Murley Score Research Articles

Assessment of surgical management for locked fracture-dislocations of the proximal humerus in patients of different ages

BackgroundLocked fracture-dislocation of the proximal humerus (LFDPH) is a very severe complex injury; neither arthroplasty nor internal plating are fully satisfactory. This study aimed to evaluate different surgical treatments for LFDPH to determine the optimal option for patients of different ages. MethodsFrom October 2012 to August 2020, patients who underwent open reduction and internal fixation (ORIF) or shoulder hemiarthroplasty (HSA) for LFDPH were retrospectively reviewed. At follow-up, radiologic evaluation was performed to evaluate bony union, joint congruence, screw cut-out, avascular necrosis of the humeral head, implant failure, impingement, heterotopic ossification, and tubercular displacement or resorption. Clinical evaluation comprised the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire and Constant–Murley and visual analog scale (VAS) scores. Additionally, intraoperative and postoperative complications were assessed. ResultsSeventy patients (47 women and 23 men) with final evaluation results qualified for inclusion. Patients were divided into three groups: group A: patients aged under 60 years who underwent ORIF; group B: patients aged ≥60 years who underwent ORIF; and group C: patients who underwent HSA. At a mean follow-up of 42.6 ± 26.2 months, function indicators, namely shoulder flexion, and Constant–Murley and DASH scores, in group A were significantly better than those in groups B and C. Function indicators in group B were slightly but not significantly better compared with group C. Regarding operative time and VAS scores, there were no significant differences between the three groups. Complications occurred in 25%, 30.6%, and 10% of the patients in groups A, B, and C, respectively. ConclusionsORIF and HSA for LFDPH provided acceptable but not excellent results. For patients aged <60 years, ORIF might be optimal, whereas, for patients aged ≥60 years, both ORIF and HSA provided similar results. However, ORIF was associated with a higher rate of complications.

Bankart repair with subscapularis augmentation: A case control study.

To examine the effect on functional shoulder scores of Bankart repair with arthroscopic subscapularis tendon augmentation applied to cases of anterior shoulder instability with < 25% glenoid defect and ligament-labral failure. A total of 83 patients underwent Bankart repair with subscapularis tendon augmentation between 2015 and 2021. The range of movement of the patients was measured by 2 doctors using a goniometer. The Constant Murley score, American Shoulder and Elbow Surgeons score, Rowe score, and the University of California at Los Angeles scores were recorded preoperatively and postoperatively. Statistically significant increases were determined in the postoperative functional scores compared to the preoperative values as mean 41.4 ± 2.08 unit increase in the Constant Murley score, mean 41.4 ± 1.8 unit increase in the American Shoulder and Elbow Surgeons score, mean 13.8 ± 1.45 unit increase in the University of California at Los Angeles and mean 49.3 ± 7.45 unit increase in the Rowe score (P = .001; P < .01). Compared with the preoperative evaluation, there was found to be a postoperative statistically significant unit decrease of 10.2 ± 1.47 in the external rotation measurement (P = .001; P < .01). The number of dislocations was determined to have a negative correlation with the internal rotation measurements (r = -0.305; P = .005; P < .01), and a weak negative statistically significant relationship with external rotation measurements (r = -0.329; P = .002; P < .01). Unlike other techniques, as this repair technique includes both the tendon and the capsule as a single piece, it was seen to be a sufficient and reliable technique that is easy-to apply.

Comparison of Constant and Murley Scores between operatively and nonoperatively managed midshaft clavicle fractures in Makassar, Indonesia

Comparison of Constant and Murley Scores between operatively and nonoperatively managed midshaft clavicle fractures in Makassar, Indonesia

A study on the functional and radiological outcome with complications in the management of proximal humerus fractures operated with proximal humerus internal locking osteosynthesis system

Background: A number of opinions exist regarding the management of proximal humerus fractures starting from conservative to tension band-wiring to internal fixation with plates. The aim of this study is to assess the functional outcome, the radiological outcome and the complications associated with the management of proximal humerus fractures treated with proximal humerus interlocking osteosynthesis system (PHILOS). Methods: A prospective descriptive study was undertaken comprising of 40 patients. Closed proximal humerus fractures meeting Neer’s criteria for operative displacement were enrolled. Patients underwent open reduction internal fixation with PHILOS plate. Post-operative radiological outcome was estimated with follow-up x-rays, functional outcome using the Constant and Murley score. Results: 60% patients were female, with the most common mode of injury being fall at a ground level. Late complications were noted in 25% of patients, which were malunion 5%, joint stiffness 10%, joint instability 5% and heterotopic ossification 5%. The mean Constant and Murley score was 79.5 and it was found to be statistically significant to the type of fracture according to the Neer’s classification (Kruskal Wallis test, p=0.005). Joint stiffness was also found to be statistically significantly correlated to the type of fracture pattern (Chi square test, p=0.016). The average time to union was 10 weeks. Conclusions: Thus, by this study it can be expressed due to appropriate articular reduction by open reduction and by the use of a fixed angle implant like the PHILOS plate, operative management of proximal humerus fractures by the said implant is a viable option to enable quick and early rehabilitation of patients.

Anxiety and Depressive Symptoms Correlated to Patient-Reported Outcome Measures after Rotator Cuff Repair: A Prospective Study in the Perioperative Period.

Anxiety and depressive symptoms adversely affect surgical outcomes in patients with rotator cuff tear (RCT) undergoing surgical repair. Patients without a diagnosis of mood disorders, such as anxiety and depression, before rotator cuff repair (RCR) can be considered an optimal candidate for surgery. The objective of this prospective observational study was to evaluate the relationship between anxiety and depressive symptoms, using the Hospital Anxiety and Depression Scale (HADS) as an assessment tool, and patient-reported outcome measures in RCT after repair surgery. This study included patients with RCT undergoing arthroscopic rotator cuff repair (RCR). Forty-three patients were included who had completed the HADS, Constant Murley Score (CMS), and Short Form Health Survey 36 (SF-36) questionnaires before surgery and in the postoperative follow-up, at 1 month, 3 months, and 6 months. The Friedman test showed that there were statistically significant changes in the different times point for HADS (p < 0.001), anxiety subscale of HADS, i.e., HADS-A (p < 0.001), depression subscale of HADS, i.e., HADS-D (p < 0.001), CMS (p < 0.001), and SF-36 (p < 0.001). The average scores of HADS, HADS-A, and HADS-D improved at each follow-up, showing improvement in discomfort. From the third month after surgery, there was an improvement in anxiety and depression disorders related to improved quality of life, functionality, and pain perception. The trend remained stable until the sixth month of follow up. This study shows that anxiety and depressive symptoms in RCT patients are significantly reduced after RCR with subsequent important improvements in terms of functionality, ability to carry out activities of daily living, perceived pain, and quality of life.

FUNCTIONAL OUTCOME OF DIAPHYSEAL FRACTURES OF HUMERUS IN ADULTS TREATED WITH CLOSED INTERLOCKING NAILS: A PROSPECTIVE STUDY

Background: Diaphyseal fractures of humerus are common, representing 3% of all fractures and 20% of all humerus fractures. Though compression plate osteosynthesis is the gold standard, interlocking intramedullary nailing is also a reliable option. In this present study we evaluated the functional outcome of diaphyseal fractures of humerus treated with interlocking nails. A total of 36 patients with diaphyseal fractures of humerus, selected Materials and Methods: between OCTOBER 2020 to MAY 2021 were managed by closed interlocking nail of humerus. This was a prospective study and all patients were followed up to a minimum of 6 months. The primary outcome measures were functional outcome assessed using DASH Score (The Disabilities of the Arm, Shoulder &amp; Hand Score) &amp; Constant-Murley scoring system respectively. Secondary outcomes were intra-operative conditions such as operative time and blood loss and post-operative complications. The mean time of radiological union was 15.7 weeks ranging from14-26 Results: weeks. All 36 fractures were united including one delayed union which united at 26 weeks. In our series, 4 patients had post operative shoulder stiffness including one prominent nail, 1 patient developed radial nerve neuropraxia which recovered in 8 weeks. All patients were evaluated on the basis of Constant Murley score for shoulder function and DASH score. In our study of 36 patients 69.4% got excellent results, 19.4% got good results, 8.3% got moderate/fair results and 2.8% got poor results. Interlocking nailing is a relatively quick, minimally invasive, biomechanica Conclusion: lly sound, cosmetically better method of internal stabilization of shaft humerus fractures with less union time, less infection and lesser threat to radial nerve and other complications. Besides it allows early mobilization. With correct anatomical knowledge, preoperative planning, good surgical techniques and postoperative rehabilitation interlocking humeral nailing is a viable option in the management of fracture shaft humerus promising excellent outcome.

Comparison of surgical treatment options in periprosthetic shoulder infections: a systematic review from 2016 to 2022.

Periprosthetic shoulder infection (PSI) management proves to be challenging because of patient morbidity, poor outcomes and need for reoperations. Different surgical treatment methods have been defined; however, a prominent method could not be determined. This systematic review investigated the most recent articles about various treatment modalities used in the surgical treatment of PSI to find the most effective method in terms of infection clearance and function. The keywords were searched using PubMed (MEDLINE), ScienceDirect (Elsevier), and Google Scholar databases on September 30, 2022. Studies which report on operative treatment and have longer than 2-year follow-up were included in this review. Of the 555 studies in total, 16 were reviewed. The absence of symptomatic persistent infection (PI) during follow-up was regarded as a satisfactory outcome. Functional outcomes were analyzed according to the reported mean pooled Constant and Murley Score (CMS) and shoulder forward elevation degree (FE) for each treatment group. A total of 339 patients (139 female, 197 male) with 342 shoulders from sixteen studies were included. The mean age of the patients was 67.5±3.8 years, mean follow-up duration was 53.3±19.5 months. In total, 217 shoulders were treated with two-stage revision, 59 were treated with one-stage revision, 37 were treated with definitive spacer, 23 were treated with debridement, antibiotics, and implant retention (DAIR), and 6 were treated with resection arthroplasty. The PI rate in whole treatment groups was 9.9%. The PI rate was significantly highest in the DAIR group (30.4%, P=0.001), while there was no significant difference between other treatment groups (P=0.23). CMS and FE were available for 156 and 190 shoulders, respectively. CMS was highest in the one-stage revision group (63.4±5.9, P=0.001), and FE was highest in the DAIR group (119.3°±28.5°, P=0.001). The revision surgeries (one-stage and two-stage revision) were more effective than the non-revision surgeries in functional outcomes. In terms of infection clearance, revision procedures were more successful. Surgeons should prefer revision methods over non-revision procedures when feasible.

Mid-term functional outcome (minimum 24 months, mean 4 years) after locking plate osteosynthesis for displaced fractures of the proximal humerus in 557 cases

BackgroundThe best surgical management of displaced proximal humeral fractures remains a matter of considerable debate. This study presents mid-term functional outcome (median 4 years) after locking plate osteosynthesis for displaced proximal humeral fractures. MethodsBetween February 2002 and December 2014 1031 patients with 1047 displaced proximal humeral fractures were treated by open reduction and locking plate fixation with the same implant and received consecutive prospective follow up at least 24 months after surgical treatment. Clinical follow-up consisted of Constant Murley score (CS), Disabilities of the Arm, Shoulder and Hand score (DASH), and Short Form 36 questionnaire (SF-36). Complete follow-up could be performed in 557 (53.2%) cases, with a mean follow-up of 4.0 ± 2.7 years. ResultsOf 557 patients (67% women; mean age at time of osteosynthesis: 68.3 ± 15.5 years) absolute CS of all patients 4 ± 2.7 years after surgery was 68.4 ± 20.3 points. Normalized CS according to Katolik was 80.4 ± 23.8 points, and CS in percentage to the contralateral side (%CS) was 87.2 ± 27.9%. DASH score was at 23.8 ± 20.8 points. Osteosynthesis related complications (secondary displacement, screw cutout, avascular necrosis (n = 117 patients) were associated with lower functional scores (mean CS was 54.5 ± 19.0 p.; nCS 64.5 ± 22.9 p.;%CS 71.2 ± 25.0%; DASH score 31.9 ± 22.4 p.). The SF 36 was 66.5 points in the case cohort and a vitality mean of 69.4 points. Patients with a complication showed lower results (SF 36 56.7; vitality mean 64.9 points). ConclusionsOverall, patients following locking plate osteosynthesis of displaced proximal humeral fractures showed good to moderate outcomes four years after surgery. Mid-term functional outcomes correlate significantly with those at 1 year postoperatively. Furthermore, there is a significant negative correlation of midterm functional outcome with the occurrence of complications. Level of evidenceLevel III, prospective nonconsecutive patients.

Mini-open vs. arthroscopic double tight-rope reconstruction after acute AC-joint dislocation: a comparison in functional outcome and sports activity.

In athletes, acromioclavicular joint disruptions account for up to 50% of all shoulder injuries. In high-grade injuries, surgery is favored to ensure a correct restoration of the joint, especially in young athletes. The aim of this study was to compare the clinical, radiological and sport related outcomes of the arthroscopic stabilization with the fixation of the AC joint in a mini-open approach. 19 patients treated arthroscopically (ASK) and 26 patients with an acute AC-joint dislocation Rockwood V who had undergone the mini-open (MO) surgery were included. Constant Murley Score (CMS), Taft Score (TS) and the Simple Shoulder Tests (SST) were evaluated. The sports activity level was determined according to Valderrabano and the athlete's recovery of their athletic activity level after surgery according to Rhee. Furthermore, all available X-ray images were analyzed. Patients in the ASK group achieved an average score of 11.7 ± 0.6 points in the SST, 10.3 ± 1.8 points in the TS and 91.2 ± 11.8 points in the CMS. On average, patients in the MO group achieved results of 10.5 ± 1.4 points in the SST, 11.7 ± 0.7 points in the TS and 91.6 ± 9.8 points in the CMS. The ASK group showed significant difference regarding the CC distance in side comparison (Δ = 3.6mm), whereas no significant difference was found in the MO group (Δ = 0.8mm). In comparison of both groups, the posterior as well as the combined translation were significantly greater in the ASK group than in the MO group (posterior: ASK: 24.8mm, MO: 19.3mm, combined: ASK: 29.1mm, MO: 20.9mm). Residual horizontal instability was greater in the ASK group (43%) than in the MO group (32%). Similar results were achieved in sports activity and the recovery of athletic activity (Valderrabano: ASK: 2.8, MO: 2.6; Rhee: ASK: 1.6, MO: 1.5). Both techniques prove to be effective for the stabilization of high-grade AC-joint disruptions in athletes and showed excellent clinical results. From a radiographic standpoint, the mini-open procedure appears superior to the arthroscopic technique. After mini-open surgery postoperative loss of correction is less common and greater horizontal stability is achieved. The results also suggest the mini-open technique is superior to the arthroscopic procedure when aiming to restore the athlete's original level of sports activity.

Reverse Total Shoulder Arthroplasty for Proximal Humeral Fractures and Sequalae Compared to Non-Fracture Indications: A Matched Cohort Analysis of Outcome and Complications

With the increase in utility and popularity of the reverse total shoulder arthroplasty (RTSA) within the last decades, indications for RTSA have expanded. As well as the established indications such as cuff tear arthropathy and massive irreparable rotator cuff tears, RTSA for complex proximal humeral fractures in elderly patients has been proven to be a reliable treatment option. A prospectively enrolled RTSA database of 1457 RTSAs implanted between September 2005 and November 2020 was reviewed. Patients treated with RTSA for a complex proximal humerus fracture and fracture sequalae (F-RTSA) were 1:1 matched with a group of patients who were treated electively with RTSA for indications other than a fracture (E-RTSA). Matching criteria included sex, age, length of follow-up and body mass index. Evaluation after a minimum of 2 years follow-up included evaluation of the absolute and relative Constant-Murley score (aCS; rCS), subjective shoulder value (SSV), range of motion (ROM) assessment and complications. Each of the matched cohorts comprised 134 patients with a mean follow-up of 58 ± 41 months for the fracture group and 58 ± 36 months for the elective group. The mean age for both groups was 69 ± 11 years in the F-RTSA and 70 ± 9 years for the E-RTSA group. There were no significant differences in clinical outcome measures including aCS, rCS and SSV (p > 0.05). There was a significant difference in mean active external rotation with 20° ± 18° in the F-RTSA group compared with 25° ± 19° in the E-RTSA group (p = 0.017). The complication rate was not significantly different, with 41 complications in 36 shoulders in the F-RTSA and 40 complications in 32 shoulders in the E-RTSA group (p = 0.73). The main complication for the F-RTSA group was dislocation of the greater tuberosity (6%), whereas acromial fractures (9%) were the leading complication in the E-RTSA group. There was also no significant difference in revision rate comparing F-RTSA with E-RTSA (10% vs. 14%; p = 0.25). RTSA for complex proximal humeral fractures and its sequalae leads to a comparable clinical outcome as that for patients treated electively with RTSA for indications other than fracture. There was, however, a significant difference in active external rotation, with inferior rotation in patients undergoing RTSA for fracture. This valuable information can help in requesting informed consent of patients with proximal humeral fractures.

Biological Reconstruction of the Coracoclavicular Ligament with Semitendinosus Autograft and Repair of Distal Clavicle Fractures.

Most of the options available to treat distal clavicle fractures involve hardware-related complications and high failure rates. This study aims to determine the outcome of distal clavicle fractures treated by a technique that combines biological reconstruction of the coracoclavicular ligament with semitendinosus autograft with reinforced fibrous tissue tapes. In this retrospective study, 8 patients with displaced distal third clavicle fracture cho's IIB or II C were operated on with the described surgical technique between 2018 and 2021. The results were assessed by comparing the preoperative Constant Murley score and the postoperative DASH score. In addition to these variables, several other variables were also assessed, such as the coracoclavicular distance, the time until union, and all intraoperative and postoperative complications. The study included eight patients with an average age of 36.5 years, and the average time from surgery to recovery was five days. According to Cho's classification, all eight patients achieved radiographic union within 89 days. Of the eight cases, six were classified as II C and two as II B. The follow-up period was an average of 13 months. During the postoperative period, the Constant Murley score score increased from 22.2 preoperatively to 92.2 postoperatively. The mean DASH score was 89.6, and the mean postoperative DASH score was 7.75. In terms of the coracoclavicular distance, the mean preoperative was 20.2mm, and the mean postoperative was 10.3mm. One patient experienced a minor wound complication after surgery, treated with secondary suturing after the operation. No intraoperative complications occurred. There was no donor site morbidity observed in the patients. It has been demonstrated that the use of this technique in displaced unstable distal clavicle fractures using a fiber tape and a semitendinosus autograft results in a satisfactory union and excellent clinical outcomes with very few complications.

Dual plate fixation of proximal humerus fractures: Retrospective review and surgical technique.

Recent interest has been directed towards dual plate fixation for comminuted proximal humerus fractures, with an aim to improve construct stability and thus improve patient outcomes while decreasing the risk of fracture-associated complications. We present our experience with this technique in a case series of patients with proximal humerus fractures and describe our surgical technique. This was a single-center retrospective case series of patients presenting with an acute (<6 weeks) proximal humerus fracture who underwent ORIF with dual plating fixation. Patient, fracture, and surgical data were collected. All patient outcomes were evaluated using Constant-Murley shoulder score and Single Assessment Numeric Evaluation. Our series included nine patients with a mean age of 46.2 years (range: 27-70 years old). All fractures healed within 4 months and no complications were encountered. At 1 year follow-up, the mean SANE score was 69.4% and the mean Constant Murley shoulder score was 78.9 (range: 70-96). Our current series shows that applying the dual plating technique in severely comminuted proximal humerus fractures provides adequate fixation and thus good patient outcomes. Further research is required before this technique can be strongly recommended for management of these complex fractures. Level 5.

Simultaneous bilateral traumatic clavicle fractures: incidence, characteristics, and surgical outcomes

BackgroundAlthough clavicle fractures are common injuries in adults, simultaneous bilateral clavicle fractures are rarely reported. The present report describes 13 patients with simultaneous bilateral traumatic clavicle fractures who were treated with surgical management and followed for more than 12 months postoperatively.MethodsThis retrospective chart review involved skeletally mature patients with traumatic clavicle injuries. Patients with bilateral clavicle fractures who were followed up for at least 12 months after surgery were included. Data regarding the patients’ demographics, injury characteristics, fracture classification, comorbidities, concomitant injuries, and treatment strategies were collected. Each displaced fracture was managed with open reduction and internal fixation. Postoperative follow-up included radiographs for assessment of bone union; calculation of the Constant–Murley score for shoulder function; administration of the Disability of the Arm, Shoulder, and Hand questionnaire for upper limb function; determination of the visual analogue scale score for pain; and assessment of complications.ResultsFrom October 2013 to November 2021, 15 patients (10 men, 5 women) were diagnosed with bilateral clavicle fractures among 1542 patients with clavicle injuries (overall incidence of 1.0%). Of these 15 patients, this study included 13 patients (8 men, 5 women; mean age, 38.3 ± 15.3 years) who were followed up for more than 12 months postoperatively. Among the 13 patients, 10 (77.0%) had associated concomitant injuries, and 25 sides were fixed with internal plate fixation. After a follow-up period of 29.9 ± 28.5 months, all fractures achieved bone healing. Eleven patients attained excellent shoulder function on both sides and returned to their pre-injury daily activities, and the remaining two patients had unilateral shoulder dysfunction. No complications occurred.ConclusionsBilateral clavicle fractures are extremely rare and associated with polytrauma. Open reduction and internal fixation is recommended for such patients, especially those with severe chest injuries, because osteosynthesis of the clavicle can improve respiratory function and reduce the duration of functional disability.

Effects of Platelet-Rich Plasma in Tear Size Reduction in Partial-Thickness Tear of the Supraspinatus Tendon Compared to Corticosteroids Injection

ObjectivesCorticosteroid (CS) injection is commonly used in partial-thickness rotator cuff tears to decrease pain. However, this could result in unwanted side effects, such as tendon rupture. Alternatively, platelet-rich plasma (PRP) injection is frequently used to treat tendinopathies because it enhances healing. This study aimed to compare the differences in tear size and functional scores between intralesional PRP and subacromial CS injections.MethodsPatients with symptomatic partial-thickness tears of the supraspinatus tendon who underwent conservative treatment for ≥ 3 months were enrolled. All patients underwent magnetic resonance imaging (MRI) to confirm the diagnosis. Fourteen and 15 patients were randomized to receive intralesional PRP and subacromial CS injections, respectively. Tears were measured in the coronal and sagittal planes. The patients underwent another MRI 6 months after the injection. Tear size was compared between the two MRI results. The American Shoulder and Elbow Surgeons Shoulder score (ASES) and Constant–Murley score (CMS) were also obtained.ResultsThe baseline data were similar between the groups. In the coronal plane, PRP and CS showed tear size reductions of 3.39 mm (P = 0.003) and 1.10 mm (P = 0.18), respectively. In the sagittal plane, PRP and CS showed tear size reductions of 2.97 mm (P = 0.001) and 0.76 mm (P = 0.29), respectively. Functional scores improved 6 months after injection in both groups, but PRP showed better functional scores than CS (P = 0.002 for ASES, P = 0.02 for CS).ConclusionIntralesional PRP injection can reduce the tear size in partial-thickness tears of the supraspinatus tendon. Subacromial steroid injection did not significantly affect the tear size. While CS improved functional scores compared with baseline, PRP resulted in better improvement 6 months post-injection.Trial registration Thai Clinical Trials Registry, TCTR20210428004. Registered 28 April 2021-retrospectively registered, TCTR20210428004.

Comparative study of three different fixation techniques for the treatment of Neer type IIb distal clavicle fractures: A retrospective cohort study.

Recently, a locking plate (LP) combined with a suture button was applied for distal clavicle Neer type IIb fractures. However, to our knowledge, there is limited information on clinical outcomes surrounding locking plates combined with a suture button in the treatment of Neer type IIb distal clavicle fractures. The aim of this study was to compare the outcomes among three different fixation techniques for the treatment of Neer type IIb distal clavicle fractures. We performed a retrospective cohort study of 53 patients with Neer type IIb distal clavicle fractures who were treated with a hook plate (HP group, 16 patients), a locking plate alone (LP group, 18 patients), or a locking plate with a suture button (LPSB group, 19 patients) in our hospital between March 2014 and August 2019. The clinical and radiological outcomes were evaluated, including union time, postoperative complications, and function of the shoulder joint. The follow-up period was at least 2 years for all patients. All patients in the LPSB group achieved bone healing at the final follow-up. No significant differences were observed, including age, sex, side, time to surgery, duration of surgery, and mean follow-up period among the three groups (p > 0.05). The union time was shorter in the LPSB group than in the other two groups (p < 0.05). Postoperative complications were lower in the LPSB group than in the other two groups (p < 0.05). The visual analog scale score and Constant-Murley score in the LPSB group were better than those in the other groups at 3 and 6 months postoperatively (p < 0.05). Compared with HP and LP alone, LPSB yields better clinical outcomes and lower complication rates in the treatment of Neer type IIb distal clavicle fractures.

A Standardized Operative Protocol for Fixation of Proximal Humeral Fractures Using a Locking Plate to Minimize Surgery-Related Complications.

The current literature suggests that up to 55% of complications after plate osteosynthesis treatment for patients with proximal humerus fractures are attributed to the surgical procedure. The hypothesis of this study was that a standardized surgical protocol would minimize surgery-related adverse events. This prospective cohort study included 50 patients with a mean age of 63.2 (range 28-92) years treated by one single surgeon using a previously published standardized surgical protocol. Clinical and radiological follow-up examinations were conducted for up to 24 months using Constant-Murley Score (CS), Subjective Shoulder Value (SSV) and radiographs in true anteroposterior, axial and y-view. Finally, CS was 73.9 (standard deviation [SD]: 14.0) points (89% compared to the uninjured shoulder), and SSV was 83.3% (SD: 16.7) at two years of follow-up. Postoperative radiologic evaluation revealed no primary surgical-related or soft-tissue-related complications (0%). The main complications were secondary, biological complications (20%), largely represented by avascular necrosis (8%). Eight patients underwent revision surgery, mainly for implant removal. In addition, a total of four patients were revised using a hemiarthroplasty (n = 2), reverse shoulder arthroplasty (n = 1) or re-osteosynthesis. The use of our standardized surgical technique on proximal humerus fractures improves fixation with regard to primary stability and prevents primary, surgical-technique-related complications. The subjective grading of a high level of difficulty surgery was associated with more complications.

Treatment and outcomes of chronic locked posterior shoulder dislocations: a retrospective case series

BackgroundPosterior shoulder dislocations are rare injuries that are often missed on initial presentation. Cases left untreated for more than three weeks are considered chronic, cannot be reduced closely (they become locked) and are usually associated with a significant reverse Hill-Sachs defect. The aim of this study was to evaluate the outcomes of chronic locked posterior shoulder dislocations treated with the McLaughlin procedure (classic or modified).MethodsThis retrospective study included 12 patients with chronic locked posterior shoulder dislocation operated on between 2000 and 2021 by two surgeons in two institutions. Patients received a thorough clinical examination and radiological assessment before and after surgery. Shoulders were repaired with the McLaughlin or modified McLaughlin procedure. Outcomes were assessed by comparing pre- and postoperative values of clinical variables.ResultsMost of the dislocations were of traumatic origin. The average delay between dislocation and surgical reduction was 13.5 ± 9.7 weeks. Postoperative clinical outcomes were favourable, with an average subjective shoulder value of 86.4 ± 11.1 and a normalized Constant –Murley score of 90 ± 8.3. None of the patients had a recurrence of shoulder dislocation, but one patient developed avascular necrosis of the humeral head and two patients developed glenohumeral osteoarthritis.ConclusionsIn this group of patients with chronic locked posterior shoulder dislocation, the clinical outcomes of McLaughlin and modified McLaughlin procedures were satisfactory, even when surgery was significantly delayed.

A COMPARATIVE STUDY ON FUNCTIONAL OUTCOMES OF NAILING VS. PLATING IN PATIENTS HAVING FRACTURE SHAFT HUMERUS

Introduction: Fractures of shaft humerus are those fractures which lie distal to the surgical neck of the humerus and proximal to the supra-condylar ridge distally. Conservative management of fracture shaft humerus yield in satisfactory results in most of the cases. Dilemma between dynamic compression plating and ante grade intra-medullary nailing occurs when a surgery is indicated. In this study, we aim to p Objectives: resent a comparative analysis of two series of patients operated with dynamic compression plating and ante-grade intra-medullary interlock nailing respectively with focus over their functional outcomes, complications and other important parameters. A total of 32 Methods: patients with fracture shaft humerus were treated surgically. 17 were subjected to plating and 15 were subjected to intramedullary nailing. Functional outcome of patients was recorded using Constant and Murley score along with other parameters such as duration of surgery, intra-operative blood loss, complications, and union time. Treat Results: ment with plates in this comparative study led to a better ROM in the shoulder and fewer complications. Loss of shoulder motion may be expected after humeral shaft osteosynthesis. However, the functional scores and the healing index can be good and excellent with both techniques. In this comparative study, treatment with plates led to a better ROM in the s Conclusion: houlder and fewer complications. However, functional scores and healing rates can be good and excellent with both techniques. A loss of shoulder motion may be expected after humeral shaft osteosynthesis. Prospective studies are necessary with a long-term follow-up to strengthen these ndings.

The Effect of PRP Augmentation of Arthroscopic Repairs of Shoulder Rotator Cuff Tears on Postoperative Clinical Scores and Retear Rates: A Systematic Review and Meta-Analysis.

The aim of this review and meta-analysis is to assess recent clinical trials concerning the combination of operative treatment of rotator cuff tears and the administration of PRP and its effect on clinical scores and postoperative retear rates. The trials were used to compare the combination of PRP treatment and arthroscopic rotator cuff repair to arthroscopy alone. Twenty-five clinical trials were reviewed. A risk-of-bias assessment was made for all randomized clinical trials included, using the Cochrane collaboration's tool as well as a quality assessment for all non-randomized studies utilizing the Newcastle-Ottawa scale. The PRP-treated patients showed statistically significant improvement postoperatively compared to control groups concerning the Constant-Murley (mean difference 2.46, 95% CI 1.4-3.52, p &lt; 0.00001), SST (mean difference 0.32, 95% CI 0.02-0.63, p = 0.04), and UCLA (mean difference 0.82, 95% CI 0.23-1.43, p = 0.07) scores. A statistically significant decrease of retear rates in the PRP-treated patients, with a risk ratio of 0.78 (95% CI 0.65-0.94, p = 0.01), was found. We believe that the results presented have positive aspects, especially concerning the retear risk, but are yet inconclusive concerning clinical results such as shoulder pain and function.

Combined Humeral Head and Shaft Fractures: Outcome Following Intramedullary Nailing and Plating.

Background and Objectives: Combined fractures of the humeral head and shaft (FHS) are rare but frequently involve an intermuscular fracture as its characteristic pattern. The aim of this retrospective study was to investigate intramedullary nailed and plated FHS in terms of outcomes and complications. Materials and Methods: The present study included patients with FHS, treated via either intramedullary nailing or plating within a period of 10 years, with a minimum follow-up of 12 months. Functional outcome was assessed using the age- and sex-adapted Constant-Murley Score (CMS-K). Rates of complications and revision surgeries were registered. Results: Twenty-five patients (18 females, 7 males, age 60.1 ± 14.2 years, range 23-76 years) were included in the study. Nailing was performed in 16 patients (12 females, 4 males, age 62.6 ± 12.4 years), whereas plating was executed in nine patients (6 females, 3 males, age 55.8 ± 17.0 years). Follow-up among all patients was 45.1 ± 26.3 months (range 12-97 months). CMS-K was 70.3 ± 32.3 in the nailing group, with reoperation in four cases, and 76.0 ± 31.0 in the plating group, with one reoperation (p = 0.42). Patients with no metaphyseal fragment displacement (n = 19; CMS-K 76.7 ± 17.3) demonstrated significantly better functional outcomes versus those with secondary displacement of the metaphyseal fragments (n = 6; CMS-K 60.0 ± 17.1), p = 0.046. Conclusions: Comparable acceptable clinical outcome is obtained when comparing nailing with additional open cerclage or lag-screw fixation techniques versus plating with open reduction. However, a higher revision rate was observed after nailing. The correct metaphyseal fragment fixation seems to be crucial to avoid loss of reduction and hence the need for revision surgery, as well as a worse outcome.