Disabilities Of The Arm, Shoulder And Hand Research Articles

Effects Supervised Versus Home-Based Rehabilitation on Functional Outcome after Surgical Fixation

Background: The focus for early postoperative motion in stable fixation is aimed at good restoration of joint anatomy in relation to movements, strength, and joint play and to compare the functional outcomes after the surgical repair of distal humerus fractures in contrast with supervised and home-based rehabilitation. Aim: To provide guidelines to effectively manage the post-operative functional complications. Method: Sixty-four patients with the distal humerus fractures were treated surgically, participated in the study at the mean follow up of 6 months. Mayo Elbow Performance Score (MEPS), Disabilities of the Arm shoulder and Hand (DASH), Visual Analogue Scale and Goniometer, radiographic evaluation was done to assess outcomes at baseline (2nd week after cast removal), 10th week &6th month post-operative. Results: Among 60 patients, average MEPS, DASH, Arc of motion was significantly better in supervised rehabilitation group in contrast with home-based rehabilitation group (p=0.00, CI 95%). Average healing time observed on radiographs was 10-12 weeks. The overall complication rate was only 4.7%, while most of the minor complications resolved without any intervention. Conclusions: Outcomes of distal humerus fractures were good to excellent in both groups, whereas supervised rehabilitation provided better outcomes in context with ranger of motion, mobility, and functionality. Keywords: Olecranon Osteotomy, Elbow Fractures, Functional outcome, Elbow Rehabilitation

Reduced Movement Variability and Kinematics Changes During a Hand to Head Movement are Associated with Improved Outcome Following Superior Capsular Reconstruction (232)

Objectives:Patients with irreparable rotator cuff tears (RCT) exhibit functional limitations including limited ability to perform functional tasks such as combing their hair. One viable treatment is superior capsular reconstruction (SCR). SCR has been shown to restore stability of the glenohumeral (GH) joint in cadavers1, but its effect on in vivo scapular and humeral motion is unknown. The aims of this study were to determine the effect of SCR on in vivo scapular and humeral kinematics during a functional hand to head motion and to identify associations between shoulder kinematics and patient-reported outcomes (PROs). We hypothesized that moving the hand to the back of the head would be accomplished by using more GH based movement including rotation and abduction, and less scapular motion after SCR, and there would be a positive correlation between kinematics changes and improved PROs.Methods:Ten patients (8M, 2F, age 63 ± 7 years) with irreparable RCT provided informed consent to participate in this prospective IRB-approved study. American Shoulder and Elbow Surgeon (ASES), Disability of the Arm Shoulder and Hand (DASH), and Western Ontario Rotator Cuff Index (WORC) surveys were completed before (PRE) and 1-year (1YR-POST) after SCR. Participants were seated and instructed to move their hand from their lap to the back of their head while synchronized biplane radiographs of the shoulder were collected PRE and 1YR-POST at 50 images/s for 3 separate trials. Six degree of freedom GH and scapular kinematics were determined with sub-millimeter accuracy by matching subject-specific CT-based bone models of the humerus and scapula to the synchronized radiographs using a validated volumetric tracking technique3. The contributions of humeral abduction, plane of elevation and internal/external (I/E) rotation relative to the scapula, as well as scapular upward rotation, protraction, and tilt, were calculated for each subject before and after SCR. Differences in rotational contributions from PRE to POST were evaluated using a paired t-test. Variability in rotational contributions was characterized by the inter-subject standard deviation in rotational component contributions to the movement. Correlations among changes in the contribution of each rotation component and between the contribution of each rotation component and PROs were evaluated with Pearson’s correlation coefficients. Significance was set at p < 0.05 for all tests.Results:No differences in contribution to motion were identified in any of the rotational components from PRE to POST (all p > 0.15, Figure 1). Inter-subject variability in rotational contributions to the movement decreased in 5 of the 6 rotational components from PRE to 1YR-POST (Table 1; Figure 1). The PRE to 1YR POST change in contribution from GH abduction was positively correlated to the change in contribution from GH I/E rotation (Figure 2, R = 0.8, p = 0.001) and negatively correlated to the change in contribution from scapular protraction (Figure 2, R = -0.94, p = 0.001). ASES scores were negatively correlated with abduction contribution PRE (R = -0.65, p = 0.043), and positively correlated with plane of elevation PRE (R = 0.685, p = 0.03). Changes in the plane of elevation contribution were also positively correlated with changes in ASES scores (R = 0.635, p = 0.048).Conclusions:This is the first study to report GH and scapular kinematics when performing the functional task of placing the hand to the back of the head. Changes in contributions to the motion were inconsistent across subjects, making it difficult to find differences from PRE to POST. However, inter-subject variation was reduced following surgery, suggesting the participants’ movement strategy converged toward a more similar and possibly more efficient movement pattern following SCR. Increased contributions of glenohumeral rotation and abduction were offset by decreased scapular protraction and indicates SCR affects the contributions from these three rotations, partially supporting our first hypothesis. In addition, increased GH plane of elevation contribution following surgery was associated with improved ASES scores supporting our second hypothesis. This may be consistent with improved glenohumeral kinematics and efficiency of movement during a functional task following SCR. Future work will investigate GH and scapular kinematics in healthy individuals performing the hand to head movement to determine if movement strategy is closer to healthy after SCR.

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.

The comparison of single plate and double plate fixation methods for treatment of humeral shaft nonunions.

Objectives This study aims to evaluate the early- and mid-term shoulder and elbow functions and compare the union rates after the application of single plate and double plate for the treatment of humerus shaft nonunions.Patients and methods This retrospective study included 56 patients (36 males, 20 females; mean age 53.8±9.5; range, 28 to 68 years) treated with double plate (n=25) and single plate (n=31) osteosynthesis between October 2012 and January 2016. Surgical treatment of the nonunion was applied in the fourth month after the fracture at the earliest. Autograft taken from the iliac bone was applied during the surgery in all patients. Evaluation was performed using The University of California at Los Angeles (UCLA) Shoulder Score, Mayo Elbow Performance Score (MEPS), Visual Analog Scale (VAS), Constant Shoulder Score, and Disabilities of the Arm Shoulder and Hand (DASH) questionnaire.Results The mean postoperative follow-up time was 40.7±9.6 (range, 25 to 58) months. No statistically significant difference was determined in respect of time to union, follow-up time, DASH questionnaire score, UCLA Shoulder Score, VAS, MEPS and Constant Shoulder Score after union in the comparison of the two groups (p>0.05). In the examination of postoperative early (three months) recovery phase of shoulder and elbow functions, statistically significant superior scores were obtained in the double plate group for MEPS (double plate median=85 [min 75-max 90], single plate median=75 [min 70-max 85]) and Constant Shoulder Score (double plate median=89 [min 85-max 92], single plate median=81 [min 75-max 90]) (p<0.001).Conclusion There was no statistically significant difference in terms of time to union and union rates between single plate and double plate fixations for surgical treatment of humeral shaft nonunions. However, superior clinical results were obtained in the early recovery phase of shoulder and elbow functions with double plate fixation.

Comparison of use of plaster casting versus elastic bandage following carpal tunnel release: a randomized controlled study.

ObjectiveTo compare the effects of two postoperative regimens following carpal tunnel release; plaster casting and elastic bandaging.DesignA randomized controlled study.PatientsPatients with carpal tunnel syndrome and planned surgical carpal tunnel release were invited to participate.MethodsA total of 94 patients were randomized to either plaster casting or elastic bandaging to be used 2 weeks postoperatively. Muscle strength, pain rated on a visual analogue scale, range of movement, sensibility, oedema, and different scores regarding symptoms and function were measured before and 2, 4, 6, 8 and 26 weeks after surgery.ResultsNo differences were found between the 2 groups for any measurement, except for the DASH (Disability of the Arm, Shoulder and Hand) Health Score and daily function, rated 2 weeks postoperatively, in which the bandage group scored better. Both groups improved significantly over time for all measurements, sensibility was improved after 2 weeks, while strength was not fully recovered until week 26.ConclusionFollowing carpal tunnel release no benefits were found in using plaster casting, compared with elastic bandaging. Among these patients there was more discomfort during plaster casting compared with elastic bandaging; therefore plaster casting is not recommended following this type of surgery.LAY ABSTRACTNo clear consensus exists regarding benefits of use of plaster casting following carpal tunnel release. This study aimed to compare two different postoperative regimens in a randomized controlled study. A total of 94 patients were randomized to either plaster casting or elastic bandage to be used for 2 weeks after surgery for carpal tunnel release. Muscle strength, rated pain, range of movement, sensibility, oedema, and different scores regarding symptoms and function were measured before and 2, 4, 6, 8 and 26 weeks after surgery. No differences were found between the 2 groups for any measurement, except for health score and rated daily function 2 weeks postoperatively, in which the bandage group scored better. Both groups improved significantly over time for all measurements, sensibility was improved after 2 weeks, while strength was not fully recovered until week 26. This study found no benefits, but some disadvantages, of plaster casting following carpal tunnel release, and therefore plaster casting is not recommended for these patients.

Patient-related outcome, fracture displacement and bone mineral density following distal radius fracture in young and older men

BackgroundDistal radius fractures can adversely affect wrist function; for men with this fracture, the role played by fracture severity, age and osteoporosis on fracture outcome has not been sufficiently studied.ObjectiveTo describe patient-reported outcome and the association with bone integrity, fracture severity and future fracture risk among young and older men with distal radius fracture.MethodsThis prospective study includes 133 men with acute distal radius fracture, mean age 54 (range 21–88), who were followed for 12 months. They were categorized as younger (< 65) and older (65+). Main outcome was DASH (Disability of the Arm, Shoulder and Hand) at 12 months; DASH > 15 was defined as poor outcome. Fractures were classified and radiographic displacement identified at initial presentation and follow-up. BMD was measured and FRAX 10-year probability of fracture calculated.ResultsDisability was higher in older men (DASHmedian 10 vs 2; p = 0.002); a clinically meaningful difference (ΔDASH = 10, p = 0.017) remained after adjustment for displacement, fracture classification and treatment method. Almost 50% of older men vs 14% in younger had poor outcome, p < 0.001. Bone mineral density did not independently predict outcome. Older men with a displaced fracture at initial presentation had greater disability (DASHmedian, IQR 45, 14;73) and risk of fracture (FRAXmajor osteoporotic 14, 8;21).ConclusionMen over the age of 65 with a distal radius fracture are more likely to have post-fracture disability regardless of radiographic appearance. Fracture displacement, indicating impaired bone strength, is also more common and associated with an increased risk of fracture within 10-years. Secondary fracture prevention should therefore be considered in men presenting with distal radius fracture.

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.

Arthroscopic labral repair with all-suture anchors: a magnetic resonance imaging retrospective study with a 2.5-year follow-up

Aim To evaluate radiological and clinical outcomes of a case series of patients affected by glenohumeral instability (Bankart lesion) or superior labrum tear from anterior to posterior (SLAP) lesions treated by arthroscopic repair using all-suture anchors. Methods Patients were operated by a single surgeon at a single Institution. Exclusion criteria were chondral lesions of the glenoid, rotator cuff lesions, previous surgery at the index shoulder, or a bony Bankart lesion. Position and numbers of anchors used depended on the dimension and type of lesion. The DASH (Disability of the Arm, Shoulder and Hand) and Constant scores were used for subjective and clinical evaluation at follow-ups (FUs); also, at 1-year FU, MRI scan was obtained to evaluate bone reaction to the implanted devices. Results Fifty-four patients were included. A mean of 2.7 devices per patient (145 in total) were implanted. Mean FU was 30 (range 12 - 48) months. No patient reported recurrent instability, nor hardware-related complications were registered. MRI analyses showed that 119 (82%) implants did not alter surrounding bone (grade 0), 26 (18%) implants were surrounded by bone oedema (grade 1), while no bone tunnel enlargement nor a bone cyst (grade 2 or 3, respectively) were registered. Conclusion This study confirmed the efficacy and safety of a specific all-suture anchor system in the arthroscopic repair of the glenoid labrum for glenohumeral instability or a SLAP lesion. In the short- and mid-term period, these devices were associated with good clinical and radiological outcomes without clinical failures or reaction at bone-device interface.

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.

EARLY COMPLEX REHABILITATION TREATMENT OF PATIENTS WITH FRACTURE OF DISTAL METAEPIPHYSIS OF THE RADIUS

Relevance. Fractures of the distal metaepiphysis of the radial bone among all fractures range from 11% to 30%. Unsatisfactory results of treatment in patients over 70 years old are found in 44% of cases. Timely and adequate rehabilitation treatment is important for obtaining good results in the treatment of such patients.&#x0D; Objective: to improve the results of the treatment of patients with fractures of the distal metaepiphysis of the radial bone based on early comprehensive individual rehabilitation treatment.&#x0D; Materials and methods. 97 patients with displaced fractures of the distal metaepiphysis of the radius were observed. Among them, 67 are women (69.1%), over 50 years old – 64 (66%). Used conservative treatment with a sparing technique of one-stage reduction. Upon completion of the correction, according to the indications, measures were prescribed for the prevention of neurodystrophic syndrome, depending on the likelihood of its development (according to the temperature gradient of the fingers of the extremities) in the form of drug therapy. Massage, kinesiotherapy, and physiotherapy began on the second day. The pain intensity was determined using a visual analog scale. The nature of pain was determined by the DN4 questionnaire (questionnaire for the diagnosis of neuropathic pain). For subjective unified assessment of hand function in the long term after a hand injury, I used a specific questionnaire DASH (Disability of the Arm, Shoulder and Hand Outcome Measure) – a questionnaire of outcomes and disability of the hand and hand.&#x0D; Results. Rehabilitation treatment at admission and at the early outpatient stage was complex, individual, taking into account the periods of illness. The debris correction was painless, low-traumatic, rational fixing bandages were used. The volume of drug therapy was determined by the value of the temperature gradient of the fingers.&#x0D; Conclusion. The proposed method for the rehabilitation of patients with fractures of the distal metaepiphysis of the radius is highly effective: good and satisfactory (according to the DASH scale) results were obtained in 97.8% of cases, unsatisfactory – in 2.2%.

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.

Observational study of outcome of open reduction and internal fixation of supracondylar with inter condylar humeral fracture in patient above 18 years at tertiary care center of south Gujarat

Aim: To anayise functional outcome of surgical management of supracondylar with inter condylar humeral fracture. Materials and Method: We hereby report the outcome of a series of Intracondylar fractures of the humerus treated by open reduction and internal fixation and discuss the controversies in light of published literature. Total 50 patients included in this retrospective study which include 36 male and 14 female. 39 patients were treated using Orthogonic platting and 11 patients were treated using parallel platting via posterior approach within 15 days of injury. Functional outcome was assessed via DASH (Disability of the Arm, Shoulder and Hand), MEPS(Mayo Elbow Performance Score) at 6 months. Results:At the end of 6 months flexion arc was 115 ± 6.79 in the orthogonal group while that in the parallel plating group was 112 ± 7.72. MEPS and DASH scores were 87.23 ± 7.75 and 24.23 ± 6.02 for the orthogonal group and 89 ± 8.07 and 23.18 ± 11.33 for the parallel plating group, respectively. In our practice, no significant differences were found between the orthogonal and parallel plating methods in terms of clinical outcomes or complication rates. Conclusion: The high rate of union can be achieved in complex intra-articular fractures of distal humerus if the proper principles of stable fracture fixation are followed, and dual fixation of both columns and restoration of the continuity of articular surface. The stability achieved by this technique permits institution of early intensive physiotherapy to restore elbow function.