改良Mclaughlin手术联合肱骨近端锁定钢板治疗肩关节后脱位伴骨折

目的:探讨改良的Mclaughlin手术联合锁定钢板治疗肱骨头损伤面积40%的肩关节后脱位伴骨折患者的临床疗效。方法:自2012年7月至2017年6月收治肩关节后脱位伴骨折患者7例,其中男5例,女2例;年龄37～53岁;合并肱骨头劈裂骨折3例,肱骨外科颈骨折4例。手术方法采用改良的Mclaughlin手术联合锁定钢板固定。观察术后肩关节活动范围,采用加州大学肩关节功能评分(University of California-Los Angeles Shoulder Scale,UCLA)进行临床疗效评价。结果:7例患者获得随访,时间10～33个月。末次随访时肩关节前屈上举130°～170°,外旋45°～75°,外展105°～150°,内旋均在L_3椎体到臀水平之间; UCLA评分29～34分,其中优1例,良6例。结论:改良的Mclaughlin手术联合肱骨近端锁定钢板对肩关节后脱位伴骨折这一罕见损伤的治疗,可有效保证术后肩关节稳定性,但对术后肩关节内旋存在一定程度的影响。     

Predictors of patient satisfaction and outcomes following reverse total shoulder arthroplasty

BackgroundObjective clinical outcomes and patient satisfaction via patient reported outcome measures (PROMs) can vary following reverse total shoulder arthroplasty (rTSA). The purpose of this study was to analyze patient specific preoperative factors that may predict postoperative PROMs and satisfaction following rTSA.MethodProspective data was collected on 144 consecutive patients who underwent primary rTSA at our institution between 2012 and 2018, all with minimum 2 year follow-up. Age, gender, race, BMI, previous surgery on the index shoulder, and comorbidity burden were analyzed as potential predictors. Shoulder specific clinical measures were collected both pre- and postoperatively via range of motion testing with active abduction, internal, and external rotation. PROMs included global shoulder function, Simple Shoulder Test (SST) and the American Shoulder and Elbow Surgeons (ASES) scoring systems, and cumulative patient satisfaction. Statistical analysis included comparison of pre- and postoperative outcome measures across the cohort as a whole and between each of the potential predictors in question. The relationship between predictors and postoperative cumulative satisfaction was investigated, with specific attention to identify the strongest predictors and account for confounding variables. Statistical significance was determined at P < .05.ResultsAll range of motion scores and PROMs were significantly improved from preoperative to postoperative assessment. Patient satisfaction was excellent with 92% rating their shoulder as “much better” or “better.” Women and minority patients displayed significantly worse preoperative active abduction, SST, and ASES, but were found to have no significant difference in these measures postoperatively. Younger age was associated with a significantly worse postoperative ASES score. Female sex was associated with significantly higher postoperative satisfaction, while minority status was associated with significantly lower cumulative satisfaction. Postoperative global shoulder function, SST, and ASES were not significantly influenced by sex, race, previous surgery, BMI, or comorbidity burden. Postoperative ASES and global shoulder function demonstrated to be independent predictors of “much better” satisfaction rating.ConclusionPostoperative PROMs and cumulative satisfaction are not influenced by BMI, previous surgery, or comorbidity burden in our cohort. Relative to their respective counterparts, older patients, females, and white patients are more likely to demonstrate higher satisfaction with their outcome following rTSA as measured by PROMs or cumulative satisfaction. Improvements in the ASES and global shoulder function scores most consistently predict higher postoperative satisfaction.Level of evidenceLevel IV; Case Series; Treatment Study     

Functional and patient reported outcomes following lateral hallucal sesamoidectomy

BackgroundLateral hallucal sesamoidectomy is an infrequently performed procedure indicated for patients with sesamoid pathology failing conservative treatment. Concerns exists regarding patient satisfaction, plantar scar pain, hallux malalignment and metatarsophalangeal joint (MTPJ) movement restriction following sesamoidectomy.This study aims to assess patient satisfaction after lateral hallucal sesamoidectomy via the plantar approach.MethodsIn this retropective study with prospective follow-up, all patients who underwent lateral hallucal sesamoidectomy between January 2004 and December 2017 were reviewed. Twelve patients (14 ft.) were available for final assessment. Outcome measures were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) clinical rating scale and the Self-Reported Foot and Ankle questionnaire (SEFAS). Patients were assessed clinically and radiologically. The average postoperative follow-up was 111.5 months (range 28–177 months).ResultsAll patients reported excellent outcome scores with a mean SEFAS score of 46.08 (range 43–48) and a mean AOFAS score of 92.33 (range 78–100) at final follow-up. All twelve patients reported their outcome as being excellent. No malalignment was noted clinically, however, three patients had a noticeable increase in the gap between the hallux and second toe when compared to the contralateral side. Range of motion at the MTPJ was preserved with a mean dorsiflexion of 80.83° (range 70–90°) and a mean plantarflexion was 25.83° (range 0–30°). None of the patients experienced any pain, discomfort or irritation related to the plantar scar. One patient developed neuroma like symptoms in the first web space.ConclusionLateral hallucal sesamoidectomy via a plantar approach is an effective and reliable treatment option as demonstrated by the high levels of patient satisfaction, preservation of function, excellent PROM scores and limited complications in this study.Level of evidenceLevel 4.     

Satisfied patients after shoulder arthrodesis for brachial plexus lesions even after 20 years of follow-up

Purpose

Patients with an upper brachial plexus lesion can suffer from dysfunction, joint deformities and instability of the shoulder. The goal of this study was to determine pain, shoulder function, patient satisfaction and muscle strength in shoulder arthrodesis in patients with an upper brachial plexus lesion more than 15 years after surgery.

Methods

We retrospectively studied 12 patients with a brachial plexus lesion of mean age 46 years (27–61). At a mean of 19.8 years (15.4–30.3) after shoulder arthrodesis, patient-reported outcome measures (PROMs), range of motion (e.g., active and passive), patient satisfaction, strength of the affected and non-affected side (e.g., maximum isometric strength in Newton in forward and retroflexion, ab- and adduction, internal and external rotation) and position of fusion were obtained. PROMS consisted of the Visual Analogue Scale (VAS; 0–100, 0 being painless) for pain and the Disabilities of the Arm, Shoulder and Hand Score (DASH; 0–100, 0 being the best score) for function.

Results

At latest follow-up, the median VAS pain score was 49 (0–96) and 0 for, respectively, the affected and unaffected side. The DASH was 15 (8–46), meaning a reasonable to good function of the upper extremity. Active and passive retroflexion was significantly different (p = 0.028). All subjects stated that in the same situation they would undergo a shoulder arthrodesis again. The unaffected side was significantly stronger in every direction. Arthrodesis showed position of fusion of 31° (12–70) abduction, 20° (10–50) forward flexion and 22° (? 14 to 58) internal rotation. The unaffected side was significantly (p ≤ 0.05) stronger in every movement direction.

Conclusion

At a mean of 20 years after shoulder arthrodesis, patients with an upper brachial plexus lesion are still satisfied with a good to moderate functional improvement.

Level of evidence III

A retrospective cohort study.

     

Good clinical outcome of combined Bankart-Bristow procedure for recurrent shoulder instability: 126 patients followed for 2-6 years

126 patients (100 men) with recurrent anterior shoulder dislocation or subluxation with severe Bankart lesion were treated with a combined Bankart and modified Bristow procedure and reviewed for this study. The mean age at operation was 25 (14-69) years, and mean follow-up period 41 (24-75) months. Averages of the Rowe score, the Constant score and the ASES score at final follow-up were 90, 95 and 91 points, respectively. The clinical outcome was excellent in 97 patients (77%), good in 16 (13%) and fair in 13 (10%). 2 patients had resubluxation, while no patient had a complete redislocation. The average loss of range of motion of external rotation, as compared to the contralateral shoulder side was 13 degrees. 67 of 72 patients returned to sports. No major postoperative complications occurred. This procedure had an excellent clinical outcome in cases of recurrent anterior shoulder dislocation or subluxation.     

Good clinical outcome of combined Bankart-Bristow procedure for recurrent shoulder instability: 126 patients followed for 2-6 years

126 patients (100 men) with recurrent anterior shoulder dislocation or subluxation with severe Bankart lesion were treated with a combined Bankart and modified Bristow procedure and reviewed for this study. The mean age at operation was 25 (14-69) years, and mean follow-up period 41 (24-75) months. Averages of the Rowe score, the Constant score and the ASES score at final follow-up were 90, 95 and 91 points, respectively. The clinical outcome was excellent in 97 patients (77%), good in 16 (13%) and fair in 13 (10%). 2 patients had resubluxation, while no patient had a complete redislocation. The average loss of range of motion of external rotation, as compared to the contralateral shoulder side was 13 degrees. 67 of 72 patients returned to sports. No major postoperative complications occurred. This procedure had an excellent clinical outcome in cases of recurrent anterior shoulder dislocation or subluxation.     

Conservative treatment for idiopathic frozen shoulder: Is supervised neglect the answer? A systematic review

Objective:The aim of this study was to assess the most beneficial conservative treatment for idiopathic frozen shoulder.Methods:A total of 498 frozen shoulder cases (mean age 52.4+3.8 years) from 10 articles consisting of seven level 1B and three level 2B studies were included after searching electronic databases of Pubmed, Embase, and Scopus from 1st January 2000 up to 30th October 2020. Patients were followed up for 7.9+7.7 and 3 (1-24) months on average. The mean duration of symptoms the patient experienced before receiving conservative treatment was 22.5+6.8 weeks. This study measured clinical outcomes using the improvement of active range of motion (ROM) and patient-reported outcome measures (PROMs). Numerical data analyses were calculated based on weighted means according to the number of patients involved in each study.Results:When comparing the ranges of motion of active flexion, abduction, external rotation, and internal rotation it was observed that conservative treatments increased the active ROM of flexion by 57.9o (22.1%), abduction by 62.4o 116 (99.1%), external rotation by 37o (230.4%), and internal rotation by 22.1o 117 (71.2%). From all current included literature on idiopathic frozen shoulder, supervised neglect resulted in the highest percentage of ROM improvement in flexion, abduction, external rotation, and internal rotation. Patients receiving supervised neglected treatment significantly improved their patient-reported outcome measures (PROMs).Conclusion:Although according to the present literature supervised neglect is the most beneficial conservative therapy, physiotherapy has been proven to provide adequate range of motion and clinical outcome improvement.Level of Evidence:Level II, Therapeutic Study     

A biomechanical analysis of strength and motion following total shoulder arthroplasty

Background:

The primary goal of total shoulder arthroplasty (TSA) has traditionally been pain relief and motion improvement. The literature contains multiple studies that have documented the restoration of motion and consistent pain relief following the procedure. However, there has been little attention placed on strength following TSA. Therefore, the purpose of this study was to determine in an objective manner whether strength and motion improve with shoulder arthroplasty and over what time course this may occur.

Materials and Methods:

Between April 2002 and January 2004, 15 patients who underwent TSA for osteoarthritis had biomechanical strength testing preoperatively, at 6 and 12 months postoperatively. The mean age at the time of TSA was 66 years (range, 52-82). None of the patients had full thickness rotator cuff tears at the time of surgery. Peak forces for shoulder flexion, extension, abduction, internal rotation and external rotation strength were recorded. In addition, patients had shoulder range of motion measurements performed.

Findings:

Range of motion improved significantly with TSA from preoperative to 6 months postoperative: flexion 104° to 147° (P = 0.0034), abduction 86° to 145° (P = 0.0001), internal rotation 43° to 54° (P = 0.0475) and external rotation 25° to 50° (P = 0.0008). There was minimal improvement in range of motion from 6 to 12 months. In contrast, there continued to be improvements in strength from the 6 month to the 12 month postoperative time frame: extension 18.3 kg to 22.4 kg (P = 0.006), abduction 11.3 kg to 12.8 kg (0.0474) and external rotation 8.8 kg to 10.1 kg (P = 0.016). Despite these improvements, compared to normative values, there continued to be relative weakness of the shoulder following TSA.

Interpretation:

The data from this study suggest that recovery of strength and motion follow different time frames after TSA. The results of this study may allow the surgeon to more accurately discuss with the patient over what time course strength and motion may return. In addition, this study raises important questions in regard to the current rehabilitation program used after shoulder arthroplasty and whether development of new protocols may improve the functional outcome from surgery.

Level of Evidence:

Level 2     

Elastic stabilisation of proximal humeral fractures with a new percutaneous angular stable fixation device (ButtonFix®): a preliminary report

Introduction

The ButtonFix^® system represents a new angular stable percutaneous fixation device for stabilisation of fractures of the proximal humerus. The purpose of this study was to present a preliminary report of the radiological and clinical outcome after minimally invasive stabilisation of selected proximal humerus fractures with the ButtonFix^®.

Patients and methods

Seventeen patients with fractures of the proximal humerus were treated in our department with the ButtonFix^® system. The mean final follow-up was performed 19 months postoperatively. Follow-up included assessment of postoperative reposition, range of motion, the DASH score, the Constant–Murley score, and the Short Form 36 (SF36).

Results

Twelve patients showed anatomical head-to-shaft angles, four revealed minor valgus replacement, and one minor varus replacement. In one patient unplanned revision surgery was necessary due to early secondary fracture dislocation requiring ORIF with an angular stable form plate. Implant removal was performed after 6 weeks in all patients. At the final follow-up, mean range of motion was: flexion 135°, extension 45°, abduction 142°, internal rotation 51°, and external rotation 62°. The mean Constant–Murley score was 70. The mean DASH score was 26 points and the average SF36 score was 76 points. One patient showed radiological signs of avascular necrosis.

Conclusion

The ButtonFix^® system represents a valuable tool in the treatment of proximal humeral fractures with results indicating fewer complications compared to prior percutaneous fixation devices. Moreover, the ButtonFix^® seems to be able to maintain reduction even in elderly patients with potentially reduced bone mass.     

Does critical shoulder angle predict abduction motion and acromion-tuberosity impingement in reverse shoulder arthroplasty?

BackgroundVirtual planning software for reverse shoulder arthroplasty (RSA) has introduced the ability to optimize implant position in an effort to maximize bony impingement–free motion. Abduction impingement typically occurs between the glenoid and polyethylene or between the tuberosities and the acromion or coracoid. Acromion-tuberosity impingement has been considered less desirable, as it may create additional stress on the acromion. Patients with a large acromion overhang may have higher rates of acromion-tuberosity impingement. As the critical shoulder angle (CSA) represents a larger distance from the glenoid face to the acromion, the purpose of this study was to evaluate the impact of implant selection and position on abduction motion and acromion-tuberosity impingement, with a focus on the association to CSA. We hypothesize that a larger CSA will be associated with less abduction motion and an increase in acromion-tuberosity impingement.MethodsThis is a retrospective cohort case series of 85 consecutive patients who underwent RSA from June 2020 to January 2021. Humeral and glenoid components were implanted virtually (SurgiCase) using a standard protocol for a single implant system (DJO AltiVate Short Stem Reverse) with an inset humeral component. Implant variables analyzed included baseplate location (central vs. inferior glenoid), glenosphere lateralization (10 mm vs. 6 mm), and humeral shell (standard vs. semiconstrained). The maximal degree of abduction and location of impingement were recorded at external rotation of 0°, 45°, and 90°. Implant combinations that resulted in no impingement and no motion were recorded.ResultsIncrease in CSA was associated with acromion-tuberosity impingement for nearly every combination at 0° and 45° external rotation; however, there were no significant associations between CSA and maximum abduction motion. Acromion-tuberosity impingement was associated with central glenosphere placement in all degrees of external rotation (P < .001), use of a 10 mm lateralized glenosphere for 0° (P < .001) and 45° (P = .076), and using a standard polyethylene shell for 0° (P = .032) and 45° external rotation (P = .007). Maximal abduction motion was associated with inferior placement (P < .001), and use of a 10 mm lateralized glenosphere (P < .001) in all positions of external rotation but was not influenced by the polyethylene type.ConclusionIncreased CSA is associated with acromion-tuberosity impingement and can be used to screen for patients at risk for bony impingement in abduction. Placement of the glenosphere centrally and use of a 10 mm lateralized glenosphere were associated with higher rates of acromion-tuberosity impingement. Maximal abduction can be achieved using a 10 mm lateralized glenosphere and inferior placement.     

Good Functional Recovery of Complex Elbow Dislocations Treated With Hinged External Fixation: A Multicenter Prospective Study

BackgroundAfter a complex dislocation, some elbows remain unstable after closed reduction or fracture treatment. Function after treatment with a hinged external fixator theoretically allows collateral ligaments to heal without surgical reconstruction. However, there is a lack of prospective studies that assess functional outcome, pain, and ROM.Questions/purposesWe asked: (1) In complex elbow fracture-dislocations, does treatment with a hinged external fixator result in reduction of disability and pain, and in improvement in ROM, function, and quality of life? (2) Does delayed treatment (7 days or later) have a negative effect on ROM after 1 year? (3) What are the complications seen after external fixator treatment?MethodsDuring a 2-year period, 11 centers recruited 27 patients 18 years or older who were included and evaluated at 2 and 6 weeks and at 3, 6, and 12 months after surgery as part of this prospective case series. During the study period, the participating centers agreed on general indications for use of the hinged external fixator, which included persistent instability after closed reduction alone or closed reduction combined with surgical treatment of associated fracture(s), when indicated. Functional outcome was evaluated using the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH; primary outcome) score, the Mayo Elbow Performance Index (MEPI), the Oxford Elbow Score, and the level of pain (VAS). ROM, adverse events, secondary interventions, and radiographs also were evaluated. A total of 26 of the 27 patients (96%) were available for followup at 1 year.ResultsAll functional and pain scores improved. The median QuickDASH score decreased from 30 (25^th–75^th percentiles [P₂₅–P₇₅], 23–40) at 6 weeks to 7 (P₂₅–P₇₅, 2–12) at 1 year with a median difference of −25 (p < 0.001). The median MEPI score increased from 80 (P₂₅–P₇₅, 64–85) at 6 weeks to 100 (P₂₅–P₇₅, 85–100) at 1 year with a median difference of 15 (p < 0.001). The median Oxford Elbow Score increased from 60 (P₂₅–P₇₅, 44–68) at 6 weeks to 90 (P₂₅–P₇₅, 73–96) at 1 year with a median difference of 29 (p < 0.001). The median VAS decreased from 2.8 (P₂₅–P₇₅, 1.0–5.0) at 2 weeks to 0.5 (P₂₅–P₇₅, 0.0–1.9) at 1 year with a median difference of −2.1 (p = 0.001). ROM also improved. The median flexion-extension arc improved from 50° (P₂₅–P₇₅, 33°–80°) at 2 weeks to 118° (P₂₅–P₇₅, 105°–138°) at 1 year with a median difference of 63° (p < 0.001). Similarly, the median pronation-supination arc improved from 90° (P₂₅–P₇₅, 63°–124°) to 160° (P₂₅–P₇₅, 138°–170°) with a median difference of 75° (p < 0.001). At 1 year, the median residual deficit compared with the uninjured side was 30° (P₂₅–P₇₅, 5°–35°) for the flexion-extension arc, and 3° (P₂₅–P₇₅, 0°–25°) for the pronation-supination arc. Ten patients (37%) experienced a fixator-related complication, and seven patients required secondary surgery (26%). One patient reported recurrent instability.ConclusionsA hinged external elbow fixator provides enough stability to start early mobilization after an acute complex elbow dislocation and residual instability. This was reflected in good functional outcome scores and only slight disability despite a relatively high complication rate.

Level of Evidence

Level IV, therapeutic study.     

Treatment and outcome of fracture-related infection of the clavicle

IntroductionThe number of operatively treated clavicle fractures has increased over the past decades. Consequently, this has led to an increase in secondary procedures required to treat complications such as fracture-related infection (FRI). The primary objective of this study was to assess the clinical and functional outcome of patients treated for FRI of the clavicle. The secondary objectives were to evaluate the healthcare costs and propose a standardized protocol for the surgical management of this complication.MethodsAll patients with a clavicle fracture who underwent open reduction and internal fixation (ORIF) between 1 January 2015 and 1 March 2022 were retrospectively evaluated.This study included patients with an FRI who were diagnosed and treated according to the recommendations of a multidisciplinary team at the University Hospitals Leuven, Belgium.ResultsWe evaluated 626 patients with 630 clavicle fractures who underwent ORIF. In total, 28 patients were diagnosed with an FRI. Of these, eight (29%) underwent definitive implant removal, five (18%) underwent debridement, antimicrobial treatment and implant retention, and fourteen patients (50%) had their implant exchanged in either a single-stage procedure, a two-stage procedure or after multiple revisions. One patient (3.6%) underwent resection of the clavicle. Twelve patients (43%) underwent autologous bone grafting (tricortical iliac crest bone graft (n = 6), free vascularized fibular graft (n = 5), cancellous bone graft (n = 1)) to reconstruct the bone defect. The median follow-up was 32.3 (P₂₅-P₇₅: 23.9–51.1) months. Two patients (7.1%) experienced a recurrence of infection. The functional outcome was satisfactory, with 26 out of 28 patients (93%) having full range of motion. The median healthcare cost was € 11.506 (P₂₅-P₇₅: € 7.953–23.798) per patient.ConclusionFRI is a serious complication that can occur after the surgical treatment of clavicle fractures. In our opinion, when treated adequately using a multidisciplinary patient-specific approach, the outcome of patients with an FRI of the clavicle is good. The median healthcare costs of these patients are up to 3.5 times higher compared to non-infected operatively treated clavicle fractures. Although not studied individually, we consider factors such as the size of the bone defect, condition of the soft tissue, and patient demand important when it comes to guiding our surgical decision making in cases of osseous defects.     

Shoulder hemiarthroplasty for complex humeral fractures: a 5 to 10-year follow-up retrospective study

Purpose

The purpose of this study is to review our experience with proximal humeral locking plates, including complications, functional outcomes, strength recovery and predictors of successful treatment.

Methods

Seventy unstable proximal humeral fractures were treated with open reduction internal fixation (ORIF) with the use of locking proximal humerus plate. At an average follow-up of 31 months, the clinical and subjective outcomes were evaluated, and complication was analysed.

Results

The average Constant score was 72. The mean disabilities of the arm, shoulder and hand score was 23. The average range of motion was as follows: mean range of anterior elevation and abduction 120°–150°; external rotation in abduction 64° and in adduction 44°; and internal rotation T12.

Conclusion

On the basis of the overall functional and clinical outcome obtained, it is possible to suggest that the ORIF of the proximal humerus fractures using locking plate represents a helpful option that can lead to a good clinical and functional outcome even in the most complex fractures. Level of evidence, Case Series, Treatment Study, Level IV.     

Treatment of proximal and middle one-third humeral fractures with lateral distal tibial helical plate

Objective

To evaluate the outcomes of treating patients with proximal and middle one-third humeral fractures treated with lateral distal tibial helical plate.

Materials and methods

From June 2004 to January 2009, 12 patients (8 men, 4 women: average age: 46.8?years, range: 25–63) with proximal and middle one-third humeral fractures were treated with open reduction and internal fixation using lateral distal tibial helical plate. Standard anterior–posterior and lateral radiographs were obtained and evaluated. Shoulder function was assessed according to the Constant–Murley score.

Results

At follow-up (average: 18?months), all fractures had healed (average: 15?weeks, range: 9–23). There were no cases of intraoperative complications, implant failures, infections, or iatrogenic intra- or post-operative nerve lesions. All patients achieved at least 100° of abduction by 3?months post-surgery and full range of movement by 12?months post-surgery, with the exception of one patient who had an impingement symptom with moderate loss of abduction and external rotation. The average Constant–Murley score was 88 points at 12-month follow-up. According to Constant–Murley score, 28% of patients had excellent functional outcome, 64% had good outcome, 8% had moderate outcome, and none had failure. According to self-reporting, all patients had returned to the pre-injury level of activity.

Conclusions

The lateral distal tibial helical plate promotes bone healing and minimizes the damage to the deltoid muscle insertion region, thereby facilitating rapid and good functional recovery. In addition, the helical plate design avoids affecting sliding of the biceps tendon and maintains good reduction position. The lateral distal tibial helical plate is an effective surgical option for proximal and middle one-third humeral fractures.     

Functional results and patient satisfaction after arthroscopic capsular release of idiopathic and post-traumatic stiff shoulder

Purpose

The purpose of this prospective study was to compare the functional results and patient satisfaction after arthroscopic shoulder capsular release in patients with idiopathic and posttraumatic stiff shoulder.

Methods

The study included 50 patients who underwent arthroscopic capsular release after failure of conservative treatment. The etiology of stiffness was either idiopathic (25 patients) or post-traumatic (25 patients). There were 28 women and 22 men with an average age of 49 years (range, 32–70 years). All patients were treated with physical therapy for a mean of six months (range, 3–12 months) before surgery. Range of motion was measured three times: 48 hours after surgery, then one month and six months after surgery.

Results

Constant score showed improvement for both groups of patients in the period of six months after surgery. In the group with idiopathic stiffness the score increased from 36 to 86, while in the group with post-traumatic stiff shoulder the score advanced from 32 to 91. The idiopathic stiff shoulder group had an improved active forward flexion from 90 to 161°, external rotation from 10 to 40°, and internal rotation from L5 to L1. In the post-traumatic stiff shoulder groupthe forward flexion was improved from 95 to 170°, external rotation from 13 to 40° and internal rotation from L4 to L1.

Conclusion

There was an improvement of range of motions and patients' satisfaction after arthroscopic shoulder capsular release and manipulation under anesthesia, equally in idiopathic and post-traumatic stiff shoulder, compared to the situation before surgery. Post-traumatic contracture patients expressed higher level of satisfaction with their shoulder function than the idiopathic stiff shoulder patients.     

Arthroscopic double-loaded single-row repair in chronic traumatic anterior shoulder dislocation

Purpose

We evaluated the clinical results of arthroscopic double-loaded single-row repair for chronic anterior shoulder dislocation.

Methods

From January 2007 to December 2008, of the 47 shoulders with chronic anterior shoulder dislocation that consecutively underwent arthroscopic double-loaded single-row repair using bio-absorbable suture anchors containing two non-absorbable braided sutures, 45 shoulders (95.7?%) had successful follow-up for a minimum of 2?years. The mean age of patients was 23.7?years, the mean frequency of dislocations before surgery was 6.8 events, and the mean interval between the initial dislocation and surgery was 47.9?months. Clinical results were evaluated using ASES, Rowe, VAS score, and range of motion before surgery and at the final follow-up.

Results

The mean number of suture anchors was 3.38 (range 2–6) and the mean number of stitches was 6.32 (range 4–10). Four of the 45 cases had recurrence (8.9?%). Of these four, three cases underwent re-operation using the same method and the other one case showed no specific discomfort except a one-time dislocation that underwent conservative treatment. The preoperative and the final follow-up ASES and Rowe scores were statistically significantly improved (P?P?P?>?0.05), but external rotation at the side was significantly decreased (P?=?0.001).

Conclusions

Arthroscopic double-loaded single-row repair using suture anchors, containing two sutures in chronic anterior shoulder dislocation, is a reliable procedure with respect to recurrence rate, range of motion, and shoulder function.     

Rekonstruktion der Schulterabduktion durch Transfer des M. trapezius

Introduction

After brachial plexus injuries, shoulder function is frequently impaired or lost. For reconstruction of the most important functions muscle transfers are indicated. To restore abduction and external rotation of the shoulder the trapezius muscle transfer is mainly used.

Patients and methods

We demonstrate 16 patients with insufficient abduction of the shoulder joint. All patients were treated with the transfer of trapezius muscle (pars horizontalis). We used a modification of the technique of Saha. After the operation, the arm was immobilized in 80° abduction for 6 weeks followed by 10° adduction of the shoulder per week. Afterwards physiotherapy was started. Evaluation was done by the DASH score and Gilbert score.

Results

In all cases, an improvement of shoulder mobility was seen, assessed clinically and individually by the patient. The average DASH score was 37.4. For ten patients the results of the operation were very good, good, or satisfactory. Active abduction increased from 15° (0–30°) to 54° (35–80°) postoperatively. The external rotation was 9° (?20–40°) preoperatively and 19° (0–70°) postoperatively.

Discussion

Trapezius muscle transfer for reconstruction of abduction is an easy and practicable method without serious complications. We achieved good stability and functionality of the shoulder. Intensive pre- and postoperative physiotherapy may provide greater improvement of mobility.     

Rheumatoid Arthritis Patients Achieve Better Satisfaction but Lower Functional Activities as Compared to Osteoarthritis Patients After Total Knee Arthroplasty

Background

Recently, poor patient satisfaction after total knee arthroplasty (TKA) has gained attention mainly in osteoarthritis (OA) patients; however, satisfaction after TKA remains to be understood in rheumatoid arthritis (RA) patients. This study aimed to examine satisfaction and function after RA TKA using patient-reported outcome measures and to compare the results with those of OA-TKA.

Midterm functional outcome after dorsal capsular imbrication for posttraumatic instability of the distal radioulnar joint

Introduction

The dorsal capsular imbrication of the distal radioulnar joint (DRUJ) which was performed because of posttraumatic dorsal instability showed promising functional results after the first postoperative years. Therefore, we hypothesized that patients after capsular imbrication are characterized by good subjective and functional outcome measurements after a midterm period.

Materials and methods

Eleven patients (range 21–50 years of age; median 35 years of age) were examined after capsular imbrication of the DRUJ because of posttraumatic instability with a mean follow-up time of 72 months (range 46–114 months; median 66 months). Examination parameters included the determination of range of motion (ROM), grip strength, pain and functional outcome scores (modified Mayo wrist score (MMWS); Disabilities of the Arm, Shoulder and Hand questionnaire (DASH score)).

Results

A mean DASH score of 6.7 (range 0–22.5) and mean MMWS of 91.8 (range 75–100) were measured. Grip strength reached 96.7 % of the contralateral hand. Range of motion reached at least 93.1 % of the contralateral hand. Eight of 11 patients regarded functional outcome and pain reduction as excellent. Six of 11 patients did not recognize a diagnosed instability of DRUJ as such. Ulnar-sided wrist pain was the apparent symptom in these cases.

Conclusions

Capsular imbrication of the DRUJ is a reliable and sufficient treatment option in case of posttraumatic dorsal instability. Since DRUJ instability is seldom recognized by the patients as such, a standardised diagnostic algorithm is mandatory to guarantee reliability and efficacy for identifying DRUJ instability.     

Arthroscopic treatment of multidirectional glenohumeral instability: 2- to 5-year follow-up

Purpose: We present the results of a prospective study evaluating arthroscopic technique in repairing multidirectional glenohumeral instability. Type of Study: Case series. Methods: The 47 patient study group consisted of 26 men and 21 women. Inclusion criteria were multidirectional glenohumeral instability diagnosed on physical examination and at arthroscopy. Exclusion criteria were unidirectional anterior or posterior instability and prior instability operation. Four patients declined to participate in the study. The average age at the time of operation was 30 years (range, 15 to 56 years). The average interval from operation to final evaluation was 35 months (range 26 to 67 months). The American Shoulder and Elbow Surgeons (ASES) Shoulder Index, Constant, Rowe, and UCLA scores were recorded preoperatively and at final evaluation. Results: Preoperatively, no patients were rated overall as good to excellent according to the Rowe scale; at final follow-up 94% (44 of 47 patients) were rated as good to excellent. One patient was considered a failure of the index operation due to persistent instability and underwent a second operative procedure. One patient noted a loss of strength during sports, and 2 patients had pain that limited their throwing ability. The ASES Shoulder Index improved to 94.7 from 45.4 (P =.001). The absolute Constant score improved to 91.7 from 60 (P =.001). The Rowe score improved to 93.7 from 14.2 (P =.001). The UCLA total score improved to 33.1 from 17.4 (P =.001). Average passive external rotation at 90° abduction measured 88.2°. Twenty-two of 26 patients (85%) returned to their desired levels of sports following the operations. Conclusions: Patients with multidirectional glenohumeral instability have multiple lesions within the shoulder and the surgeon must individualize the operative treatment. Arthroscopic surgery produced successful results in 44 of 47 patients.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 3 (March), 2001: pp 236–243