Mean Disabilities Of Arm, Shoulder And Hand Research Articles

Results of open reduction and internal fixation of proximal humerus fractures using a proximal humeral plating system with smooth pegs.

The aim of this study was to evaluate clinical results and complication rate in patients with proximal humeral fracture treated with Anatomical Locking Plate System (A.L.P.S.) Proximal Humeral Plating System with smooth pegs. Retrospective evaluation of 116 consecutive patients treated with A.L.P.S. Proximal Humeral Plating System. Shoulder function was evaluated by Constant score and disabilities of arm, shoulder and hand (DASH). Furthermore, European Quality of life 5 Dimensions (EQ-5D) and single shoulder value (SSV) were assessed. Fractures were classified according to Neer. Fifty-two patients were included with a mean follow-up of 49 months. Mean Constant score was 62.8. Mean DASH was 17, and the mean EQ-5D was 0.91. According to Neer classification 63% (n = 33) of the fractures were two-part, 31% (n = 16) three-part, and 6% (n = 3) four-part fractures. Peg penetration was registered in 13 cases (25%, n = 52). In total a reoperation rate of 23% (n = 12) and an overall complication rate of 37% (n = 19) were recorded. Open reduction and plate fixation with the A.L.P.S. Proximal Humeral Plating System with smooth pegs provides a stable fixation with good clinical outcome and complication and reoperation rates in line with previous studies with plates using screws in the humeral head.

Internal brace augmentation in elbow varus posteromedial rotatory instability (VPMRI) allows early rehabilitation and prevents stiffness.

Varus posteromedial rotatory instability (VPMRI) involves anteromedial coronoid fracture (AMCF), lateral ulnar collateral ligament (LUCL), and medial collateral ligament (MCL) injury. There is no general consensus regarding the surgical treatment, but most surgeons recommend internal fixation of the coronoid along with primary ligament repair. This methodology involves postoperative immobilization to allow ligament healing, occasionally associated with stiffness. Augmentation of one/or both collateral ligaments using a non-absorbable suture tape as an internal brace in VPMRI cases was the subject of the presented study. This method allows brace-free initiation of full elbow range of motion while protecting bony and soft tissue healing. 17 patients (13 males and four females) with VPMRI were treated in the center from 2017 to 2021 with internal brace augmentation of collateral ligament along with ORIF (Open reduction & internal fixation)/ reconstruction of the coronoid fragment. All patients were actively mobilized early after surgery. Patients who completed a minimum follow up of 24 months were included in the study. Clinical examination findings at follow-up assessment included ROM (range of motion) recording and instability testing, including special instability tests such as moving valgus stress test, lateral pivot shift test, Posterolateral rotatory drawer test, and gravity-assisted varus stress test. Disabilities of arm, shoulder and hand (DASH) score, Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES), Visual Analogue Score (VAS), and SEV (Simple Elbow values) were assessed and noted at follow-up. At 43 months of mean follow-up, none of the patients had significant postoperative contracture, and none had any clinically apparent signs of instability or suffered subluxation or re-dislocation. Postoperative radiographs showed complete fracture/graft healing with no signs of subluxation in all patients. The mean range of motion of the patients was 6.20 (1.00-11.30) to 139.10 (136.20-142.00), with a mean Oxford elbow score (OES) of 42.0 (39.9-44.7). The mean DASH (Disability of Arm, Shoulder & Hand) score was 11.4 (6.7-16.1), the mean MEPS (Mayo Elbow Performance Score) was 91.2 (86.3-96.0), the mean Visual Analogue Score (VAS) score was 0.6 (0.1-1.2), and the mean Simple Elbow value (SEV) was 85.4% (81.1-89.8%). Internal brace augmentation with a non-absorbable suture tape in the setting of VPMRI is a safe and helpful adjunct to coronoid repair/reconstruction and primary ligament repair and allows early mobilization and recovery of elbow stability and range of motion.

Outcomes of Arthroscopic Debridement of the First Carpometacarpal Joint: A Systematic Review.

Background: Arthroscopic debridement is increasingly being utilised in patients with early-stage first carpometacarpal joint (FCMCJ) arthritis but has limited supportive evidence. This systematic review evaluates the literature, and reports on outcomes and adverse events following this procedure. Methods: An electronic literature search of PubMed, Embase, Medline and Cochrane Central, looking for studies describing outcomes following arthroscopic debridement in FCMCJ arthritis, was performed in November 2022. Studies where bony resection or interposition was performed as adjuncts were excluded. Reported outcomes included visual analogue scores (VAS) for pain; Disabilities of Arm, Shoulder and Hand (DASH) scores; pinch and grip strength; complications and re-operations. Results: Out of a total of 90 studies revealed from the search, only two studies were eligible for inclusion, with a cohort of 34 patients. Following arthroscopic debridement for FCMCJ osteoarthritis, the mean VAS improved by four units, mean DASH by 22 points, grip strength by 4.5 kg and pinch strength by 2 kg at mean follow-up of 18 months. The pooled complication and re-operation rates were 8.8% and 23.5%, respectively. Conclusions: There is a lack of evidence supporting the utility of FCMCJ arthroscopy and debridement in the management of patients with early arthritis. Although the limited evidence suggests that there may be some therapeutic benefit, further large-scale prospective studies need to be performed before making conclusive recommendations. Level of Evidence: Level III (Therapeutic).

Short- to Mid-term Results of Patient-Specific Polymethylmethacrylate Radial Head Prosthesis in Complex Radial Head Fractures Using 3-Dimensional Mold System.

Background: We used antibiotic-impregnated polymethylmethacrylate (PMMA) bone cement to make a patient-specific radial head prosthesis (RHP) by applying the 3-dimensional (3D) designing technique in patients with Mason types 3 and 4 radial head fractures. The aim of this study is to report the short- to mid-term outcomes of this procedure. Methods: This is a prospective study of all patients who underwent a patient-specific PMMA bone cement RHP at our institute over a 1-year period from May 2017 to June 2018. The outcome measures included range of motion, grip strength, visual analogue scale (VAS) for pain at rest and at activity, disabilities of arm, shoulder and hand (DASH) score and Mayo elbow performance index (MEPI). Radiographs of the elbow ere obtained at final follow-up and any complications were also recorded. Results: Our study included eight patients with a mean follow-up of 18 months (13-20 months). The mean arc of extension-flexion and supination-pronation of the operated side was 86% and 96% of the unaffected side, respectively. Mean grip strength was 86% of the unaffected side. The mean VAS for pain at rest was 0 and during activity was 2 out of 10. The mean DASH score was 8 out of 100 (0-22), showing minimal disability and ability to cope with most living activities. MEPI showed four excellent, three good and one fair result. One patient complained of proximal forearm pain that appeared 1 year after surgery. No patient complained of ulnar nerve symptoms requiring intervention. No RHP was removed during the follow-up. Conclusions: PMMA RHP can be used safely as an alternative to metal prostheses to restore valgus and axial stability of the forearm. The use of 3D printing optimised the design and surgical technique of radial head arthroplasty, and we need further studies to assess the long-term follow-ups. Level of Evidence: Level IV (Therapeutic).

Do Variable Locking Plates Provide Better Functional and Radiological Outcomes in Volar Barton Fractures?

A volar or reverse Barton fracture refers to an intra-articular distal radius fracture that extends out to the volar aspect of the distal radius and there may be subluxation or dislocation in that direction. The overall goal of managing volar Barton fractures is to obtain motion that is pain-free, allow the patient to return to their usual activities, and minimize the risk of development of early-onset arthritis which may cause disability. Though various management options are available, this study deals with the assessment of functional and radiological outcomes of volar Barton fracture fixed with a variable locking plate. A prospective, observational, and hospital-based study was conducted at R. L. Jalappa Hospital and Research Centre, Sri Devaraj Urs Medical College (SDUMC), Tamaka, India, on patients with volar Barton fracture managed with a variable locking plate from the period December 2019 to June 2021. Clinical data were assessed with Disabilities of Arm, Shoulder and Hand (DASH) score, Gartland and Werley demerit criteria, and Sarmiento modification of Lindstrom criteria. Results: Forty subjects with a mean age of 36.43 ± 10.59 years were included in the study. The mean flexion, extension, supination, and pronation were 70.63° ± 3.6°, 74.3° ± 3.64°, 79.83° ± 2.67°, and 76.28° ± 1.99° degrees respectively at the end of six months. Based on Gartland and Werley's outcome, the majority (65%) of the study population was found to have an excellent outcome, 30% had a good outcome and only 5% had a fair outcome. The mean DASH score was 13.98 ± 5.76. According to Sarmiento's modification of Lindstrom criteria, 22 patients had good radiological outcomes, 11 had excellent outcomes and seven hadfair outcomes. The study concludes that fixation of volar Barton fractures with variable locking plates has a better role in immediate stability, maintaining anatomic reduction, and early mobilization. It also provides better functional outcomes and a good anatomical reduction.

Outcomes of Arthroscopic Scaphoid Excision and Lunocapitate Fusion for Advanced Traumatic Arthritis of the Wrist.

Arthroscopic lunocapitate (LC) fusion can be an alternative surgical treatment for scapholunate advanced collapse (SLAC) or scaphoid nonunion advanced collapse (SNAC) of the wrist. We retrospectively reviewed patients who had arthroscopic LC fusion to estimate clinical and radiological outcomes. From January 2013 to February 2017, all patients with SLAC (stage II or III) or SNAC (stage II or III) wrists, who underwent arthroscopic LC fusion with scaphoidectomy and were followed up for a minimum of 2 years, were enrolled in this retrospective study. Clinical outcomes included visual analog scale (VAS) pain, grip strength, active range of wrist motion, Mayo wrist score (MWS), and the Disabilities of Arm, Shoulder and Hand (DASH) score. Radiologic outcomes included bony union, carpal height ratio, joint space height ratio, and loosening of screws. We also performed group analysis between patients with 1 and 2 headless compression screws to fix the LC interval. Eleven patients were assessed for 32.6 ± 8.0 months. Union was achieved in 10 patients (union rate, 90.9%). There was improvmenet in mean VAS pain score (from 7.9 ± 1.0 to 1.6 ± 0.7, p = 0.003) and grip strength (from 67.5% ± 11.4% to 81.8% ± 8.0%, p = 0.003) postoperatively. The mean MWS and DASH score were 40.9 ± 13.8 and 38.3 ± 8.2, respectively, preoperatively and improved to 75.5 ± 8.2 and 11.3 ± 4.1, respectively, postoperatively (p < 0.001 for all). Radiolucent screw loosening occurred in 3 patients (27.3%), including 1 nonunion patient and 1 patient who underwent screw removal due to the screw migration encroaching the lunate fossa of radius. In group analysis, only the frequency of radiolucent loosening was higher in 1 screw (3 of 4) than 2 screw fixation (0 of 7) (p = 0.024). Arthroscopic scaphoid excision and LC fusion for patients with advanced SLAC or SNAC of the wrist was effective and safe only in cases fixed with 2 headless compression screws. We recommend arthroscopic LC fusion using 2 screws rather than 1 to decrease radiolucent loosening, which might affect complications such as nonunion, delayed union, or screw migration.

The outcome of treatment of Kienbock's disease stage III by excisional arthroplasty and palmaris longus spacer

Purpose: To present the outcomes of treatment of Kienbock's Disease (KD) stage III, by excisional arthroplasty of lunate with Palmaris Longus (PL) tendon as a spacer. Methods: Twenty-one patients were diagnosed with KD stage III, 14 females, and 7 males. They were treated by excision of the lunate plus PL tendon ball as a spacer. Mean follow up period was 38 months (24-60). Pre- and post-operative treatment assessment were by recording the clinical examination data, the investigation by radiological imaging (plain and CT scan), MRI, and scoring of Disabilities of Arm, Shoulder and Hand (DASH) system. Results: Nineteen patients improved clinically to a great extent, by relieving symptoms, a better range of movement, functional satisfaction and no conspicuous Carpal Height Ratio (CHR) change. Mean DASH score improved from 38.5 to 6.8. Two patients had less favorable clinical outcome, yet, they were not interested to have further operations. Conclusions: Treatment of KD stage III by excisional arthroplasty plus palmaris longus tendon spacer is a low demand operation, which can be performed in a moderate hospital environment, and can accomplish good satisfactory results comparable to other more sophisticated, costly procedures. Type of study/Level of evidence: Prospective case series, level IV.

Outcomes With Surgery vs Functional Bracing for Patients With Closed, Displaced Humeral Shaft Fractures and the Need for Secondary Surgery

Existing evidence indicates that surgery fails to provide superior functional outcome over nonoperative care in patients with a closed humeral shaft fracture. However, up to one-third of patients treated nonoperatively may require secondary surgery. To compare the 2-year outcomes of patients who required secondary surgery with the outcomes of patients with successful initial treatment. This 2-year follow-up of the Finnish Shaft of the Humerus (FISH) randomized clinical trial comparing surgery with nonoperative treatment (functional brace) was completed in January 2020. Enrollment in the original trial was between November 2012 and January 2018 at 2 university hospital trauma centers in Finland. A total of 321 adult patients with closed, displaced humeral shaft fracture were assessed for eligibility. After excluding patients with cognitive disabilities, multimorbidity, or multiple trauma and those refusing randomization, 82 patients were randomized. Interventions were surgery with plate fixation (n = 38; initial surgery group) or functional bracing (n = 44); the latter group was divided into the successful fracture healing group (n = 30; bracing group) and the secondary surgery group (n = 14) with fracture healing problems. The primary outcome was Disabilities of Arm, Shoulder and Hand (DASH) score at 2 years (range, 0 to 100 points; 0 denotes no disability, 100 extreme disability; minimal clinically important difference, 10 points). Of 82 randomized patients, 38 (46%) were female. The mean (SD) age was 48.9 (17.1) years. A total of 74 patients (90%) completed the 2-year follow-up. At 2 years, the mean DASH score was 6.8 (95% CI, 2.3 to 11.4) in the initial surgery group, 6.0 (95% CI, 1.0 to 11.0) in the bracing group, and 17.5 (95% CI, 10.5 to 24.5) in the secondary surgery group. The between-group difference was -10.7 points (95% CI, -19.1 to -2.3; P = .01) between the initial and secondary surgery groups and -11.5 points (95% CI, -20.1 to -2.9; P = .009) between the bracing group and secondary surgery group. Patients contemplating treatment for closed humeral shaft fracture should be informed that two-thirds of patients treated with functional bracing may heal successfully while one-third may experience fracture healing problems that require secondary surgery and lead to inferior functional outcomes 2 years after the injury. ClinicalTrials.gov Identifier: NCT01719887.

Treatment of diaphyseal forearm defects caused by infection using Ilizarov segmental bone transport technique

BackgroundThe Ilizarov segmental bone transport technique can be applied in the reconstruction of the bone defects with less invasive fashion and more versatility compared to other methods, while most studies were focused on the lower extremity. The purpose of this study was to evaluate the effectiveness of the Ilizarov segmental bone transport technique in the treatment of diaphyseal forearm bone defects caused by infection.MethodsThis study included 12 patients with diaphyseal forearm bone defects caused by infection, who underwent bone transport procedures using the monolateral external fixator at our institution from January 2010 to January 2018, including 10 males and 2 females with a mean age of 39 years (range 23–57 years). Patient’s demographic data and clinical outcomes at least two years follow-up after removing the external fixator were collected and retrospectively analyzed. The functional results were evaluated by the questionnaire of Disability of Arm, Shoulder and Hand (DASH) and the modified Mayo wrist score (MWS) at the final follow-up.ResultsThere were 10 radii and 2 ulnae bone transport procedures collected. The average defect size was 5.1 cm (4-6.5 cm). All patients were successfully followed up with a mean period of 28.2 months (24 to 36 months) and achieved infection-free union. There was no recurrence of infection observed. The mean external fixation time was 232.6 days (182 to 276 days), and the mean external fixation index was 46.3 days/cm (40.9 to 61.8 days/cm). The mean DASH score was 30.6(18 to 49) preoperative, while 13.8 (5 to 26) at the final follow-up. The average modified MWS improved from 68.8 (55 to 80) pre-operatively to 83.8 (65 to 90) at the final follow-up. All the differences between the preoperative and final scores were statistically significant (p < 0.05). Almost all the patients achieved satisfactory clinical outcomes and were able to perform activities of daily living.ConclusionsIlizarov segmental bone transport technique is an alternative and effective method for the treatment of diaphyseal forearm bone defects caused by infection, and this method acquired satisfactory clinical outcomes.

Clinical comparison of management of intra-articular distal humerus fractures with two surgical approaches; TRAP vs Olecranon osteotomy

Background: The aim of this study is to evaluate and compare the functional outcomes of patients with intra-articular distal humerus fractures treated with triceps-reflecting anconeus pedicle (TRAP) and olecranon osteotomy. Methods: Thirty three patients with intra-articular distal humerus fractures were retrospectively analysed. TRAP approach was used in 17 patients (10 males, 7 females; mean age 35.9 years, range 17-70), and olecranon osteotomy in 16 patients (11 males, 5 females; mean age 34.4 years, range 18-62). Fractures were classified using the AO/ASIF classification. Functional results were evaluated with the Mayo elbow performance score (MEPS) and the Disabilities of Arm, Shoulder and Hand (DASH) questionnaire score. Results: The overall mean arc of elbow motion was 108° (range 70°-140°) in the TRAP group, whereas that of the olecranon osteotomy group was 102° (range 70°-130°). There were no significant differences noted between the two groups in terms of mean MEPS and DASH scores (p=0.318, p=0.236, respectively). The overall complication rate was 41.17% in the TRAP group and 56.25% in the olecranon osteotomy group. Conclusion: Intra-articular distal humerus fractures mandates surgical fixation for best functional outcomes. Both TRAP and olecranon osteotomy approaches can be used in the treatment of intra-articular distal humerus fractures. Both approaches yields no significant difference in clinical and functional results for intra-articular distal humerus fracture management.

The treatment of complex intra-articular distal radius fractures with turning radius and distal volaris radius plate fixation

BackgroundAlthough distal radius fractures (DRFs) are clinically common, intra-articular DRFs accompanied by dorsally displaced free fragments are much less so. At present, it is very difficult to fix and stabilize the intra-articular distal radius fractures accompanying dorsally displaced free fragments with a plate. Our aim was to investigate the clinical effect of DRFs with distally displaced dorsal free mass treated with distal volaris radius (DVR) combined with turning of the radius via the distal palmar approach.MethodsFrom 2015 to 2019, 25 patients with intra-articular distal radius fractures associated with dorsally displaced free fragments were selected and treated with distal volaris radius (DVR) combined with turning of the radius via the distal palmar approach. This study involved 14 males and 11 females, with an average age of 34.5 years (ranging from 21 to 50 years). The mean follow-up period was 16.5 months (ranging from 12 to 22 months). The dorsal displacement of the free fragments was analyzed by X-ray and three-dimensional computed tomography, allowing characterization of postoperative recovery effects by radial height, volar tilt and radial inclination. For the follow-up, we evaluated effects of the surgery by analyzing range of motion (ROM); Modified Mayo Wrist Score (MMWS); and Disabilities of Arm, Shoulder and Hand (DASH) score. Postoperative wound recovery and complications were also monitored to evaluate the clinical therapeutic effects of the surgical procedures.ResultsX-ray showed that all patients showed reduced fractures, well-healed wounds and recovered function with no obvious complications. Based on the follow-up, patients had a mean radial height of 10.5 mm (ranging from 8.1 to 12.6 mm), mean MMWS of 78.8° (ranging from 61° to 90°), mean DASH score of 16.25 (ranging from 11 to 21), mean ROM for volar flexion of 76.5° (ranging from 62° to 81°), mean ROM for dorsiflexion of 77.1° (ranging from 59 to 83) and mean VAS score of 1.4 (ranging from 1 to 3).ConclusionTreatment of the intra-articular distal radius fractures accompanying dorsally displaced free fragments with turning of the radius and the DVR plate system via the distal palmar approach is effective and has no obvious complications.

Effect of Surgery vs Functional Bracing on Functional Outcome Among Patients With Closed Displaced Humeral Shaft Fractures

Humeral shaft fractures traditionally have been treated nonsurgically, but there has been a steady increase in the rate of surgery over the past 2 decades without high-quality evidence to justify the trend. To compare the effectiveness of surgical treatment with open reduction and internal plate fixation to nonsurgical treatment with functional bracing in the treatment of closed humeral shaft fractures. Randomized clinical trial conducted at 2 university hospital trauma centers in Finland, enrollment between November 2012 and January 2018 with a final follow-up of January 2019. A total of 82 adult patients with closed, unilateral, displaced humeral shaft fracture met criteria for inclusion. Patients were excluded if they had cognitive disabilities preventing them from following the protocol or had multimorbidity or multiple trauma. Patients were randomly assigned to surgical treatment with open reduction and internal plate fixation (n = 38) or to nonsurgical treatment with functional bracing (n = 44). The primary outcome was Disabilities of Arm, Shoulder and Hand (DASH) score at 12 months (range, 0 to 100 points, 0 denotes no disability and 100 extreme disability; minimal clinically important difference, 10 points). Among 82 patients who were randomized (mean age, 48.9 years; 38 women [46%]; 44 men [54%]), 78 (95%) completed the trial. Thirteen (30%) of the patients assigned to functional bracing underwent surgery during the 12-month follow-up period to promote healing of the fracture. At 12 months, the mean DASH score was 8.9 (95% CI, 4.2 to 13.6) in the surgery group and 12.0 (95% CI, 7.7 to 16.4) in the bracing group (between-group difference, -3.1 points; 95% CI, -9.6 to 3.3; P = .34). Eleven patients (25%) allocated to functional bracing developed fracture nonunion. Three patients (8%) allocated to surgery developed a temporary radial nerve palsy. Among patients with closed humeral shaft fracture, internal fixation surgery, compared with nonoperative functional bracing, did not significantly improve functional outcomes at 12 months. However, the substantial amount of treatment crossover from nonoperative to surgical treatment should be considered when interpreting the trial results. ClinicalTrials.gov Identifier: NCT01719887.

Functional outcome of locking anatomical plate in extra articular fractures of the distal humerus

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Extra articular distal humerus fractures are difficult to treat with conventional implants like intra medullary nail, 4.5 DCP and dual plate. The present study aims to study the functional outcome of the extra articular distal humerus plate (EADHP).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 48 patients with displaced extra articular distal humerus fractures were included in the study. Inclusion criteria were age more than 18 years, closed fractures with or without radial nerve palsy and less than 3 weeks old trauma. Patients aged less than 18 years, those having open fractures, fractures more than 3 weeks old, non – unions and pathological fractures were excluded from the study. All patients were operated with EADHP. Clinically, the outcome was assessed by the disability of arm, shoulder and hand (DASH) score and elbow range of motion radiologically, union was evaluated on anteroposterior and lateral radiographs.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of 48 patients, 12 had AO type 12 A1 fracture, 26 patients had type B1 fractures and remaining 10 had type C1 fractures. Mean DASH score at final follow up was 18.1; range being 12.6 to 35.7 points. The mean elbow range of motion was 0 to 130 degrees (range: 120 to 140 degrees). The mean duration for complete radiological fracture union was 14 weeks, range being 12 to 18 weeks.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The extraarticular distal humerus plate is an ideal implant for the fixation of distal humerus fractures since it provides good stability of fracture and enables early return to function.&lt;/p&gt;

In intra-articular distal humeral fractures: Can combined medial-lateral approach gain better outcomes than olecranon osteotomy?

This research aimed to evaluate the functional outcomes of intra-articular distal humeral fractures treated through a combined medial-lateral approach and comparing with olecranon osteotomy simultaneously. In this study, 62 distal humeral fractures patients were assessed retrospectively. The olecranon osteotomy was used in 30 cases (14 males, 16 females) and combined medial-lateral in 32 cases (15 males, 17 females). The outcomes of function were assessed by the Mayo Elbow Performance Score (MEPS) and the Disabilities of Arm, Shoulder and Hand (DASH) questionnaire score. The follow-up time was 15.4±3.5 months (range 10-24 months) for a combined medial-lateral group and 14.6±2.6 months (range 10-20 months) for olecranon osteotomy. Level, retrospective study. The flexion-extension of elbows was 115.3°±16.1° in the combined medial-lateral group, and the olecranon osteotomy group was 110.1°±15.2°. A significant difference was observed between the two groups for flexion-extension of the elbows (p=0.041). Pronation-supination of the forearms had a significant difference (p=0.025) between the combined medial-lateral group (160.6°±7.2°) and the olecranon osteotomy group (154.1°±9.3°). Mean MEPS, DASH, excellent and good rate and complication rate for combined medial-lateral approaches were 88.6±6.9 points, 9.8±6.6 points, 90.6% and 9.4%, respectively. Significant differences were not noted between the two groups for mean MEPS, DASH scores and excellent and good rate (p=0.594, p=0.505, p=0.934, respectively) except complication rate (p=0.005). The combined medial-lateral approach is successful approach in the treatment of intra-articular distal humeral fractures (especially type C1 and C2) that provides better outcomes for the motion of the elbow, bleeding volume in surgery and complications than olecranon osteotomy.

One portal endoscopic release of the first extensor compartment in de Quervain's disease

ObjectivesWe aimed to present preliminary result of one portal endoscopic assisted release of first dorsal compartment at wrist in a case series with de Quervain disease as a minimal invasive surgical method. Materials and methodsThe patients, who underwent an endoscopic-assisted release of the first extensor compartment for de Quervain's disease by same hand surgeon between 2015 and 2017, were retrospectively analyzed. Operative treatment was considered if the patients did not respond to non-operative treatment including oral anti-inflammatory medications, splinting, and steroid injection. Surgical release was recommended after minimum four months of unsuccesful non-operative treatment, including a steroid injection. 10 wrists were treated with one portal endoscopic assisted release. All patients were evaluated at an average of 16.1 months follow-up using visual analog scale (VAS) pain ratings and the Disabilities of Arm, Shoulder and Hand (DASH) score. ResultsThe mean operating time was 13.9 min (range, 10–21min). The mean VAS and DASH scores were improved from 8.2 to 1.9 and 70.51 to 2.81 respectively. No significant difference was found between operated and non-operated arms in postoperative pinch and strengths. Transient superficial radial nerve paresthesia (two wrists) and significant scar tenderness (one) were identified in three cases. There was no patient that complain of unsightly scar and tendon subluxation. ConclusionsOne portal endoscopic assisted release of the extensor compartment is an effective and safe minimal invasive procedure with similar complication rates reported previously in open and endoscopic procedures in patients with de Quervain's disease who are unresponsive to non-operative treatments. Level of EvidenceLevel IV Therapeutic Study

Radial head resection versus prosthetic arthroplasty in terrible triad injury: a retrospective comparative cohort study

The crucial role of the radial head in the stability of the elbow in terrible triad injury is acknowledged. This retrospective study aims to compare the results of resection of a severely comminuted radial head with or without prosthetic arthroplasty as part of the reconstruction for this injury. The outcome of radial head resection was compared with prosthetic arthroplasty in 29 and 15 patients with terrible triad injuries, respectively. There were ten female patients (34.5%) in the resection group and six female patients (40%) in the prosthesis group. The mean age was 40.7 years (sd 13.6) in the resection group and 36 years (sd 9.4) in the prosthesis group. The mean follow-up of the patients was 24.4 months (sd 12) in the resection group and 45.8 months (sd 6.8) in the prosthesis group. Outcome measures included visual analogue scale (VAS) for pain, Mayo Elbow Performance Score (MEPS), Disabilities of Arm, Shoulder and Hand (DASH) Score, and range of movement. Postoperative radiological complications were also recorded. The mean ranges of extension, flexion, supination, and pronation were not significantly different between the two study groups (p = 0.75, p = 0.65, p = 0.82, and p = 0.68, respectively). The mean VAS score, DASH score, and MEPS of the two groups were also not statistically significantly different (p = 0.93, p = 0.19, and p = 0.32, respectively). At the final visit, the elbow was stable in all patients. No patient was found to have developed an Essex-Lopresti injury. Osteoarthritis grade I and II was observed in five and three patients of the resection group, respectively, and four and one patients of the arthroplasty group, respectively. The outcome of patients undergoing treatment for terrible triad injuries is similar whether the patient's radial head was excised or replaced. Cite this article: Bone Joint J 2018;100-B:1499-505.

Functional outcomes and complications of open elbow dislocations.

BackgroundThe current study investigated the clinical outcome of open elbow dislocations, focusing on the influence of associated soft tissue and bone injury.Patients and methodsFrom October 2008 to August 2015, 230 patients with elbow dislocations were treated at the study center. Our retrospective study comprised 21 cases of open elbow dislocations. The mean age of patients was 49 years (20–83 years); there were six (29%) female and 15 (71%) male patients. The range of motion (ROM) of the injured and uninjured elbow was measured, and the Mayo Elbow Performance Score (MEPS), Mayo Wrist Score (MWS), and Disability of Arm, Shoulder and Hand (DASH) score were assessed. Complications and revision surgeries were recorded. The influence of the severity of soft tissue injury (I°/II° open vs. III° open) and type of dislocation (simple vs. complex) was evaluated.ResultsAfter a 57-month follow-up (range, 24–98 months), the mean DASH score was 20 ± 15, the MEPS was 82 ± 11, and the MWS was 74 ± 22. The ROM of the injured elbow was significantly decreased compared with the uninjured one (arc of ulnohumeral motion: 104° vs. 137°; p = 0.001). Patients with I°/II° open elbow dislocations had a better clinical outcome according to the MEPS (86 ± 11 vs. 76 ± 9; p = 0.045) and a comparable outcome according to the DASH score (19 ± 18 vs. 21 ± 9; p = 0.238). In all, 11 patients (52%) had postoperative complications and 11 patients underwent at least one revision surgery. Complex elbow dislocations had significantly more complications and revision surgeries than simple dislocations (77% vs. 13%; p = 0.008).ConclusionFavorable clinical outcomes can be achieved after treatment of open elbow dislocations. These injuries are prone to neurovascular damage and complex dislocations are linked to high rates of complications and revision surgeries.

Does Conservative Rehabilitation Program Lead to Long-Term Stiffness after Arthroscopic Rotator Cuff Repair?: 關節鏡修復肩袖後，保守康復方案會導致長期僵硬嗎?

BackgroundEvidence on the ideal rehabilitation program for arthroscopic rotator cuff repair is lacking. Most data and results are conflicting with no consensus made. This study aims to compare between an early aggressive program with immediate postoperative range-of-motion (ROM) exercises and a more conservative program with early restriction of motion in Hong Kong Chinese population. Materials and methodsWe retrospectively evaluated 37 arthroscopic rotator cuff repair cases who underwent a standardized delayed rehabilitation protocol of immobilization for 4 weeks to 6 weeks before formal passive ROM exercises. Patients were evaluated at 3 months, 6 months, and 12 months after the surgery, for which they would be tested on passive forward flexion (FF). They were categorized as “stiff” if FF was less than 100°. Constant score, Disability of Arm, Shoulder and Hand (DASH) score, Visual Analog Scale (VAS) score, and isometric abduction power deficit percentage were parameters to assess the functional outcome, and they were obtained in all of the patients' last follow-up assessments. ResultsTwo cases (5.4%) are considered “stiff” 6 months after the surgery. At 1 year, the stiffness in both cases resolved, resulting in 0% rate of stiffness. The mean FF at 1 year was 153.33 ± 20.15, which is comparable to the literature. Two cases (5.4%) of clinical retear occurred. Mean Constant score at the latest follow-up was 62.4 ± 13.2. Mean VAS score was 1.1 ± 1.8 at rest and 2.8 ± 2.0 on exertion. Mean DASH score was 25.3 ± 21.9. Mean isometric abduction power deficit was 42.7% ± 0.2%. DiscussionHistorically, due to concerns on long-term stiffness, an early aggressive postoperative rehabilitation protocol was used. We found that an early restriction of ROM with 4 weeks to 6 weeks of immobilization did not lead to long-term stiffness and functional disadvantage. This includes patients with stiffness even before the operations. ConclusionsImmobilization for 4 weeks to 6 weeks after arthroscopic rotator cuff repair does not result in long-term stiffness and may even be beneficial to cuff tendon healing.

Outcome of Ulnar Shorting Osteotomy

Introduction: Ulnar shortening is a treatment option for ulnar wrist pain. Most frequently, this procedure is performed for ulnocarpal impingement, but it may also be useful in patients with persistent ulnar wrist pain after a sprain. The aim of the study was to assess outcome of patients who were operated on in our hospital with a diaphysial ulnar shortening osteotomy; to look for complications; and to find out if results were influenced by factors such as age, gender, hand dominance, smoking, type of osteotomy (horizontal or oblique), and length of follow-up; and whether or not a trauma was involved. Methods: Between 2006 and 2014, 37 out of 46 patients who were operated on in our hospital were available for evaluation with a mean follow-up of 54 months (range, 7-69). Mean age at the time of surgery was 39 years (range, 15-69), 24 were women, in 19 the dominant hand was involved, 15 were smokers, and in 28 a horizontal and in 9 an oblique osteotomy was performed. In 18 a trauma was involved, and in 14 there was an associated fracture of the radius or ulna. In all patients, Disability of Arm Shoulder and Hand (DASH) questionnaire, patient rated wrist hand evaluation (PRWE), visual analogue scale (VAS) for pain, satisfaction, and complications could be assessed, and in 25 grip strength and range of motion were determined. Statistical analyses (Mann-Whitney U test, independent samples t test) were performed to find out which factors had an influence on the outcome. Multiple regression analysis was done to assess influences on the DASH score. Results: Mean DASH was 22 (range, 0-75) and mean PRWE score 33 (range, 0-90). Mean VAS for pain was 2.6 (range, 0-7.8). Thirty patients were satisfied and 7 would not undergo the same operation again. In 17 the plate and screws had to be removed. In 3 cases with a horizontal osteotomy, a second operation had to be performed for nonunion. Two of them were smokers. Mean grip strength was 84%, mean wrist flexion 84%, extension 75%, pronation 85%, and supination 86% of the contralateral side. PRWE and DASH scores were significantly better in smokers. PRWE was significantly worse in posttraumatic ulnocarpal impaction syndrome. Multiple regression analysis showed a significantly better DASH score in smokers, in patients operated on the nondominant side and with a longer follow-up. Discussion and Conclusion: Ulnar shortening may not be able to solve ulnar wrist pain in all patients as one fifth was not satisfied. Complications should not be underestimated. Reoperations were needed in half of patients. Outcomes were better in idiopathic ulnocarpal impaction. In posttraumatic cases, ligamentous lesions may also play a role in causing ulnar wrist pain. Results were better when the follow-up was longer which may indicate that recovery after ulnar shortening may take long time or that patients may have adapted their activities. In contrast to other studies, outcome scores in the present study were better in smokers, but 2 of the 3 patients with nonunion were smokers.

The Effect of Stabilization Exercises on Playing Performance in Musicians With Joint Hyperlaxity

Purpose/Hypothesis: Joint hypermobility is defined as an abnormal increase in the range of active and passive motion, which is a very common situation in musicians. However, its relation to injuries and on musical performance is not clear; it is thought that unstable joint can be harmed with repetitive playing task. Therefore, stabilization exercises can have a positive effect in hypermobile hands. This study is aimed to investigate the effect of stabilization exercises in musicians having hypermobile joints. Material and Methods: Seventy-five musicians who are playing string instruments and piano at conservatory were assessed if they have joint laxity, and it was found that 45% of this population had joint laxity. The ones who had laxity have asked if they would like to attend to an exercise program aiming stabilization. Twelve people accepted to do the exercises. These 12 people have been assessed by Disability of Arm, Shoulder and Hand (DASH). In addition, they are asked to rate their musical performance, fatigue, and pain according to visual analogue scale, and hand strength was evaluated with pinchmeter. Stabilization exercises were given for 4 weeks; once a week, students worked with the therapist, and during the whole week, they did home exercises. Ten people completed the exercise program, and they were evaluated again at the end of the month. Results: The mean DASH score (musician part) of the musicians was 25.12; this score decreased significantly ( P &lt; .05) after exercises. Also hand strength and musical performance increased significantly( P &lt; .05). Conclusion: When treating a musician patient, if she or he has joint hyperlaxity, adding stabilization exercises to rehabilitation program can be useful. It is also suggested that musicians with hypermobile joints can do stabilization exercises to prevent their joints from injury and to increase musical performance. Preventive programs of musicians mostly include stretching exercises, however 1 or 2 stabilization exercise can be added for especially musicians with hyperbole joints.