Disabilities Of The Arm, Shoulder And Hand Score Research Articles

Comparison of Locking Plate Alone and Locking Plate Combined with 3D Printed Polymethylmethacrylate Augmentation in Treating Proximal Humerus Fractures in the Elderly

BackgroundLocking plates are widely used in open reduction internal fixation (ORIF) for proximal humeral fracture (PHF). However, the optimal surgical treatment of unstable, displaced PHF in elderly patients remains controversial. This study aimed to compare the radiological and clinical outcomes of surgical treatment of PHF in the elderly with locking plate (LP) alone and locking plate combined with 3D printed polymethylmethacrylate (PMMA) prosthesis augmentation (LP-PA). MethodsFrom May 2015 to April 2021, a total of 97 patients aged ≥ 60 years with acute unstable PHF who underwent osteosynthesis with either LP (46 patients) or LP-PA (51 patients) were retrospectively analyzed. For the LP-PA group, a customized proximal humeral prosthesis made of PMMA cement was intra-operatively fabricated by a three-dimensional (3D) printed prototype mold for the humeral medial support. Radiological outcomes were analyzed by measuring the value of neck-shaft angle (NSA) and humeral head height (HHH). The clinical outcomes were evaluated using Constant-Murley Score (CMS), Disabilities of the Arm Shoulder and Hand (DASH) score, American Shoulder and Elbow Surgeons (ASES) score, and the shoulder range of motion (ROM). Pain was measured using a visual analogue scale (VAS). ResultsAt the one-year follow-up, all fractures healed radiologically and clinically. The mean changes of NSA and HHH over the follow-up period were markedly smaller in the LP-PA group (3.8 ± 0.9° and 1.7 ± 0.3 mm) than those in the LP group (9.7 ± 2.1° and 3.2 ± 0.6 mm, both P < 0.0001). The LP-PA group also presented lower DASH score (17.1 ± 3.6), higher ASES score (89.5 ± 11.2) and better ROM in forward elevation (142 ± 26°) and external rotation (59 ± 11°) compared to the LP group (28.9 ± 4.8 for DASH score, P < 0.0001; 82.3 ± 9.0 for ASES score, P < 0.001; 129 ± 21° for forward elevation, P = 0.008; and 52 ± 9° for external rotation, P = 0.001). There was no significant difference in overall complication rate between the two groups, although the complication rate of screw perforation was higher in the LP-PA group (P = 0.172). ConclusionsFor PHF in elderly patients, the combination of LP fixation and PMMA prosthesis augmentation effectively improved humeral head support and reduction maintenance, providing satisfactory outcomes both radiologically and clinically. This technique also reduced the incidence of screw perforation associated with plate fixation alone, making it a reasonable option to ensure satisfactory clinical outcomes.

Outcomes following reverse total shoulder arthroplasty vs operative fixation for proximal humerus fractures: a systematic review and meta-analysis.

Proximal humerus fractures are common in the older population. A consensus on the optimal management of complex fractures requiring surgery has yet to be reached. A systematic review and meta-analysis was performed to compare clinical outcomes between reverse total shoulder arthroplasty (RTSA) and open reduction and internal fixation (ORIF). A systematic search of the literature was undertaken using the Medline®, PubMed, Embase™ and Cochrane Central Register of Controlled Trials databases. Prospective and retrospective studies comparing clinical and patient reported results as primary outcome measures were included in this review, with secondary outcome measures including complications and revision surgery. A meta-analysis was conducted. A total of 326 patients from 5 studies were eligible for inclusion in this review. Superior Constant-Murley scores (mean difference [MD]: 13.4, 95% confidence interval [CI]: 6.2-20.6; p<0.001), Oxford shoulder scores (MD: 4.3, 95% CI: 1.2-7.4; p=0.007), simple shoulder test scores (MD: 0.95, 95% CI: 0.01-1.89; p=0.05) and DASH (Disabilities of the Arm, Shoulder and Hand) scores (MD: 5.1 [1study], 95% CI: 2.1-8.1; p=0.034) were noted in patients receiving RTSA. Range of motion and revision surgery rates were also superior in this group. This study suggests that RTSA affords more favourable outcomes and lower revision rates than ORIF following proximal humerus fractures. Definitive conclusions are precluded, however, owing to small sample sizes and risk of bias in retrospective studies.

Clinical analysis of posterior axillary approach internal fixation for IdebergⅠa andⅡglenoid fractures

To investigate the efficacy of posterior axillary approach internal fixation for Ideberg Ⅰa andⅡ glenoid fractures. From December 2018 to September 2021, 9 patients with lower part of glenoid fractures were treated by posterior axillary approach, including 3 males and 6 females, aged from 50 to 78 years old. All the fractures were closed fractures. According to Ideberg type of scapular glenoid fracture was type Ⅰa in 6 cases and type Ⅱ in 3 cases. AP and lateral X-ray films of scapula were taken at 6, 12 weeks and 6 and 12 months postoperatively. Constant-Murley and disabilities of the arm shoulder and hand (DASH), and other complications were recorded at the latest follow-up. Nine patients were followed up, ranged from 6 to 15 months. And bone healing was achieved in all 9 patients at the final follow-up, the healing time 3 to 6 months, Constant-Murley score at the final follow-up ranged from 55 to 96, and DASH score ranged from 3.33 to 33.33. Both of them were better than preoperative. The posterior axillary approach internal fixation for Ideberg Ⅰa and Ideberg Ⅱ Glenoid fractures scapular fracture is satisfactory and worthy of clinical application.

A comparative study on the clinical efficacy of microplate trans-carpometacarpal joint fixation and non-trans-carpometacarpal joint fixation in treating fractures with dislocation or subluxation of the base of the fourth and fifth metacarpal bones

BackgroundThis study aimed to compare the clinical efficacy of microplate trans-carpometacarpal joint fixation and non-trans-carpometacarpal joint fixation in treating fractures and dislocation or subluxation of the base of the fourth and fifth metacarpal bones.MethodFrom 2015 to 2021, 100 cases of metacarpal basal fractures with dislocation or subluxation were randomly divided into the trans-carpometacarpal joint fixation group (group A) and non-trans-carpometacarpal joint fixation group (group B). Group A (n = 50) comprised 44 males and 6 females, with an average age of 28.8 ± 6.1 y and an Orthopedic Trauma Association (OTA) fracture classification of type B1 (n = 29) or C1 (n = 21). Group B (n = 50) comprised 45 males and 5 females, with an average age of 28.9 ± 5.7 y and an OTA fracture classification of type B1 (n = 28) or C1 (n = 22). All patients were complicated with dislocation or subluxation. The surgery time, fracture healing time, postoperative handgrip strength, and total active motion (TAM) scores of the ring and little fingers were recorded and compared between the two groups. The clinical efficacy of patients was evaluated using scoring methods such as DASH (disabilities of the arm, shoulder and hand), visual analogue scale (VAS), and Mayo at 3, 6, and 12 months after surgery.ResultsThere was no significant difference in the general indexes, surgery time, or fracture healing time between the two groups (P > 0.05). There were no significant differences in handgrip strength and TAM scores of the ring and little fingers between the two groups at 3 and 12 months postoperatively (P > 0.05), but there were significant differences in these indexes 6 months postoperatively (P < 0.05). There were no significant differences in the DASH, VAS, and Mayo scores at 3 and 12 months postoperatively (P > 0.05), but there were significant differences between the two groups in the DASH and Mayo scores (P < 0.05) but not the VAS score (P > 0.05) 6 months postoperatively.ConclusionIn the treatment of fourth and fifth metacarpal basal fractures with dislocation or subluxation, both microplate transarticular fixation and non-transarticular fixation could achieve fracture fixation and healing, and each method had advantages and disadvantages. The clinically appropriate fixation method should be selected according to the experience of the surgeon and the degree and type of fracture and dislocation.

Corticosteroid injections for the treatment of lateral epicondylitis are superior to platelet rich plasma at 1 month but platelet rich plasma is more effective at 6 months: An updated systematic review and meta-analysis of level 1 and 2 studies.

The purpose of this study was to perform a systematic review and meta-analysis of studies comparing local injections of either platelet-rich plasma (PRP) or corticosteroid for the treatment of lateral elbow epicondylitis. A systematic review of Medline, Embase, Scopus, and Google Scholar was performed, and all level 1 and 2 randomized studies from 2000 to 2022 were included. Clinical symptoms, patient perceived outcomes, and pain were assessed by the DASH (disabilities of the arm, shoulder and hand questionnaire) and pain by the VAS (visual analog scale). Publication bias and risk of bias were assessed using the Cochrane Collaboration's tools. The modified Coleman Methodology Score (CMS) and the GRADE system were used to assess the quality of the body of evidence. Heterogeneity was assessed using χ2 and I2 statistics. Thirteen studies were included in the analysis. Five studies had a high risk of bias, and the risk of bias across studies was assessed as unclear. There was no publication bias identified. Two of the four GRADE domains (inconsistency of results, imprecision of results) were downgraded to low quality, and the final GRADE assessment was downgraded to a low quality of evidence. The mean CMS score was 62.8, indicating fair quality. The pooled estimate for VAS at 1 month favored corticosteroids (p=0.75), but favored PRP at three (p=0.003) and six months (p=0.0001). The pooled estimate for the DASH score favored corticosteroids at 1 month (p=0.028), but favored PRP at three (p=0.01) and six months (p=0.107) CONCLUSION: The results of this meta-analysis suggest that PRP has no advantage over steroid injections within the first month of treatment, but that it is superior to steroids at both 3 and 6 months. These results also suggest that corticosteroids have a short-term beneficial effect during the early treatment period, although the quality of the available evidence is not very robust in support of this finding. However, these findings must all be viewed with caution as the high risk of bias and moderate to low quality of the included studies may not justify a recommendation of one treatment over another.

FREE VASCULARIZED FIBULA GRAFTING AS MANAGEMENT FOR LARGE SKELETAL DEFECTS IN HUMERAL OSTEOMYELITIS IN NORTHERN IRELAND

IntroductionThe purpose of this study is to evaluate the radiological and clinical outcomes in Northern Ireland of free vascularised fibular bone grafting for the treatment of humeral bone loss secondary to osteomyelitis. Upper limb skeletal bone loss due to osteomyelitis is a devastating and challenging complication to manage for both surgeon and patient. Patients can be left with life altering disability and functional impairment. This limb threatening complication raises the question of salvage versus amputation and the associated risk and benefits of each. Free vascularised fibula grafting is a recognised treatment option for large skeletal defects in long bones but is not without significant risk. The benefit of vascularised over non-vascularised fibula grafts include preservation of blood supply lending itself to improved remodeling and osteointegration.Materials &amp; MethodsSixteen patients in Northern Ireland had free vascularised fibula grafting. Inclusion criteria included grafting to humeral defects secondary to osteomyelitis. Six patients were included in this study. Patients were contacted to complete DASH (Disabilities of the Arm, Shoulder and Hand) questionnaires as our primary outcome measure. Secondary outcome measures included radiological evaluation of osteointegration and associated operative complications. Complications were assessed via review of Electronic Care Record outpatient and in-patient documents.ResultsSix patients in Northern Ireland have been treated with free fibula grafting for humeral defects secondary to osteomyelitis. Regarding aetiology of osteomyelitis, five patients had sustained humeral fractures which were initially managed with open reduction internal fixation and complicated by infected non-union. These cases required removal of metalwork, segmental resection and placement of cement spacer with prolonged antibiotic therapy before return to theatre for vascularised fibula grafting. One patient developed native humeral osteomyelitis, the exact cause of which was unclear. Four patients were contactable for outcome score completion. The average DASH score was 45.5. (range 11.1 – 70.4). The median score was 50.2. With regard to post-operative complications, four of the six patients required return to theatre. Reasons were flap congestion, failure of metalwork at three months, donor site skin grafting for delayed healing and external fixation of graft fracture following trauma. Three patients experienced donor site morbidity in the form of delayed healing or infection requiring admission for intravenous antibiotics. One patient died due to cerebrovascular accident (CVA) within one month of return to theatre for a graft related complication - radiographic osteointegration was not assessed for this patient. At the time of this study, three of the remaining five patients have achieved graft osteointegration. Two patients are within 6 months of grafting procedure therefore too early to comment on radiographic osteoingreration. Radiographs to date are encouraging.ConclusionsFree vascularised fibula grafting for humeral shaft bone defects is a viable option for limb salvage but carries significant risk of complications. Our study highlights the need for proper informed consent regarding risk for this uncommon complex procedure which should only be undertaken by a multidisciplinary team in a specialist orthoplastic unit. This procedure is performed infrequently and our study has given us more information on risk and clinical outcomes to provide full and informed consent for patients in the future.

Comparison of Clinical and Functional Outcomes after Platelet-Rich Plasma Injection and Corticosteroid Injection for the Treatment of de Quervain's Tenosynovitis.

Background Platelet-rich plasma (PRP) has local anti-inflammatory actions, which is being used as a treatment in various tendinopathies. Purpose The aim of the study is to compare the clinical results of PRP injection and corticosteroid injection in the management of de Quervain's tenosynovitis (DQTSV). Patients and Methods In this prospective study, 60 patients of DQTSV, fulfilling the predefined inclusion and exclusion criteria, were randomised into two groups. In group 1 ( n = 30), patients received a single injection of autologous PRP and in group 2 ( n = 30) they received a single injection of corticosteroid (methylprednisolone). All patients were followed up at 1 month, 3 months, 6 months, and 1 year for evaluation by Finkelstein test, visual analogue scale (VAS), DASH (Disabilities of the Arm, Shoulder and Hand) score, and Modified Mayo Wrist score (MMWS). Results In both the groups improvement occurred in Finkelstein test, VAS score, DASH score, and MMWS which were found to be statistically significant at all points of follow-ups when compared to the pre-intervention values. Comparison of scores between the two groups did not show any statistical significance. No complications were reported in PRP group. Statistically significant complications ( p -value = 0.026) like subcutaneous fat atrophy, depigmentation, and temporary increase in pain were seen in eight patients in the corticosteroid group with an overall complication rate of 26.67%. Conclusion Both the modalities are equally effective in the management of DQTSV remittance. PRP is equally effective as corticosteroid in reducing symptoms of first dorsal compartment stenosing tenosynovitis. PRP may have a lower complication profile, however, this benefit should be weighed against the slight increase in cost and time of PRP preparation and injection. Level of Evidence Level 2, prospective comparative study.

Comparison of the effectiveness of proprioceptive neuromuscular facilitation exercises and shoulder mobilization patients with Subacromial Impingement Syndrome: A randomized clinical trial

IntroductionThe aim of this study was to compare the effectiveness of Proprioceptive Neuromuscular Facilitation (PNF) exercises and shoulder mobilization (SM) in addition to conventional physiotherapy on pain, range of motion (ROM), functionality, and muscle strength in patients with Subacromial Impingement Syndrome (SIS). MethodsForty-four patients were randomly allocated into three groups as conventional physiotherapy (control group; n = 14), conventional physiotherapy + PNF exercises (PNF group; n = 15), and conventional physiotherapy + SM techniques (SM group; n = 15). Pain, ROM, muscle strength, and functionality were evaluated by using VAS (Visual Analog Scale), goniometer, push-pull dynamometer, Constant-Murley score and DASH (Disabilities of the Arm, Shoulder and Hand) score. Patients were received 20 sessions (4 weeks) of treatment. Assessments were performed at baseline, and weeks two, four, and sixteen. ResultsAfter treatment, significant improvements in outcome measurements were observed in all groups (all p < 0.05). PNF or SM groups were not superior to each other in terms of improving pain and functionality. SM group was superior to PNF group for improving shoulder flexion ROM at week 4 (p = 0.009). The improvements in shoulder extension muscle strength were greater in PNF group at weeks 2 and 16 compared with other groups (p = 0.030, 0.035). ConclusionPNF or SM, in addition to conventional physiotherapy, might help to improve pain and functionality more in patients with SIS. It is recommended to add SM or PNF to conventional treatment to maintain the ROM increase gained with SIS treatment after treatment, and to apply this treatment for 4 weeks for muscle strength increase.

Early Results of a Variable-Angle Volar Locking Plate for Distal Radius Fractures: A Bi-centre Study.

PurposeThis study examines the clinical, functional and radiological outcomes of distal radius fracture fixation with the Aptus® (Medartis, Pennsylvania) locking plate in order to determine its efficacy and identify notable findings related to treatment variations.MethodsThis is a retrospective bi-centre study collecting patient details from a district general hospital and a regional hand unit. We assessed 61 consecutive patients with distal radius fractures (Arbeitsgemeinschaft für Osteosynthesefragen (AO) grade A=19, B=9, C=33) fixed using an Aptus® plate with a minimum of six months follow-up. Outcome measures included the DASH (Disabilities of the Arm, Shoulder and Hand) score, wrist range of movement and grip strength, and complications. Radiographs were reviewed to assess restoration of anatomy and union.ResultsAll but two fractures united within six weeks. The mean ranges of movement were only mildly restricted compared to the normal wrist (flexion/extension = 102°; radial/ulna deviation = 53°; pronation/supination = 169°). Mean postoperative grip strength was 23.8 kg, which was comparable to the contralateral side at 31.5 kg. The mean DASH score was 18.2. Seven patients had screws misplaced outside the distal radius although three of these remained asymptomatic.ConclusionVariable-angle locking systems benefit from the flexibility of implant positioning and may allow enhanced inter-fragmentary reduction for accurate fixation of intra-articular fractures.

Comparative effectiveness of treatment options for displaced midshaft clavicle fractures : a systematic review and network meta-analysis.

AimsThe aims of this network meta-analysis (NMA) were to examine nonunion rates and functional outcomes following various operative and nonoperative treatments for displaced mid-shaft clavicle fractures.MethodsInitial search strategy incorporated MEDLINE, PubMed, Embase, and the Cochrane Library for relevant randomized controlled trials (RCTs). Four treatment arms were created: nonoperative (NO); intramedullary nailing (IMN); reconstruction plating (RP); and compression/pre-contoured plating (CP). A Bayesian NMA was conducted to compare all treatment options for outcomes of nonunion, malunion, and function using the Disabilities of the Arm Shoulder and Hand (DASH) and Constant-Murley Shoulder Outcome scores.ResultsIn all, 19 RCTs consisting of 1,783 clavicle fractures were included in the NMA. All surgical options demonstrated a significantly lower odds ratio (OR) of nonunion in comparison to nonoperative management: CP versus NO (OR 0.08; 95% confidence interval (CI) 0.04 to 0.17); IMN versus NO (OR 0.07; 95% CI 0.02 to 0.19); RP versus NO (OR 0.07; 95% CI: 0.01 to 0.24). Compression plating was the only treatment to demonstrate significantly lower DASH scores relative to NO at six weeks (mean difference -10.97; 95% CI -20.69 to 1.47).ConclusionSurgical fixation demonstrated a lower risk of nonunion compared to nonoperative management. Compression plating resulted in significantly less disability early after surgery compared to nonoperative management. These results demonstrate possible early improved functional outcomes with compression plating compared to nonoperative treatment. Surgical fixation of mid-shaft clavicle fractures with compression plating may result in quicker return to activity by rendering patients less disabled early after surgery.Cite this article: Bone Jt Open 2021;2(8):646–654.

A prospective comparative evaluation of outcome of surgical management of unstable comminuted fracture of distal radius using external and internal fixation

Background: The goal of treatment of distal fracture of radius is restoration of normal function and prevention of complication like malunion, joint stiffness, and deformity but achievement of desired outcome is always a challenge in fracture of distal end of radius. As there is variability in the conclusion of various literature present study has been conducted to evaluation of outcome of surgical management of unstable comminuted fracture of distal radius using external and internal fixation in our clinical conditions. Method: Patients with unstable comminuted fracture of distal radius admitted in the department of orthopaedics and trauma are enrolled for this study based on inclusion and inclusion criteria. For functional assessment of outcome, we used DASH (Disability of the Arm, shoulder and hand) Method. Result:The mean of DASH score was16.24±4.62 in external fixation group and 14.65±3.98 in internal fixation group. Both groups are comparable to each other as it is not statistically significant (P˃ .05). There is no incidence of compressive neuropathy, Sudeck’s osteodystrophy, iatrogenic rupture and nerve injury. Discussion: From present study we can conclude that fracture of distal end of radius is common fracture with male predominance. Injury is more common on right side and fall from height is common mode of injury. DASH score was less in internal fixation group. Post-operative infection was high in infernal fixation group. Functional outcome was better in outcome was better in internal fixation group.

Comparison of "Bilboquet" device and locking plate for surgical treatment of proximal humerus complex fractures at two years follow-up.

Surgical treatment of three or four part fractures of the proximal humerus is complex. Different conservative techniques have been described. The main goal of this study was to compare the clinical and radiological outcomes of Bilboquet and locking plate at two year follow-up. This is a retrospective, comparative study, with a continuous series of 41 patients. Bony fixation was achieved with a Bilboquet device in 22 patients or a locking plate in 19 patients. Patient evaluation included clinical data: shoulder range of motion, Constant-Murley shoulder score and DASH (Disabilities of the Arm, Shoulder and Hand) score, and imaging using standard shoulder X-rays. Of the 41 patients included, 1 patient was lost to follow-up in the locking plate group. At a mean follow-up of 24 months patients in Bilboquet group showed a Constant score higher than in locking plate (p = 0.02). Range of motion and DASH score were not significantly different between the two groups. avascular necrosis occured in three patients of Bilboquet group (14%) versus in two patients in the locking plate group (11%) (p > 0.5). Complication and reintervention rate were non-significantly higher in the locking plate group than in the Bilboquet group (37 vs 14%). Bilboquet and locking plate give good functional outcomes in complex proximal humerus fractures. However, the Bilboquet device appears to provide better functional results than locking plate at mid-term follow-up.

Clou centromédullaire versus plaque en compression verrouillée pour le traitement des fractures de la diaphyse humérale (AO/OTA 12-A et B) : étude rétrospective

IntroductionThere has been great progress in surgical techniques for treating humeral shaft fractures over the past few decades. The purpose of this study was to compare the therapeutic effects of IMN and LCP for humeral shaft fractures (AO/OTA 12-A and B). HypothesisCompared with locking compression plate (LCP), better therapeutic effects could be obtained with less invasive intramedullary nailing (IMN). Materials and methodsPatients with a humeral shaft fracture who received anterograde IMN or LCP fixation in our institution from December 2011 to June 2016 were reviewed in this study. They were divided into two groups according to the different fixation methods: Group A (IMN) and Group B (LCP). The surgical time, intraoperative blood loss, and complications of the patients were reviewed. Fracture healing was evaluated by radiographs performed at each follow-up. The functional outcome was assessed by the DASH (Disabilities of the Arm, Shoulder and Hand) scoring system at the final follow-up. ResultsThirty-four patients in Group A and forty-six patients in Group B were included in this study. Mean incision length and blood loss in Group B were greater than those in Group A (p<0.001). The average surgical times were 118.53minutes in Group A and 128.91minutes in Group B (p=0.114). The mean DASH scores were 23.76±16.78 in Group A and 22.37±15.18 in Group B (P=0.609). The complication rates were 8/34 in Group A and 7/46 in Group B, respectively (p=0.887). DiscussionThe study hypothesis was partially confirmed. Although IMN was a less invasive technique, similar therapeutic results were obtained for humeral shaft fractures (AO/OTA 12-A and B) fixed with two surgical methods. Levels of EvidenceIII, retrospective comparative study.

Allogeneic Platelet-Rich Plasma Versus Corticosteroid Injection for the Treatment of Rotator Cuff Disease

The use of platelet-rich plasma (PRP) for the treatment of rotator cuff disease is still controversial. The purpose of the present study was to investigate the safety and efficacy of a fully characterized allogeneic pure PRP injection into the subacromial space of patients with rotator cuff disease in comparison with corticosteroid injection. A 2-group, parallel, assessor-blinded, randomized controlled trial was conducted. A total of 60 patients with clinically and structurally diagnosed rotator cuff disease were randomly assigned to receive a subacromial injection of either 4 mL of allogeneic pure PRP or a 4-mL mixture of 1 mL of 40-mg/mL triamcinolone acetonide and 3 mL of 2% lidocaine under ultrasonographic guidance. The primary outcomes were safety and the Constant score at 1 month. The secondary outcomes were pain, range of motion, muscle strength, functional scores, and overall satisfaction and function. There were no treatment-related adverse events. The Constant score at 1 month did not significantly differ between the PRP and corticosteroid groups. At 6 months, the DASH (Disabilities of the Arm, Shoulder and Hand) score, overall function, and external rotation were significantly better in the PRP group than in the corticosteroid group, and the other clinical outcomes did not show significant differences. All pain measurements, the strength of the supraspinatus and infraspinatus, and 5 functional scores also improved slowly and steadily after injection, becoming significantly better at 6 months compared with those before the injection, whereas those in the corticosteroid group responded promptly but did not further improve. Allogeneic PRP injections for the treatment of rotator cuff disease are safe but are not definitely superior to corticosteroid injections with respect to pain relief and functional improvement during 6 months. The DASH score, overall function, and external rotation were significantly better in the PRP group than in the steroid group at 6 months. Generally, PRP slowly but steadily reduced pain and improved function of the shoulder until 6 months, whereas corticosteroid did not. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Evaluation of outpatient cancer rehabilitation for upper extremity functioning for individuals with breast cancer.

287 Background: Specialized cancer rehabilitation is recommended for individuals with breast cancer from diagnosis throughout survivorship to mitigate the negative acute, late and lasting effects of cancer and cancer treatment on upper extremity functioning. However, evidence supporting the impact of community-based outpatient rehabilitation services is lacking, especially for older adults. Methods: Individuals with breast cancer attended cancer-specialized outpatient physical or occupational therapy provided by a single institution with multiple locations across the US in 2019, and completed the Quick DASH (Disabilities of the Arm, Shoulder and Hand). From de-identified rehabilitation records, we abstracted patient and therapy characteristics, Quick DASH scores and therapy satisfaction scores (0-10 point scale) for individuals with a history of breast cancer (identified by ICD code). We used descriptive statistics to summarize characteristics, paired samples t-tests to evaluate Quick DASH scores from initial evaluation (pre) and discharge (post) therapy, and independent samples t-test to compare mean pre-post difference for individuals younger than 65 ( &lt; 65) versus 65 and older (≥ 65). Results: Patients ( N= 556) were 60.56 ± 12.24 (range = 31.52-89.95) years old and predominantly female ( n= 551, 99.1%). They attended cancer rehabilitation (Physical: n= 477, 85.8%, Occupational: n = 79 (14.2%)) for a median of 8 ( IQR= 5.0 – 13.0) sessions over 8.97 ± 7.57 (range = 0.71-47.7) weeks. Average pre-post change in Quick DASH score (-13.51) was significant (p &lt; .01) and exceeded the validated minimal clinically important difference (-11.20). There was no significant difference between average pre-post change for Quick Dash scores between &lt; 65 (n = 334, 60.1%) and ≥ 65 (n = 222, 39.9%) groups (-15.84 vs. -10.01, p = .07). Therapy satisfaction was rated high (median = 10.0, IQR = 10.0-10.0). Conclusions: Specialized rehabilitation for individuals with breast cancer was associated with statistically and clinically significant improvement in upper extremity function and high rates of satisfaction. Older adults demonstrated benefits similar to younger adults. These findings add to the growing evidence for specialized outpatient cancer rehabilitation.

Outcome of absolute fixation by 3.5mm superior locking plate for displaced diaphyseal fractures of clavicle

The current study is a multi centre study done by both the surgeons in different tertiary care hospitals on thirty four patients, both the orthopedic surgeons followed the same operative protocols. It’s a prospective observational study of outcome of diaphyseal fractures managed by absolute fixation by 3.5 mm superiorly placed anatomically contoured locking plate. In case of comminuted fractures lag screws were also used in antero superior plane of clavicle. DASH (Disability of the Arm, Shoulder and Hand) Score was used to quantify the outcome. Regular follow-ups were done and our study showed a mean outcome of DASH score of 3.3 at 2 yrs.

The functional and radiological comparison of the surgical treatment results of forearm diaphyseal fractures in adults treated with open reduction internal fixation and intramedullary locking nail

Objectives: The results of two different methods applied in the surgical treatment of forearm fractures in adults were evaluated. Methods: Thirty-nine patients who applied to our clinic between 2016-2018 and were treated surgically were included in the study. Twenty-three patients out of these were treated with plate osteosynthesis (group 1), and 16 patients were treated with intramedullary locking nail (group 2). While 14 of the patients in group 1 were male, 9 were female, and the average age was 39.8 years (range; 19-74 years); and 11 of the patients in group 2 were male, 5 were female, and the average age was 36.6 years (range; 18-68 years). Patients were called for monthly check-ups until fracture union. Then, radiographic evaluation was done at 3, 6 and 12 months. The average follow-up time was 26 months (range;12-36 months) for group 1 and 25 months (range;12-35 months) for group 2. The loss of the line of fracture through radiographic imaging of trabeculations or callus formation in the cortex on the anteroposterior and lateral radiographs, and clinically loss of sensitivity on fracture were considered fracture union. In the last controls, while the elbow was at 90 degrees of flexion, the amount of rotation of both forearms was measured by using the goniometer. In the functional evaluation, the system described by Grace and Eversmann and used to evaluate fracture union and forearm rotation was used. Patient satisfaction was evaluated by using the DASH (Disabilities of the Arm, Shoulder and Hand) method. Results: While the union duration in group 1 was 12.3 weeks (range; 8-18 weeks), the union duration in group 2 was 12 weeks (range; 9-16 weeks). There was no statistical difference in terms of union durations (p &amp;gt; 0.05). In Group 1, according to the Grace-Eversmann evaluation, 19 (82.6%) patients had excellent and good results, three (13.1%) patients had acceptable results, and 1 (4.3%) patient had poor results. Forearm pronation of the patient with poor results was less than 60% but his bone union was complete. In group 1, the average DASH score was 15.04 (range; 3-28). In group 2, Grace-Eversmann evaluation showed excellent and good results in 13 (81.3%) patients and acceptable results in 3 (18.7%) patients. Average DASH score was found to be 14.6 (range; 2-34). When Grace-Eversmann criteria and DASH values were compared, no significant difference was found between the two groups (p &amp;gt; 0.05). Vascular nerve injury, tendon injury, radioulnar synostosis, and compartment syndrome were not observed in any patient. Conclusions: The results of the two fixation methods in terms of functional recovery and patient satisfaction were similar in the surgical treatment of forearm double fractures in adults.

Arthroscopic reconstruction of acute acromioclavicular joint disruption using dog-bone button construct: A prospective study

IntroductionInjuries to the acromioclavicular joint (AC) are not uncommon accounting for 9% of all shoulder injuries. Surgical management is the mainstay of treatment in severe injuries. Numerous surgical techniques have been described in the literature with variable results. Arthroscopic stabilization using a suspensory fixation is one of the most commonly performed procedure. Current study was done to evaluate the functional and radiological results of arthroscopic acromioclavicular joint reconstruction using dog bone button, a special type of suspensory fixation. Materials and methodsOur study included 14 cases of Rockwood type III and V acute AC joint disruptions. A thorough clinico-radiological evaluation was done preoperatively including a Zanca view and compared with the contralateral side. All patients underwent arthroscopic acromioclavicular joint reconstruction using dog bone button. Radiological and functional results were studied during follow up at 6 weeks, 3 months and 6 months. Functional results were assessed using DASH (Disabilities of the Arm, Shoulder and Hand) score. ResultsThe mean pre-operative coracoclavicular (CC) distance was 16.11 mm with SD ± 1.94 and mean post-operative CC distance was 10.76 mm with SD of ±2.76. Mean DASH scores during follow up were 60, 9.71 and 0.36 at 6 weeks, 3 months and 6 months respectively. There was a significant difference in the pre and post-operative CC distance and DASH t scores (P < 0.001). ConclusionOur study results infer that arthroscopic AC joint reconstruction using dog bone button construct in acute cases provides good functional and radiological results. No significant postoperative complications were associated with the same procedure.

Reversed shoulder arthroplasty leads to significant histological changes of the deltoid muscle: a prospective intervention trial

IntroductionReverse shoulder arthroplasty (RSA) shows promising short- and mid-term results in cuff tear arthropathy. However, functional impairments are described in long-term findings. Micromorphological changes in the periarticular musculature could be in part responsible for this, but have not yet been analysed. Thus, histological changes of the deltoid muscle and their association to the functional outcome were evaluated in this study.Material and methodsA total of 15 patients treated with RSA were included in this prospective study. Functional outcome was assessed using the Constant Score (CS) and the DASH (disabilities of the arm, shoulder and hand) Score before RSA and after a mean follow-up of 12 months. Deltoid muscle biopsies were harvested intraoperatively and 12 months postoperatively. Mean deltoid muscle fibre area (MMFA) was calculated histologically after haematoxylin–eosin staining.ResultsPostoperative shoulder function significantly improved within 12 months (CS: Δ 37.4 ± 22.6, p = 0.001; DASH: Δ 27.1 ± 29.1, p = 0.006). The MMFA significantly decreased (p = 0.02), comparing the results from the intraoperative biopsy (MMFA: 8435.8 µm2, SD ± 5995.9 µm2) to the 12 months biopsy (MMFA: 5792. µm2, SD ± 3223.6 µm2). No correlation could be found between the functional score results and MMFA.ConclusionSigns of deltoid muscle changes in terms of a reduced MMFA can be detected 1 year after RSA and thus already a long time before long-term functional impairments become apparent. Further studies with larger patient series and longer follow-up periods as well as extended histological assessments and simultaneous radiological examinations are required.

Functional outcome following elbow release and hardware removal after bicolumnar fixation of distal humeral fractures

IntroductionIntra-articular fractures of the distal humerus are typically treated with bicolumnar plate fixation. Despite prompt and accurate reduction and fixation, there is a high rate of complications post-surgical fixation. The purpose of this study was to determine the indications, technique, and outcomes of patients who had undergone an elbow release and hardware removal following bicolumnar plate fixation for an intra-articular fracture of the distal humerus. MethodsPatients who had undergone an elbow release and hardware removal by a single surgeon following bicolumnar fixation of an intra-articular fracture of the distal humerus were identified. Patients were contacted to participate in a chart review and to return to clinic for a follow-up visit. Patients who returned for a follow-up visit completed the DASH (Disabilities of the Arm, Shoulder and Hand), the MEPS (Mayo Elbow Performance Score), and the SF-36. ResultsForty-two patients were included in the final analysis. The average time from the original injury to the elbow release procedure was 17.5 months. There was an improvement of 33° in the mean flexion-extension arc following the procedure (p<0.001). The mean DASH score was 21 (SD=19) and the mean MEPS score was 82 (SD=16). There was a high rate of post-traumatic osteoarthritis (n=30). Two patients underwent a total elbow arthroplasty (TEA). One patient sustained a re-fracture of the distal humerus, and subsequently underwent repeat bicolumnar fixation. There were four reoperations (10%): two patients had a revision release of contracture and two patients underwent a closed manipulation. ConclusionsIt appears safe to remove both plates and to re-intervene relatively early. There is a modest but consistent improvement in flexion-extension arc, and the re-operation rate is low. Although there is a high rate of post-traumatic arthritic change radiographically, TEA was rare, and elbow-based outcome scores were good, although not normal.