Outcome analysis following open rotator cuff repair. Early effectiveness validated using four different shoulder assessment scales

Evaluation of upper extremity function after reconstructive surgery is increasingly important both to predict outcome and for the control of cost-effectiveness. Three validated, self-administered shoulder questionnaires were applied prospectively in 23 otherwise healthy patients with rotator cuff deficiency and correlated to the Constant-Murley Shoulder Score and a visual analogue scale for satisfaction. Seven women and 16 men with combined tears of supraspinatus and infraspinatus (mean age 55.3 ± 10.5 years, r/l: 14/9, follow-up 57.8 ± 15.7 weeks) were gathered prospectively and evaluated pre- and postoperatively with the American Shoulder and Elbow Surgeons (ASES) Shoulder Index, the Simple Shoulder Test (SST) and the Disabilities of the Arm, Shoulder and Hand Module (DASH questionnaire). Additionally, a visual analogue scale for satisfaction was employed. All four scores and the visual analogue scale revealed improvement at a statistically significant level (P < 0.01) after surgery. All questionnaires showed a significant correlation with the Constant-Murley Shoulder Score (ASES: r = 0.871, P < 0.01; DASH: r = –0.758, P < 0.01, SST: r = 0.494, P < 0.05, Pearson’s correlation coefficient). Taken together, all questionnaires were easy to apply, and reliable evaluation of shoulder function was possible with significant correlation to the Constant-Murley Shoulder Score postoperatively. The SST was easy to apply, and compound outcome analysis was possible with the ASES Shoulder Index and DASH questionnaire. The DASH scale was the most complex evaluation instrument. The Constant-Murley Shoulder Score comprises a physical examination, which is advantageous but restricts the application to the office. For postoperative assessment without the patient having to return to the clinic, the ASES Shoulder Index is preferred because of its good correlation to the Constant-Murley Shoulder Score (r = 0.871) and the visual analogue scale for satisfaction (r = 0.762). Received: 4 October 1999     

A retrospective study of the association between shortening of the clavicle after fracture and the clinical outcome in 136 patients

Background and purpose

The purpose of this retrospective study was to examine the association between shortening of the clavicle after a united midshaft fracture and clinical outcome. Second, the purpose was to compare the results obtained by conservative treatment with either a figure-of-eight bandage or a simple sling.

Materials and methods

This study included 136 patients with a united, conservatively treated, midshaft clavicle fracture. Mean age was 35 years (range 15-70 years); mean follow-up time was 55 months (range 24-83 months). The shortening of the clavicle was measured on a radiograph including one antero-posterior view of both clavicles on a single film and defined as the difference between the injured and the contralateral clavicle. The clinical outcome was measured using the Constant-Murley Score.

Results

The mean difference in the Constant-Murley Score between the injured and the contralateral shoulder was 7.3, P < 0.001 (95% confidence interval (CI) 5.6; 9.1). Mean shortening of the injured shoulder was 11.6 mm, P < 0.001 (95% CI 10.2; 13.0). A shortening of more than 20 mm was not associated with a poorer clinical outcome. The results obtained by conservative treatment with either a figure-of-eight bandage or a simple sling showed no difference in shortening or in the Constant-Murley Score.

Conclusions

We found that conservative treatment of midshaft clavicle fractures resulted in final shortening and mild reduction of shoulder function. A shortening of 20 mm or more was not associated with a poorer clinical outcome. The figure-of-eight bandage and a simple sling were equal treatments of midshaft clavicle fractures.     

全关节镜下肩袖修补术对老年肩袖损伤患者术后72 h内疼痛程度和并发症的影响

目的:分析全关节镜下肩袖修补术与小切口肩袖修补术对老年肩袖损伤患者的临床效果。方法:选取2017年1月至2018年11月收治的60例老年肩袖损伤患者作为研究对象,男37例,女23例;年龄61~77(63.45±12.34)岁;病程6~12(5.32±1.02)个月;左侧29例,右侧31例。其中,行全关节镜下肩袖修补术者30例,为观察组;行小切口肩袖修补术者30例,为对照组。观察并记录两组患者术前术后美国加州大学肩关节评分系统(University of California,Los Angeles,UCLA)评分,美国肩肘外科协会(American Shoulder and Elbow Surgeons,ASES)评分,Constant-Murley评分,肩关节前屈活动度、外旋活动度、外展活动度,术后72 h内视觉模拟疼痛评分(visual analogue scale,VAS)及并发症发生情况,然后进行对比分析。结果:两组患者术后UCLA评分、ASES评分、Constant-Murley评分较术前均显著提高(P<0.05),两组术后UCLA、ASES、Constant-Murley评分相比差异无统计学意义(P>0.05)。两组患者术后肩关节前屈活动度、外旋活动度、外展活动度较术前均显著增加(P<0.05),术后两组间比较差异无统计学意义(P>0.05);观察组术后24、48、72 h VAS低于对照组(P<0.05);观察组并发症总发生率13.33%(4/30)低于对照组33.33%(10/30)(P<0.05)。结论:全关节镜下肩袖修补术和小切口肩袖修补术均可以改善老年肩袖损伤后的肩部功能,但全关节镜下肩袖修补术后72 h内疼痛程度和并发症均明显优于小切口肩袖修补术,可根据患者临床实际情况与需求进行选择。     

Functional and clinical results after anterior interbody lumbar fusion

The functional and clinical results of anterior interbody lumbar fusion were assessed in 134 patients. Functional tests included spinal mobility and isokinetic trunk muscle strength measurements. The score rating system of the Japanese Orthopaedic association (JOA) and the Oswestry disability index were used for clinical evaluation. Functional results revealed decreased spinal flexibility when compared with normal values. A reduction in physical ability was also seen in the isokinetic trunk muscle measurements. Non-union seemed to have only little effect on the functional results. Patients under 20 years at operation had the best results, but beyond this threshold results did not vary with age. The JOA rating score was 25 or more in 50% of patients. The mean Oswestry disability index was 47.8 (range 1–82) preoperatively and 20 (range 0–68) at follow-up (P<0.001), indicating a clear decrease in subjective disability. Solid fusion was seen in 107 patients (80%) at follow-up.     

关节镜下两种不同松解方法治疗原发性冻结肩的临床疗效比较

目的 :比较关节镜下使用Inside-out技术与Outside-in技术治疗原发性冻结肩的临床疗效。方法 :自2015年4月至2019年7月,65例原发性冻结肩患者按照治疗方法不同分为观察组和治疗组。观察组32例,男14例,女18例;年龄48～64(54.82±5.35)岁;右侧18例,左侧14例;病程4～10(7.76±1.19)个月;采用Outside-in技术松解治疗。对照组33例,男16例,女17例;年龄45～62(54.64±4.16)岁;右侧18例,左侧15例;病程5～9(7.65±1.24)个月;采用Inside-out技术松解治疗。比较两组患者手术时间、住院天数及住院费用,比较手术前后Constant-Murley功能评分及术后1个月肩关节活动度评价临床疗效。结果:65例获得随访,时间9～17(11.34±2.24)个月。两组患者住院天数及住院费用比较差异无统计学意义(P>0.05),观察组手术时间短于对照组(P<0.05);两组患者术后Constant-Murley功能评分较术前提高(P<0.05),但两组间Constant-Murley功能评分比...     

Clinical and radiological outcomes using the LIMA SMR stemless implant—A 2-year follow-up in 49 patients

BackgroundSince the introduction of stemless anatomic total shoulder arthroplasty (TSA), many studies have been published on this specific group of TSA implants. The following study aimed to evaluate clinical and radiological short- to mid-term outcomes of the LIMA SMR stemless anatomical implant.MethodsWe prospectively evaluated the outcome of 53 TSAs in 52 patients, with a mean age of 58.45 years (range 47-78 years) at the time of implantation with a minimum follow-up of 2 years (range 24-47 months). All patients were physically and radiologically examined; the results were documented by the Constant-Murley Score and the Simple Shoulder Value.ResultsSignificant improvements from preoperative to latest follow-up were documented in Constant-Murley Score (29.0-75.84 pts; P < .001), active range of motion (abduction 84.7°-133.2°, flexion 95.3°-146.4°, and external rotation 12.7°-32.4°). The mean Simple Shoulder Value was 82.15% at the last follow-up. There was no complete loosening of the humeral component, but a lowering of bone mineral density (radiolucencies, RLL) was observed in anteroposterior or axially views—radiographs at the humeral component in 10.2% of the cases, most of them on the anteroposterior view at the calcar region. There was no statistical difference in the outcome of the patients with RLL compared with the ones without radiolucencies. Major complications or revisions did not occur.ConclusionThis study provides comparable improvement in functional, radiographic, and subjective mid-term results with other stemless anatomic implants.     

双纽扣钢板联合加强锚钉治疗肩锁关节脱位

目的: 探讨双纽扣钢板联合加强锚钉技术与锁骨钩钢板内固定治疗完全性肩锁关节脱位的疗效及预后。方法: 选取2017年7月至2020年9月收治的手术治疗肩锁关节脱位患者42例为研究对象,分为观察组（21例）和对照组（21例）。观察组中,男14例,女7例;年龄21~63（45.05±8.70）岁;对照组中,男16例,女5例;年龄25~68（45.00±9.44）岁。观察组行双纽扣钢板联合加强锚钉技术治疗,对照组行锁骨钩钢板内固定术治疗。比较两组患者手术时间、术中出血量、术后住院时间,术前及术后1、3、6个月肩关节疼痛视觉模拟评分（visual analogue scale,VAS）,肩关节功能Constant-Murley评分以及术后并发症发生情况。结果: 两组术中出血量及术后住院时间比较,差异无统计学意义（P>0.05）;双纽扣钢板联合加强锚钉技术组手术时间（65.24±5.36）min,较锁骨钩钢板组（48.81±4.72） min长（P<0.05）。肩关节功能及疼痛程度测定显示,术前两组差异无统计学意义（P>0.05）;术后1、3、6个月,观察组Constant-Murley评分分别为（73.29±2.15）、（85.43±1.47）、（93.86±1.24）分,与对照组比较差异有统计学意义;VAS评分为（2.76±0.62）、（1.71±0.64）、（0.57±0.51）分,与对照组比较,差异有统计学意义（P<0.05）。观察组术后1例肩部疼痛;对照组术后5例肩部疼痛,2例肩关节活动受限,1例肩峰下骨质吸收,两组均未出现复位丢失。结论: 双纽扣钢板联合加强锚钉治疗完全性肩锁关节脱位能够获得良好的临床效果,无须取出内固定,患者肩关节功能恢复情况及疼痛改善情况优于锁骨钩钢板内固定术,更值得临床推广。     

Transurethral microwave thermotherapy for treatment of benign prostatic hyperplasia: results obtained with the Prostalund device

The 6-month results of treatment with transurethral microwave thermotherapy (Prostalund) of 28 patients with lower urinary tract symptoms (LUTS) due to benign hyperplasia of the prostate are reported. The median International Prostate Symptom Score (I-PSS) fell from 16.5 (range 9–33) to 10.5 (range 3–30; P < 0.00005). Quality-of-life assessment improved from a median value of 4 (range 2–6) to 2 (range 1–5; P = 0.0001). In the Danish Prostate Symptom Score (DAN-PSS) the median total score fell from 20 (range 5–55) to 5 (range 0–43; P = 0.001). The median peak urinary flow increased from 10.6 to 11.5 ml/s (P = 0.20). Pressure-flow studies revealed no decrease in the median detrusor pressure at peak uroflow (Pdet_Qmax) from 56 cmH₂O preoperatively to 56 cmH₂O after 6 months (P = 0.36). No change was found in postvoid residual urinary volume or in the calculated prostate volume. Complications included hematuria in most patients, urinary tract infections in 6 (21.4%) patients, and transient retention in 3 (10.7%) patients. In all, 20 (71.4%) patients responded to treatment with good symptomatic relief, but only minor changes were observed in urodynamic parameters.     

Exercise maintains bone density at spine and hip EFOPS: a 3-year longitudinal study in early postmenopausal women

It is an important aim in the prevention of osteoporosis to stop or decelerate bone loss during the early postmenopausal years. Here we report on results of the 3-year EFOPS exercise trial in osteopenic women. The exercise strategy emphasized low-volume high-resistance strength training and high-impact aerobics. Forty-eight fully compliant women (55.1±3.3 years) with no medication or illness affecting bone metabolism participated in the exercise group (EG); 30 women (55.5±3.0 years) served as non-training controls (CG). At baseline there were no significant between-group differences with respect to physical fitness, bone mineral density, pain and nutritional status. The training consisted of two group training and two home training sessions per week. The study participants of both groups were individually supplemented with calcium and vitamin D (cholecalciferol). Bone mineral density (BMD) was measured by DXA at the lumbar spine, proximal femur and distal forearm and by QCT at the lumbar spine. Speed of sound and broadband ultrasound attenuation were determined at the calcaneus by quantitative ultrasound (QUS). Pain frequency and intensity at different skeletal sites were assessed via questionnaire. After 38 months, the following within-group changes were measured: DXA lumbar spine, EG: 0.8% n.s.; CG: –3.3% P <0.001; QCT trabecular ROI, EG: 1.1% n.s; CG: –7.7% P <0.001; QCT cortical ROI, EG: 5.3% P <0.001; CG: –2.6% P <0.001; DXA total hip: EG: –0.2% n.s; CG –1.9%, P <0.001; DXA distal forearm, EG: –2.8% P <0.001; CG: –3.8% P <0.001; BUA, EG: –0.3% n.s; CG –5.4% P <0.001; SOS, EG: 0.3% n.s; CG –1.0% P <0.001. At year 3 between-group differences relative to the exercise group were: DXA lumbar spine: 4.1% P <0.001; QCT trabecular ROI: 8.8% P <0.001; QCT cortical ROI: 7.9% P <0.001; DXA total hip: 2.1%, P <0.001; DXA distal forearm: 1.0% n.s.; BUA: 5.8% P <0.05; SOS: 1.3% P <0.001. Pain frequency and intensity in the spine significantly decreased in the exercise group and increased in the control group, while no between-group differences were detected in the main joints. In summary, over a period of 3 years our low-volume/high-intensity exercise program was successful to maintain bone mineral density at the spine, hip and calcaneus, but not at the forearm.     

Preoperative Pain Catastrophizing Prior to Total Knee Arthroplasty is Associated With Worse Preoperative Symptoms and More Clinical Improvement: A Prospective Comparative Study

BackgroundTotal knee arthroplasty (TKA) is a reliable procedure for end-stage osteoarthritis with excellent long-term survivorship, but approximately 15% of patients are not satisfied. Pain catastrophizing (PC) has been proposed as a potential cause but current evidence is limited to smaller studies with short-term follow-up. Our goal was to assess outcomes following TKA in a large cohort with and without PC.MethodsA prospective comparative study was performed with patients undergoing unilateral primary TKA between 2019 and 2021 with 2-year follow-up. All patients completed a PC Scale questionnaire preoperatively and a score of minimum 30 was considered PC. Outcomes consisted of Knee injury and Osteoarthritis Outcome Score-Physical Function Shortform (KOOS-PS), Oxford Knee Score (OKS), numeric rating scale Pain, and aseptic revisions. Ultimately, 301 patients were included (mean age 69 years [range, 30-92 years], with 60.8% women). Forty four patients (14.6%) had PC.ResultsPreoperatively, PC patients had inferior KOOS-PS, inferior OKS, and more pain than non-PC patients (all P < .001). PC patients had more improvement from preoperatively to 6 months postoperatively for KOOS-PS, OKS, and pain (all P < .05) and to 12 months for KOOS-PS and OKS (both P < .005). Similarly, PC patients had more improvement from preoperative to 24 months for OKS (P = .003). At 24 months, however, PC patients reported more pain than non-PC patients. There was no difference in revision rates (P = .192).ConclusionPatients who had PC reported worse function and pain preoperatively but had more improvement to 6 months and 12 months postoperatively. At 24 months, similar subjective function was noted, although PC patients reported more pain.     

The fifth metatarsal rotational osteotomy for the correction of tailor’s bunion deformity

Twenty patients with a mean age of 45 (range=16–77) underwent tailor’s bunion correction using a rotational osteotomy of the fifth metatarsal.The fourth/fifth intermetatarsal angle was measured with weight bearing dorsiplantar radiographs pre-operatively and at an average of 27 months post-operatively. The American Orthopedic Foot and Ankle Society (AOFAS) clinical rating system was also applied pre-operatively and at an average of 27 months post-operatively.X-ray review revealed a mean pre-operative angle of 10.0° and mean post-operative angle of 6.3° (P=0.0001), mean pre-operative AOFAS score=50.2, mean post-operative score=92.8 (P=0.0001). No transfer metatarsalgia was noted at final review, and all osteotomies proceeded to union. All patients stated that they were satisfied with the outcome of surgery.     

Isolated Limb Perfusion Prolongs the Limb Recurrence-Free Interval After Several Episodes of Excisional Surgery for Locoregional Recurrent Melanoma

Background The influence of isolated limb perfusion (ILP) on the limb recurrence-free interval (LRFI) and the number of lesions per recurrence was studied for patients with frequently recurring regional in-transit metastases previously managed by excisional surgery.Methods All 43 patients who had their first ILP for a third or further limb recurrence were selected from our computer database of 451 patients who underwent therapeutic ILP for recurrent extremity melanoma in our centers. Eighteen patients had resectable and 25 had locally unresectable lesions at the time of ILP. The patients had a total of 269 intervals between treatment of their primary melanoma and last recurrence or last follow-up. Median follow-up was 35 months (interquartile range, 14–64 months).Results The median LRFI decreases over time from primary melanoma to the third or further recurrence for which ILP was performed (P < 0.001). The median LRFI is 4.7 times longer (95% confidence interval [CI], 2.8–7.9; P < 0.001) after ILP in comparison with the last interval before ILP. Patients with resectable lesions have a median LRFI that is 5.9 times longer (95% CI, 2.7–13; P < 0.001). In all patients, the number of lesions increases by 22% per recurrence number (95% CI, 10%–35%; P = 0.02). At the same recurrence number, patients before ILP have a 2.6-fold higher (95% CI, 1.6–4.5) mean number of lesions than do patients after ILP (P < 0.001).Conclusions ILP lengthens the LRFI and decreases the number of lesions per recurrence significantly in patients with repeatedly recurrent limb melanoma. Therefore, ILP could be a valuable adjunct to excisional surgery for in-transit metastases in these patients whose LRFIs tend to shorten over time.     

During treatment protocol for univentricular heart serum levels of natriuretic peptides decrease

Objective: In children treated for univentricular heart (UVH), prospective evaluation of serum levels of N-terminal proatriopeptide (ANPN) and N-terminal pro-brain natriuretic peptide (NT-proBNP) was performed. Methods: Serum samples were analysed in 19 children before the first operation, before the bi-directional Glenn (BDG) operation, at age 1 year and before total cavopulmonary connection (TCPC). In addition, we performed cross-sectional measurement of peptide levels in 32 children: 22 hypoplastic left ventricle (LV), 10 hypoplastic right ventricle (RV) before; and in 12 children: nine hypoplastic LV, three hypoplastic RV, 2 (range: 0.5–5.3) years after the TCPC operation. Controls comprised 12 children aged less than 6 months and 41 children aged from 6 months to 7 years. Results: Between the first and second operations, peptide levels decreased. Before TCPC, further decreases had occurred. Throughout follow-up, peptide levels were higher than in controls. In the cross-sectional study, before TCPC, median ANPN concentration measured 0.37 (range: 0.18–1.00) nmol l⁻¹ (P = 0.059, compared with controls) and NT-proBNP 155 (range: 13–718) ng l⁻¹ (P < 0.001). After TCPC, median ANPN concentration measured 0.39 (range: 0.09–0.98) nmol l⁻¹ (P = ns) and NT-proBNP 201 (range: 76–1406) ng l⁻¹ (P < 0.001). Before TCPC, levels of NT-proBNP were higher in patients with RV than with LV morphology. Conclusions: Natriuretic peptide levels decreased during treatment protocol for UVH, but NT-proBNP levels remained higher than in controls. These reflect reduction of volume overload of the single ventricle and can prove useful for haemodynamic monitoring.     

Assessment of shoulder function using the coronal plane angle

Background:

Assessment of shoulder function is an essential part of clinical practice. Current scoring relies on multiple subjective and / or objective components. We present a single angular measurement, the coronal plane angle, which relates to the functional assessment of the shoulder.

Materials and Methods:

One hundred patients were prospectively enrolled and assessed using the Constant-Murley score and the Oxford shoulder questionnaire, and the coronal plane angle was measured for both symptomatic and asymptomatic shoulder.

Results:

Nine patients were excluded from the study: Four had apprehension and five were not able to get their hand to head. The mean coronal plane angle on the symptomatic side was +11.3° and the asymptomatic side −1.5° (P ≤ 0.01). Pearson''s correlation of 0.9 and 0.84 was demonstrated for the Constant-Murley and Oxford shoulder scores, respectively, with the coronal plane angle.

Conclusion:

The coronal plane angle is a single objective assessment and provides a simple alternative to shoulder assessment for the majority of patients.     

Operative treatment of acromioclavicular joint dislocation: a new technique with suture anchors

Objective：To evaluate clinical outcome of suture anchors in strengthening both acromioclavicular and coracoclavicular ligaments in the surgical treatment of acromioclavicular joint dislocation.Methods：Twenty-eight patients with acute traumatic Rockwood Ⅲ,Ⅳ and Ⅴ dislocations of the acromioclavicular joint surgically treated at our institute between October 2010 and January 2012 were recruited.All patients underwent open reduction combined with suture anchors.Function was evaluated using the ConstantMurley shoulder score.Clinical and radiographic shoulder ratings were evaluated using Taft criteria at 3,6 and 12 months.Results：Two cases with fixation loosening were not included in final statistical analysis.Other patients obtained full joint reposition on immediate postoperative radiographs.Follow-up was performed with an average of 15.6 months （range,12-19）.After early range of motion exercises,96.2％ of the patients （25/26） could abduct and elevate their shoulders more than 90 degrees within postoperative 3 months.There was no infection.Average Constant-Murley score was 96.3 points （range,94-100）and mean Taft shoulder rating was 10.7 points （range,8-12） at 12 months.Conclusion：The suture anchor is a relatively simple technique and can avoid screw removal which is helpful in reconstructing both acromioclavicular and coracoclavicular ligaments in acute traumatic acromioclavicular joint dislocation.     

关节镜下Bankart损伤修复联合Remplissage填塞术治疗合并Hill-Sachs缺损的成年人复发性肩关节前脱位

目的:探讨关节镜下Bankart损伤修补术联合Remplissage填塞术治疗复发性肩关节前脱位合并Hill-Sachs损伤的方法和临床疗效.方法:回顾性分析2016年3月至2019年3月行关节镜下Bankart损伤修复治疗关节盂骨缺损＜20％的复发性肩关节前脱位患者106例,其中男76例,女30例;年龄18～45(2...     

肩关节镜下清理治疗钙化性冈上肌腱炎的疗效分析

[目的]探讨肩关节镜下清理冈上肌腱内钙化灶治疗钙化性冈上肌腱炎的手术疗效。[方法]自2010年1月～2011年7月对在本院就诊的9例确诊为钙化性冈上肌腱炎的患者行肩关节镜下清理冈上肌腱内钙化灶治疗,术前患者肩关节疼痛剧烈伴活动受限,经正规保守治疗3个月以上无效。术中清理肩峰下间隙,切除炎性滑囊,常规行肩峰成形术,彻底清理冈上肌腱内的钙化灶。术前及术后随访均采用VAS疼痛评分、Constant-Murley评分和X线检查对患者进行评估并做手术前后的对比分析。[结果]术后平均随访6个月,所有患者肩关节疼痛及活动受限均得到明显改善或完全缓解,VAS疼痛评分术前(8.33±1.0)分,术后最后一次复查为(1.44±0.88)分,术前、术后VAS评分差异有统计学意义(P<0.01)。Constant-Murley评分术前为(50.44±10.06)分,术后最后一次复查为(93±4.21)分,术前、术后Constant-Murley评分差异有统计学意义(P<0.01)。术后复查X线片显示冈上肌腱内钙化灶均已完整清除。[结论]关节镜下行冈上肌腱内钙化灶清理,具有手术创伤小、病灶清除彻底、对肩袖及盂肱关节损伤小、术后康复快等优点,临床疗效确切。     

Clavicular non-union treated with fixation using locking compression plate without bone graft

Background

The articles that have reported on the size at which a segmental defect of clavicular non-union requires bone grafting are scarce. This study evaluated the functional and radiologic results of fixation by locking compression plate (LCP) without bone graft when the defect size is less than 2?cm following bone sclerosis removal for the treatment of clavicular non-union.

Methods

The study included 17 patients with mid-shaft clavicular non-union. All patients underwent bone sclerosis resection and fixation using LCP without bone graft. The patients were evaluated preoperatively, and after a minimum of 24?months (mean, 44.47?months; range, 24 to 60?months) postoperatively in terms of the disabilities of the arm, shoulder and hand (DASH) score, the Constant-Murley score, and radiography.

Results

In this study, no patients were lost to follow-up. The mean DASH score improved from 38.76?±?7.76 (31.00–46.52) points preoperatively to 19.88?±?7.18 (12.70–27.06) points 2?years postoperatively (P?<?0.01). The mean Constant-Murley score improved from 41.59?±?8.81 (32.78–50.40) points preoperatively to 75.47?±?13.50 (61.97–88.97) points 2?years postoperatively (P?<?0.01). Radiographs revealed fracture union in all patients. No correlations between the defect size and the postoperative Constant-Murley score or between the defect size and the postoperative DASH score were found based on Pearson tests. No complications, particularly acromioclavicular joint complications and sternoclavicular joint complications, were observed.

Conclusions

In conclusion, we can suggest, from the findings of our study, that bone sclerosis resection and fixation using LCP without bone graft is effective for the treatment of clavicular non-union involving a gap of less than 2?cm and has a low rate of complications.

     

A two-year follow-up observational study of the T-14 paediatric throat disorders outcome measure in tonsillectomy and adenotonsillectomy

IntroductionThe T-14 questionnaire is a validated patient reported outcome measure used to assess the value of paediatric tonsillectomy from the patient’s perspective. There are currently limited data revealing the long-term postoperative effects of tonsillectomy on quality of life in the paediatric population. A previously published study was therefore extended to provide additional data at 12 and 24 months following surgery.MethodsA prospective uncontrolled observational study was undertaken examining 54 paediatric patients undergoing tonsillectomy at Portsmouth Hospitals NHS Trust. Parents of children having surgery were invited to complete a T-14 questionnaire preoperatively as well as at 3, 6 (previously published), 12 and 24 months postoperatively.ResultsThe questionnaire was completed for 50 of the 54 patients preoperatively as well as at 3, 6 and 12 months postoperatively, with 44 being completed at 24 months. The mean difference between the preoperative T-14 scores and the scores at 3, 6, 12 and 24 months following surgery were highly statistically significant (p<0.001).ConclusionsThis is the first study published in the literature to assess the T-14 questionnaire at 12 and 24 months following paediatric tonsillectomy, providing evidence of the ongoing benefit of patient reported outcome measures. This further confirms the value of tonsillectomy in the paediatric population and demonstrates its ongoing positive effects on quality of life.