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2022 ◽  
Vol 11 (2) ◽  
pp. 362
Author(s):  
Roman Madeja ◽  
Jana Pometlová ◽  
Roman Brzóska ◽  
Jiří Voves ◽  
Lubor Bialy ◽  
...  

Data on the effectiveness of arthroscopic arthrolysis and extraction of osteosynthetic material after osteosynthesis of the proximal humerus in patients with persisting problems are rare and insufficient. In this study, we performed arthroscopic arthrolysis and extraction of fixation screws, and, where protruding, extraction of the nail in 34 patients with problems persisting 12 months after osteosynthesis of the proximal humerus using an intramedullary nail. The effectiveness of the treatment was assessed using the Constant–Murley shoulder score and forward flexion difference between the treated arm and the contralateral one. A median increase of 16 points in CMS score and 30 degrees reduction in the arm forward flexion difference was recorded 12 months after the arthroscopy. The improvement was significantly higher in the patient group with intramedullary nail extraction (however, this group had worse pre-operative values and the screw was only extracted where likely to cause problems). The median time to heal was 11 weeks; no serious peri- or post-procedural complications occurred. Mini-invasive arthroscopic arthrolysis combined with extraction of osteosynthetic material proved to be a safe and effective method for treatment of patients after osteosynthesis of the proximal humerus using an intramedullary nail with persisting pain and/or mobility limitation.


2021 ◽  
pp. 175857322110671
Author(s):  
Garrett R Jackson ◽  
Joshua Meade ◽  
Bradley L Young ◽  
David P Trofa ◽  
Shadley C Schiffern ◽  
...  

Background Advances have been made to the traditional inlay Grammont Reverse Shoulder Arthroplasty (RSA) design such as the onlay humeral component prosthesis. Currently, there is no agreement in the literature regarding the best option for the humeral component when comparing inlay and onlay designs. This review compares the outcomes and complications between onlay versus inlay humeral components for RSA. Methods A literature search was conducted using PubMed and Embase. Only studies reporting outcomes comparing onlay versus inlay RSA humeral components were included. Results Four studies with 298 patients (306 shoulders) were included. Onlay humeral components were associated with better external rotation (ER) ( p < 0.0001). No significant difference in forward flexion (FF) or abduction was found. Constant scores (CS) and VAS scores did not differ. Increased scapular notching was found in the inlay group (23.18%) versus the onlay group (7.74%) ( p = 0.02). Postoperative scapular fractures and acromial fractures did not differ. Conclusion Onlay and inlay RSA designs are associated with improved postoperative range of motion (ROM). Onlay humeral designs may be associated with greater ER and lower rate of scapular notching; however, no difference was found in Constant and VAS scores, so further studies are required to assess the clinical significance of these differences.


2021 ◽  
pp. 175857322110671
Author(s):  
Edoardo Franceschetti ◽  
Edoardo Giovannetti de Sanctis ◽  
Pietro Gregori ◽  
Michele Paciotti ◽  
Alessio Palumbo ◽  
...  

Background Two surgical techniques were compared : Standard BIO-RSA, performed with a glenoid eccentric reaming along with a cylindric bone graft augmentation vs. the Angled BIO-RSA, performed with a glenoid concentric reaming and a defect correction with an angled bone graft. Methods Patients undergoing RSA from January 2016 to April 2019, with one of the two techniques being performed, were retrospectively reviewed. Glenoids were classified according to Favard. Clinical (Constant-Murley, VAS and ROM) and radiographic (superior tilt correction) data were collected pre-operatively and at 12 months post-operatively. Results 141 shoulders were included. Angled BIO-RSA group showed statistically significant better outcomes in terms of forward flexion (149.9° Vs 139.3°) and abduction (136.4° Vs 126.7°). The use of an Angled BIO-RSA showed a statistically significant better superior tilt correction (1.252° Vs 4.09°). Angled BIO-RSA, leads to a better inclination correction and a mean postoperative tilt value inferior to 5° in E1 and E3 differently from standard BIO-RSA. Discussion Both techniques were able to correct glenoid superior inclination with excellent postoperative short-term results. However, angled BIO-RSA technique appears to be more effective in ensuring a correct inclination of the prosthetic glenoid component with better clinical outcomes.


2021 ◽  
Vol 10 (22) ◽  
pp. 5274
Author(s):  
Marko Nabergoj ◽  
Lionel Neyton ◽  
Hugo Bothorel ◽  
Sean W. L. Ho ◽  
Sidi Wang ◽  
...  

There are different techniques to address severe glenoid erosion during reverse shoulder arthroplasty (RSA). This study assessed the clinical and radiological outcomes of RSA with combined bony and metallic augment (BMA) glenoid reconstruction compared to bony augmentation (BA) alone. A review of patients who underwent RSA with severe glenoid bone loss requiring reconstruction from January 2017 to January 2019 was performed. Patients were divided into two groups: BMA versus BA alone. Clinical outcome measurements included two years postoperative ROM, Constant score, subjective shoulder value (SSV), and the American Shoulder and Elbow Surgeons Shoulder (ASES) score. Radiological outcomes included radiographic evidence of scapular complications and graft incorporation. The BMA group had significantly different glenoid morphology (p < 0.001) and greater bone loss thickness than the BA group (16.3 ± 3.8 mm vs. 12.0 ± 0.0 mm, p = 0.020). Both groups had significantly improved ROM (anterior forward flexion and external rotation) and clinical scores (Constant, SSV and ASES scores) at 2 years. Greater improvement was observed in the BMA group in terms of anterior forward flexion (86.3° ± 27.9° vs. 43.8° ± 25.6°, p = 0.013) and Constant score (56.6 ± 10.1 vs. 38.3 ± 16.7, p = 0.021). The BA group demonstrated greater functional and clinical improvements with higher postoperative active external rotation and ASES results (active external rotation, 49.4° ± 17.0° vs. 29.4° ± 14.7°, p = 0.017; ASES, 89.1 ± 11.3 vs. 76.8 ± 11.0, p = 0.045). The combination use of bone graft and metallic augments in severe glenoid bone loss during RSA is safe and effective and can be considered in cases of severe glenoid bone loss where bone graft alone may be insufficient.


2021 ◽  
Vol 14 (11) ◽  
pp. e246294
Author(s):  
Chad Mears ◽  
Renuka Rudra ◽  
Alex John ◽  
Weibin Shi

A 64-year-old woman presented to an academic medical centre with postoperative left ischial pain following a left total hip replacement. Her pain was exacerbated by sitting down and with forward flexion of the spine, and the pain radiated from the left ischial tuberosity to the left perineum, groin and medial thigh. An ischial bursa injection was performed, but only resulted in 1 day of excellent pain relief. A diagnosis of inferior cluneal neuralgia was then made. Subsequent inferior cluneal nerve radiofrequency ablation was performed, and provided sustained 50% relief in pain. The patient had a concomitant sensation of ‘ball like’ pressure at her rectum which was determined to be due to levator ani syndrome. She was prescribed pelvic floor physical therapy and botulinum toxin injection, which resulted in further notable improvement of her symptoms.


2021 ◽  
Vol 11 (10) ◽  
Author(s):  
Neil Jones ◽  
Oliver Clough ◽  
Avadhoot Kantak ◽  
Surendra Patnaik

Introduction:It is rare to see chronic bilateral anterior fracture-dislocations as a result of seizure, and we present a case of this type and review of the literature. Despite the signs and symptoms of shoulder dislocation being well documented, and X-ray imaging being good at identifying such pathology, there are a few cases in the literature of missed or chronic shoulder dislocation (a shoulder that has been dislocated for more than 3 weeks) but these are extremely rare. Our case represents the first example of chronic bilateral locked anterior fracture-dislocations requiring open reduction and coracoid osteotomy with GT takedown to gain adequate exposure and allow soft tissue release to facilitate joint reduction. No other case has used anchors to achieve GT fixation, and our patient is the youngest published case with such pathology. Case Report: A 16-year-old boy presented to the emergency department with reduced range of movements in both shoulders. Six weeks prior he had suffered an epileptic seizure. X-rays confirmed bilateral anterior shoulder dislocations with displaced greater tuberosity (GT) fractures. Staged open reduction was performed in the right and then left shoulder. Coracoid osteotomy with takedown of the malunited GT fracture was needed to assist with gradual soft tissue contracture release and a successful relocation. Latarjet procedure was then performed and the GTs were fixed using rotator cuff anchors. At 6 months post-operation, on the right side, he achieved forward flexion to 150o and abduction to 120o. On the left side, forward flexion was 110o and abduction was 90o. X rays showed satisfactory maintenance of the reduction without signs of avascular necrosis of the humeral head. Conclusions: Surgical management of this injury in this way is effective and achieves good results in the first 6 months of follow up. A high index of suspicion should be employed for this injury in post-ictal patients with shoulder pain. Early mobilization and


2021 ◽  
Vol 6 (10) ◽  
pp. 941-955
Author(s):  
Heri Suroto ◽  
Brigita De Vega ◽  
Fani Deapsari ◽  
Tabita Prajasari ◽  
Pramono Ari Wibowo ◽  
...  

Despite rapid medical technology development, various challenges exist in three- and four-part proximal humeral fracture (PHF) management. This condition has led to a notably increased use of the reverse total shoulder arthroplasty (RTSA); however, open reduction and internal fixation (ORIF) is still the most widely performed procedure. Thus, these two modalities are crucial and require further discussion. We aim to compare the outcomes of three- or four-part PHF surgeries using ORIF and RTSA based on direct/head-to-head comparative studies. We conducted a systematic review and meta-analysis based on the Cochrane handbook and PRISMA guidelines. We searched MEDLINE (PubMed), Embase (Ovid), and CENTRAL (Cochrane Library) from inception to October 2020. Our protocol was registered at PROSPERO (registration number CRD42020214681). We assessed the individual study risk of bias using ROB 2 and ROBINS-I tools, then appraised our evidence using the GRADE approach. Six head-to-head comparative studies were included, comprising one RCT and five retrospective case-control studies. We found that RTSA significantly improved forward flexion but was comparable to ORIF in abduction (p = 0.03 and p = 0.47, respectively) and more inferior in external rotation (p < 0.0001). Moreover, RTSA improved the overall Constant-Murley score, but the difference was not significant (p = 0.22). Interestingly, RTSA increased complications (by 42%) but reduced the revision surgery rates (by 63%) compared to ORIF (p = 0.04 and p = 0.02, respectively). RTSA is recommended to treat patients aged 65 years or older with a three- or four-part PHF. Compared to ORIF, RTSA resulted in better forward flexion and Constant-Murley score, equal abduction, less external rotation, increased complications but fewer revision surgeries. Cite this article: EFORT Open Rev 2021;6:941-955. DOI: 10.1302/2058-5241.6.210049


2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0034
Author(s):  
Trevor McBroom ◽  
Paul Abraham ◽  
Nathan Varady ◽  
Michael Kucharik ◽  
Evan O’Donnell ◽  
...  

Objectives: Surgical treatment options for the repair of symptomatic partial thickness and minimally retracted full-thickness rotator cuff tears include transtendinous or tear-completion transosseous-equivalent approaches. While transtendinous repairs are associated with superior biomechanical outcomes and lower rates of cuff re-tear, they have been linked to greater stiffness and a slower rate of recovery in comparison to tear-completion transosseous-equivalent repairs, especially in the first three months postoperatively. The purpose of this retrospective matched cohort study was to examine whether expediting a patient’s physical therapy (PT) regimen immediately following transtendinous rotator cuff repair can avert complications of postoperative stiffness and improve range of motion. Methods: After institutional review board approval, the medical records of all patients who underwent arthroscopic rotator cuff repair by the senior author between March of 2015 and May of 2019 were reviewed for inclusion in the study. Inclusion criterion was transtendinous repair. Patients that underwent an accelerated PT regimen were compared to a historical control cohort. The accelerated rehabilitation cohort was allowed passive range of motion (PROM) at 2-4 weeks, active-assisted range of motion (AAROM) at 2-4 weeks, active range of motion (AROM) at 4-6 weeks and strengthening exercises at 6-8 weeks. The historical control cohort received transtendinous rotator cuff repair between February 2005 and February 2015, and subsequently underwent a standard postoperative protocol with no shoulder motion until 6 weeks, PROM at 6-12 weeks, and AROM and strengthening exercises at 3-6 months. These cohorts were propensity matched for age, sex, BMI, and smoking status (with exact matches for sex and smoking status). Medical charts were reviewed for arthroscopic findings, including the tendons repaired (supraspinatus, infraspinatus, subscapularis, or a combination), arthroscopic classification of the tear thickness (partial, high-grade partial, focal full, or full), and presence of a concurrent labral tear. Patient data were analyzed with a mixed effects model to evaluate differences in active ROM at 2 weeks, 6 weeks, 3 months, and 6 months postoperatively. Forward flexion, abduction, and external rotation were recorded in degrees. Internal rotation was converted from vertebral levels to the Constant Shoulder Score’s numerical ten-point scale for analysis. Finally, re-tear complications were recorded at final follow-up of 6 months and then analyzed with Fisher’s exact test. Results: Sixty-one accelerated PT patients and 61 standard PT controls were included in the study. Mean age (57.02 ±2.70 years [95% confidence interval] vs. 57.45 ± 2.78 years, p=0.83), BMI (28.13 ± 1.13 kg/m2 vs. 28.28 ± 0.99 kg/m2, p=0.84), sex (61.66% female vs. 61.66% female p=1.00), and smoking status (p=1.00) were similar between groups. There were no significant differences between groups in the tendons repaired, the arthroscopic tear thickness, nor the presence of labral tears. (Table 1). The accelerated PT cohort showed significantly increased AROM at 6 weeks and 3 months postoperatively. At 6 weeks, ROM in forward flexion (136.97° vs. 110.52°; p<0.001), abduction (126.08° vs. 100.73°; p=0.003), and external rotation (51.65° vs. 37.90°; p=0.009) were all significantly higher in the accelerated PT cohort. A similar increase was seen at 3 months, with superior forward flexion (147.47° vs. 132.84°; p=0.009), abduction (140.44° vs. 121.91°; p=0.02), and external rotation (57.70° vs. 40.76°; p=0.001) in patients who received accelerated PT. With the exception of forward flexion, which was improved in the accelerated cohort (151.32° vs. 139.11°; p=0.04), there were no other differences in active ROM at 6 months. Internal rotation metrics approached statistical significance at 2 and 6 weeks postoperatively (p=0.07 and p=0.06, respectively). There were no re-tears (0.00%) in the accelerated PT cohort and 1 re-tear (1.64%) in the standard PT cohort (p=1.00). (Table 2). Conclusions: Accelerated PT following transtendinous rotator cuff repair is associated with substantial improvement in AROM at 6 weeks and 3 months when compared to standard PT protocols. Further, the early motion does not seem to result in a higher rotator cuff re-tear rate. Thus, early motion and liberation from obligate sling wear may reduce stiffness and be better tolerated following transtendinous rotator cuff repair surgery.


Author(s):  
Antonio Cejudo ◽  
Josep María Centenera-Centenera ◽  
Fernando Santonja-Medina

Athletes have higher thoracic and lumbar curvature in standing than the reference values of the non-athletic population. The sagittal integral morphotype method (SIM) assessment has not previously been applied to competitive amateur athletes (CAA). The propose of the present study was to determine the SIM of CAA treated at a sports-medicine center and to identify spinal misalignments associated with recurrent low back pain (LBP). An observational analysis was developed to describe the SIM in 94 CAA. The thoracic and lumbar curvatures of the CAA were measured in standing, sitting, and trunk forward flexion. Association analysis (Pearson’s chi-square and Cramér’s V tests) was then performed to identify the SIM misalignments associated with LBP. Effect size was analyzed based on Hedges’ g. The most common thoracic SIMs in CAA were total hyperkyphosis (male = 59.02%; female = 42.42%) and static hyperkyphosis (male = 11.48%; female = 6.06%). Hyperlordotic attitude (female = 30.30%; male = 4.92%), static-functional hyperkyphosis (male = 16.39%; female = 3.03%), and structured hyperlordosis (female = 21.21%; male = 1.64%) were the most common lumbar SIMs. Hyperlordotic attitude, static functional lumbar hyperkyphosis, and structured hyperlordosis were associated with LBP in male and female athletes.


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