuals who recalled within the minimal detectable change (MDC) of each PROM was calculated. Results: Comparison between the means of the actual and recalled preoperative scores for both groups did not demonstrate significant differences (early recall differences, MISS 1.05 and WOSI –38.64; late recall differences, MISS –0.25 and WOSI –24.02). Evaluation of the absolute difference, however, revealed a significant difference between actual and recalled scores for both the late and early groups (early recall absolute differences, MISS 12.26 and WOSI 216.71; late recall absolute differences, MISS 12.84 and WOSI 290.08). Average absolute differences were above the MDC scores of both PROMs at both time points. Subsections of each PROM demonstrated weak to moderate correlations between actual and recalled scores (ICC range, 0.17-0.61). Total scores for the PROMs reached moderate agreement between actual and recalled scores. Conclusion: Individual recall after shoulder instability surgery was not accurate. However, the mean recalled PROM scores of each group were not significantly different from the actual scores collected preoperatively, and recall did not deteriorate significantly over 2 years. This suggests that recall of the individual, even in this younger group, cannot be considered accurate for research purposes.

scholarly journals Clinical Outcomes and Return to Sport After Arthroscopic Anterior, Posterior, and Combined Shoulder Stabilization

2018 ◽  
Vol 6 (4) ◽  
pp. 232596711876375 ◽  
Author(s):  
Matthew J. Kraeutler ◽  
Nicholas S. Aberle ◽  
Colin C. Brown ◽  
Joseph J. Ptasinski ◽  
Eric C. McCarty
Keyword(s):  
Shoulder Instability ◽  
Return To Sport ◽  
Arthroscopic Stabilization ◽  
Shoulder Stabilization ◽  
Posterior Shoulder ◽  
Significant Difference ◽  
Patient Reported ◽  
Activity Scale ◽  
Anterior Posterior

Background: Glenohumeral instability is a common abnormality, especially among athletes. Previous studies have evaluated outcomes after arthroscopic stabilization in patients with anterior or posterior shoulder instability but have not compared outcomes between groups. Purpose: To compare return-to-sport and other patient-reported outcomes in patients after primary arthroscopic anterior, posterior, and combined anterior and posterior shoulder stabilization. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent primary arthroscopic anterior, posterior, or combined anterior and posterior shoulder stabilization were contacted at a minimum 2-year follow-up. Patients completed a survey that consisted of return-to-sport outcomes as well as the Western Ontario Shoulder Instability Index (WOSI), Single Assessment Numeric Evaluation (SANE), American Shoulder and Elbow Sur’geons (ASES) score, and Shoulder Activity Scale. Results: A total of 151 patients were successfully contacted (anterior: n = 81; posterior: n = 22; combined: n = 48) at a mean follow-up of 3.6 years. No significant differences were found between the groups with regard to age at the time of surgery or time to follow-up. No significant differences were found between the groups in terms of WOSI (anterior: 76; posterior: 70; combined: 78; P = .28), SANE (anterior: 87; posterior: 85; combined: 87; P = .79), ASES (anterior: 88; posterior: 83; combined: 91; P = .083), or Shoulder Activity Scale (anterior: 12.0; posterior: 12.5; combined: 12.5; P = .74) scores. No significant difference was found between the groups in terms of the rate of return to sport (anterior: 73%; posterior: 68%; combined: 75%; P = .84). Conclusion: Athletes undergoing arthroscopic stabilization of anterior, posterior, or combined shoulder instability can be expected to share a similar prognosis. High patient-reported outcome scores and moderate to high rates of return to sport were achieved by all groups.

Biaxial Wrist Replacement

1999 ◽  
Vol 24 (1) ◽  
pp. 32-34 ◽  
Author(s):  
N. H. COURTMAN ◽  
D. H. SOCHART ◽  
I. A. TRAIL ◽  
J. K. STANLEY
Keyword(s):  
Rheumatoid Arthritis ◽  
Range Of Motion ◽  
Short Term ◽  
Psoriatic Arthropathy ◽  
Radiolucent Lines ◽  
Special Surgery ◽  
The Mean ◽  
Hospital For Special Surgery

We report a short term review of 26 patients after Biaxial total wrist replacement. The mean follow up was 33.6 months (range, 24–62). All except one patient with psoriatic arthropathy had either seropositive or negative rheumatoid arthritis. A significant improvement in the range of motion was obtained; however, only 14 of 26 achieved a “functional” range. Eighteen obtained an excellent or good result when graded using the Hospital for Special Surgery score. Two radial and three carpal components showed radiolucent lines. Follow-up, however, was too short to determine whether this indicates progressive loosening.

scholarly journals Prevalence of Clinical Depression among Patients after Shoulder Stabilization Repair: A Prospective Study

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0025 ◽  
Author(s):  
Danielle G. Weekes ◽  
Richard E. Campbell ◽  
Nicholas J. Giunta ◽  
Matthew D. Pepe ◽  
Bradford S. Tucker ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Depressive Symptomatology ◽  
Significant Proportion ◽  
Well Being ◽  
Shoulder Function ◽  
Depression Symptoms ◽  
Shoulder Stabilization ◽  
Test Analysis ◽  
Arthroscopic Shoulder Stabilization ◽  
Significant Difference

Objectives: Young, athletic patients who sustain a musculoskeletal injury can suffer from major depressive disorder (MDD), either pre-existing the injury, or in response to injury. Depression can have deleterious effects on mental and physical well-being, and can ultimately lead to suicide. In fact, suicide may represent over 7% of deaths in young, high-level athletes. Therefore, it is paramount among surgeons to recognize vulnerable patient populations. The purpose of the present investigation was to determine the prevalence of MDD in patients with shoulder instability and its’ effect on outcomes in patients undergoing primary arthroscopic shoulder stabilization. Methods: Eighty-eight patients undergoing primary arthroscopic shoulder stabilization were prospectively enrolled and queried at 6 weeks, 3 months, 6 months, and 1 year. Depression symptoms were assessed with the Quick Inventory of Depressive Symptomatology (QIDS-SR16). MDD diagnosis was defined as a QIDS-SR16 score ≥6. Shoulder functionality was assessed with the Western Ontario Shoulder Instability Index (WOSI). Patients were grouped based on their MDD symptomatology preoperatively into MDD and Non-MDD groups. T-test analysis was used to compare outcomes between the groups. Results: The average age of patients on the day of surgery was 29.9 years old. Seventy-four (84.1%) participants were male, while 14 (15.9%) were female. Of the 88 patients enrolled, 44 (50%) met MDD criteria. Baseline averaged WOSI scores for the MDD cohort were worse than the non-MDD group (p= 0.016), 64.9% and 55.0%, respectively. Shoulder function, measured via the WOSI score, significantly improved throughout the study except at the 6-week follow-up point; however, the MDD group continued to have worse shoulder function at 6 weeks post-op (p= 0.04), 6 months post-op (p=0.03) and 1 year post-op (p< 0.01). There was no significant difference in mean WOSI score between the MDD and non-MDD group at 3 months (p= 0.16). WOSI scores at 1-year for the MDD and non-MDD cohort were 21.1% and 8.9%, respectively. MDD diagnosis increased at the 6-week time point (p= 0.023); however, it declined during the rest of the study period (p< 0.01). Conclusion: A significant proportion of patients with shoulder instability exhibit depression symptoms (50% in this series). Our results suggest that pre-operative depression negatively correlates with shoulder outcome functionality. Interestingly, arthroscopic shoulder stabilization can lead to post-operative depression; however, by 3-months there is a strong reversal of this effect, with significant reduction of depression symptoms in all patients. This effect may be secondary to the significant physical limitations caused by shoulder immobilization protocols for the first 6 weeks. As patients regain shoulder strength, stability and function, they exhibit less depression symptoms, indicating surgical intervention can significantly decrease depression symptoms that are secondary to musculoskeletal injuries.

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