Sprengel’s deformity of the shoulder joint treated by Woodward operation

European Journal of Orthopaedic Surgery & Traumatology - Sprengel’s shoulder deformity is a rare condition that happens because of the abnormal termination of the caudal migration of the...     

Treatment of frozen shoulder by manipulation under anaesthetic and injection: does the timing of treatment affect the outcome?

The effect of timing of a manipulation under anaesthetic (MUA) and injection of corticosteroid and local anaesthetic for the treatment of frozen shoulder has attracted little attention to date. All studies describe a period of conservative treatment before proceeding to an MUA. Delay has been associated with a poorer outcome. We present a retrospective review of a prospectively collected, single-surgeon, consecutive series of 246 patients with a primary frozen shoulder treated by MUA within four weeks of presentation. The mean duration of presenting symptoms was 28 weeks (6 to 156), and time to initial post-operative assessment was 26 days (5 to 126). The Oxford shoulder score (OSS) improved by a mean of 16 points (Wilcoxon signed-ranks test, p < 0.001) with a mean OSS at this time of 43 (7 to 48). Linear regression analysis showed no correlation between the duration of presenting symptoms and OSS at initial follow-up (R2 < 0.001) or peri-operative change in OSS (R2 < 0.001) or OSS at long-term follow-up (R2 < 0.03). Further analysis at a mean of 42 months (8 to 127) revealed a sustained improvement with a mean OSS of 44?(16?to 48). A good outcome follows an MUA and injection of corticosteroid and local anaesthetic in patients with primary frozen shoulder, independent of the duration of the presenting symptoms, and this improvement is maintained in the long term.     

Radiological factors affecting functional outcome after the implantation of BDYN™ dynamic stabilization system for low-grade lumbar degenerative spondylolisthesis

BackgroundThe objectives of this study are to identify radiological factors associated with good functional outcomes after the implantation of BDYN™ dynamic stabilization system in the setting of painful low-grade degenerative lumbar spondylolisthesis (DLS).Material and methodsIn this monocentric, retrospective study, we followed 50 patients, a 5-years period, with chronic lower back pain, radiculopathy and/or neurogenic claudication evolving for at least one year that failed conservative treatment. All patients presented low-grade DLS and underwent lumbar dynamic stabilization. Radiological and clinical outcomes were assessed preoperatively and 24 months after surgery. Functional evaluation was based on the Oswestry Disability Index (ODI), the Numerical Rating Scale (NRS), and the Walking Distance (WD). Radiological analysis was based on lumbar X-rays and MRI parameters. Patients were divided into two groups according to the reduction in the postoperative ODI score (more or less than 15 points), and statistical analysis was performed between both groups to find predictive radiological factors for a satisfying functional outcome.ResultsClinically, 80% (40 patients) had a satisfying functional result, and 20% (10 patients) were considered having a poor outcome according to the ODI score. Radiologically, the loss in segmental lordosis was statistically associated with bad functional outcomes (18° for ODI decrease > 15 versus 11° for ODI decrease < 15). There is also a tendency showing that a higher Pfirmann disc signal grade (grade IV) and a severe canal stenosis according to Schizas classification (grade C & D) are predictive of a poor clinical result, but that must be confirmed in future studies.ConclusionsBDYN™ appears safe and well-tolerated. This new device should be effective for the treatment of patients with low-grade DLS. It provides significant improvement in terms of daily life activity and pain. Moreover, we have been able to deduce that a kyphotic disc is associated with a bad functional outcome after BDYN™ device implantation. It may represent a contraindication for the implantation of such DS device. Moreover, it seems that it is better to implant BDYN™ in DLS with mild or moderate disc degeneration and canal stenosis.     

Exploring the criteria and factors affecting firefighters’ resilience: A qualitative study

PurposeFirefighters are exposed to high levels of occupational risk factors, such as safety risks, chemical, ergonomic, and physical hazards that may jeopardize their lives. To overcome these hazards, firefighters must be physically, mentally, and personally fit to work. This study aimed to explore the criteria and factors affecting firefighters' resilience based on stakeholders’ experiences.MethodsThis qualitative study was carried out using conventional content analysis. In total, 21 face-to-face interviews were conducted by firefighters who were experienced in the field. The interviews were carried out from July 2019 to January 2020. The data were collected using 3 unstructured interviews and then resumed by 18 semi-structured interviews. Data analysis was done using Graneheim method.ResultsThe participants had more than 5 years of experience in the field of search and rescue. The extracted codes through data analysis were classified into 3 main categories (individual, organizational, and social factors), 9 sub-categories (mental, physical, occupational, managerial, colleagues-related, equipment-related, environmental, community-related, and family-related factors), as well as 19 sub-sub-categories and 570 codes.ConclusionFirefighters' personality, physical condition, behavior and psychological characteristics can affect their resilience along with organizational and management factors that play significant role in people's safety. Developing a tool for assessing resilience can help decision makers to have a real depict of firefighters' job qualifications.     

Crescent fractures of the pelvis treated by open reduction and internal fixation: a critique of Day’s guidelines

Introduction

Day’s classification and treatment guidelines are considered the gold standard in crescent fractures of the pelvis. The objective of this study was to retrospectively evaluate 10 surgically treated crescent fractures of the pelvis in the context of Day’s recommendations.

Methods

This is a retrospective cohort study. Ten consecutive cases of crescent fractures that were treated surgically at a level 1 trauma center formed the cohort. Six were operated anteriorly, three posteriorly and one percutaneously. Classification and treatment strategy were compared to Day’s guidelines. The minimum follow-up was 13 months. Outcomes were assessed using the modified Majeed’s scoring system.

Results

Three out of 10 cases were difficult to classify by Day’s criteria. There were 4 type I, three type III and no type II cases. Our surgical strategy was independent of Day’s recommendations in this series and based on ease of access, ability to restore the sacroiliac joint anatomy and other associated injuries. All the patients were mobilized early and the fractures united without any major incident. The results of these cases were quite good with outcome scores over 67/96.

Conclusions

Assigning Day’s classification to a given case can be difficult in up to 33% patients with crescent fractures due to the obliquity of the iliac fracture line in axial sections. Sacroiliac articular alignment is the primary factor determining the surgical approach. Besides the fracture configuration, additional factors like delay in surgery, locking of the fracture fragments, comminution of the iliac or sacral fragment as well as access to the additional injuries contribute to the decision making.

     

Laparoscopic and open reversal of Hartmann’s procedure—a comparative retrospective analysis

Background

Restoration of intestinal continuity after Hartmann’s procedure has traditionally required laparotomy. This study compares our experience with laparoscopic and open reversal of Hartmann’s procedure.

Study design

All laparoscopic and open Hartmann’s reversal procedures performed between January 1998 and June 2006 were reviewed. Patients with laparoscopic reversal were retrospectively matched by age, body mass index (BMI), and indication to controls with open reversal. Demographic data, perioperative course, and postoperative complications were documented.

Results

We identified 41 patients who underwent laparoscopic reversal of Hartmann’s procedure and these were matched to 41 patients with open reversal. The groups had similar average age and BMI. The predominant indication for surgery in both groups was diverticular disease. Conversion to laparotomy occurred in eight patients (19.5%), and was due to dense adhesions or difficulty in identification of the rectal stump. Adhesions were significantly greater in the conversion group (p <0.05), and the rectal stump was not marked in any of these cases. The most common short-term complications were ileus and surgical site infection. There were no anastomotic leaks and no mortalities. The mean operative times in the laparoscopic and open groups were 193 versus 209 min, respectively (p = 0.33). The laparoscopic group had a significantly lower estimated blood loss of 166 versus 326 mL (p < 0.0005), shorter time to bowel function return (4.1 versus 5.2 days, p < 0.05), and a shorter hospital stay (6.4 versus 8.0 days, p < 0.05). The major complication rate was also significantly lower in the laparoscopic group than in the open group (4.8% versus 12.1%, p < 0.05).

Conclusions

Laparoscopic reversal of Hartmann’s procedure is a safe and practical alternative to open reversal. It can be performed with similar operative time, fewer complications, and a faster recovery time. Conversion during the reversal procedure was significantly impacted by severity of adhesions and marking of the rectal stump.     

Shockwave application in calcifying tendinitis of the shoulder – prediction of outcome by imaging

This prospective study examined 62 patients (65 shoulders) with chronic courses of calcifying tendinitis of the shoulder before and after low-energy extracorporeal shockwave application (ESWA) in order to identify variables associated with the outcome of this treatment. Before ESWA, radiographs and contrast-enhanced magnetic resonance imaging (MRI) of the affected shoulders were obtained in order to document the size and morphology of the calcifications and the contrast media reactions in areas of interest (deposit, synovia, bursae), respectively. In addition, a clinical evaluation was performed. After ESWA (mean follow-up 18.2 months), clinical evaluations of all 65 shoulders revealed an increase in the Constant score from 44% to 78% (p < 0.0001). While size (p = 0.61) and morphology (p = 0.7) of the deposits before ESWA were not associated with the clinical outcome, negative contrast reactions around the deposits (p = 0.0001), synovia (p = 0.0049) and bursae (p < 0.01) were associated with improved clinical outcomes. After the total study group was divided into two groups, one with Constant scores ≥ 75% (n = 43) and the other with scores < 75% (n = 22), the positive predictive value (ppv), specificity (sp) and sensitivity (se) were determined for the negative reaction around the deposit (ppv: 0.94; sp: 0.95; se: 0.38), synovia (ppv: 0.84; sp: 0.82; se: 0.49) and bursae (ppv: 0.86; sp: 0.86; se: 0.44). In 5 cases (7.7%), surgery of the affected shoulder during the follow-up period was performed. No major side-effects were seen in the study group. In conclusion, our results suggest that in patients with chronic calcifying tendinitis, the absence of contrast enhancement, especially around the deposit, is a strong predictive parameter of a positive clinical outcome of ESWA. Received: 23 November 1999     

Anterior shoulder stabilization by Bristow–Latarjet procedure in athletes: return-to-sport and functional outcomes at minimum 2-year follow-up

Purpose

The aim of this study was to assess return-to-sport outcomes following the Latarjet–Bristow procedure.

Methods

This retrospective study included all athletes <50 years old, who underwent a Latarjet–Bristow procedure for anterior shoulder instability in 2009–2012. Main criteria assessments were the number of athletes returning to any sport and the number returning to the same sport at their preinjury level. The main follow-up was 46.8 ± 9.7 months.

Results

Forty-seven patients were analyzed, 46 men/1 women, mean age 27.9 ± 7.9 years. Eighteen patients practiced competitive sports and 29 recreational sports. None of them were professional athletes. One hundred percent returned to sports after a mean 6.3 ± 4.3 months. Thirty/47 (63.8 %) patients returned to the same sport at the same level at least and 10/47 (21.3 %) patients changed sport because of their shoulder. Compared to patients who returned to the same sport at the same level, patients who changed sports or returned to a lower level had practiced overhead or forced overhead sports [OR = 4.7 (1.3–16.9), p = 0.02] before surgery, experienced avoidance behavior at the final follow-up (p = 0.002), apprehension (p = 0.00001) and had a worse Western Ontario Shoulder Instability Index score and sub-items (p = 0.003) except for daily activities (p = 0.21). At the final follow-up, 45/47 (95.7 %) patients were still practicing a sport.

Conclusion

All the patients returned to sports, most to their preinjury sport at the same level. Patients who practiced an overhead sport were more likely to play at a lower level or to change sport postoperatively.

Level of evidence

IV, retrospective study—Case series with no comparison group.

     

Revision of the Keller’s procedure – pilot study

Keller’s excisional arthroplasty has become a popular procedure for the treatment of osteoarthrosis of the first metatarsophalangeal joint, and exceptional rates of success have been reported in the literature. However, a number of reports on its limitations have also been published. We report our technique and the results of a pilot study in 3 patients for the revision of a failed Keller’s procedure. Arthrodesis of the first MTP joint was performed in patients after a Keller’s procedure had failed. A 1/3 semitubular plate was used to stabilize an interposition bone graft, between the first metatarsal and proximal phalanx. Postoperative follow-up ranged from 6 to 18 months (mean 8 months). Each patient reported excellent pain relief and return to full mobility.     

Factors affecting reversal following Hartmann’s procedure: Experience from two district general hospitals in the UK

Purpose  

Restoration of gastrointestinal continuity following Hartmann’s procedure is a challenging task associated with significant morbidity and mortality. New strategies to avoid a stoma are not readily available in general hospitals. Knowledge of the factors related to reversal is required to develop treatment strategies and counsel patients realistically. The present study was conducted to determine the reversal rate and factors affecting Hartmann’s reversal in our practice.     

Difference in outcome of shoulder surgery between workers’ compensation and nonworkers’ compensation populations

The purpose of this study was to review the association between compensation status and surgical outcome especially of the shoulder. Given the high prevalence of shoulder injuries in the workplace and the large proportion of workers compensation (WC) claims involving such injuries, it is worth examining the correlation between WC status and surgical outcome of the shoulder. All studies published in journals (MEDLINE and PubMed) from 1980 through 2007 on surgical interventions performed on the shoulder in which workers compensation status was documented and the postoperative functional outcome was compared according to that status were pooled for meta-analysis. This systematic review shows that compensation status of an individual receiving shoulder surgery is a consistent positive predictor of poor functional outcome. The majority of questions posed in the most commonly adopted shoulder-specific functional outcome measurement tools were subjective in nature and may account for part of the phenomenon.

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Résumé  Analyser l’effet du statut d’accident du travail sur les résultats de la chirurgie au niveau de l’épaule. Etant donnée la fréquence élevée des traumatismes de l’épaule sur le lieu de travail et la part importante de demandes d’indemnisation chez les travailleurs avec ce type de blessures, il est intéressant d’étudier la corrélation entre le statut accident du travail et les résultats de la chirurgie de l’épaule. Toutes les études publiées dans les journaux médicaux (MEDLINE et PUBMED) de 1980 à 2007 concernant des interventions réalisées au niveau de l’épaule dans lesquelles le statut accident du travail était documenté et le résultat post opératoire étudié en fonction de ce statut ont été réunis pour une méta analyse. Cette revue systématique montre que le statut accident du travail d’un individu opéré de l’épaule est un facteur prédictif d’un mauvais résultat. La majorité des questions posées dans les tests spécifiques de l’épaule les plus couramment utilisés sont de nature subjective et cela pourrait expliquer en partie ce phénomène.

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An erratum to this article can be found at