Murley Score Research Articles

Treatment of bipolar clavicle injury with internal plating: a case series and literature review

BackgroundBipolar clavicle injury is a rare injury involving any combination of dislocation and/or fracture at both ends of the clavicle. Most reports of bipolar clavicle injury have been based on a single case, and treatment of this injury remains controversial. The present study was performed to evaluate the efficacy of surgical management with internal plating for bipolar clavicle injuries.MethodsWe performed internal plating to treat seven consecutive bipolar clavicle injuries with different injury patterns from May 2013 to June 2021. A clavicle hook plate was used for five sternoclavicular joint injuries (including a revision surgery) and three acromioclavicular joint dislocations, a T plate was used for one sternoclavicular joint injury, and an anatomic plate was used for one distal clavicle fracture. At follow-up, radiographs were assessed for bone alignment, joint congruity, fracture union or malunion, and implant failure or migration. Clinical evaluation included determination of the Disability of the Arm, Shoulder, and Hand (DASH) score; Constant–Murley score; visual analog scale (VAS) score; and complications.ResultsThe patients were regularly followed up after the operation, and functional parameters were assessed over time. At a mean follow-up of 28.1 ± 22.0 months, each fracture had solid bone union, and each dislocation showed no sign of recurrent instability. The mean shoulder forward flexion was 159.3° ± 7.9°, and the mean DASH score was 8.8 ± 5.1. The mean Constant–Murley score was 88.9 ± 7.9, with six cases assessed as excellent and one case assessed as good. The mean VAS score was 1.0 ± 1.5, and the mean patient satisfaction score was 9.3 ± 0.8. No complications occurred, and each patient was able to resume their preinjury daily activity and was highly satisfied with their treatment.ConclusionsIn the present study, internal plating for bipolar clavicle injury allowed early mobilization and resulted in good joint function. We recommend fixation of the more severely affected side first because the other side may be passively reduced and acquire stability once the more severely affected side has been fixed. Internal fixation of the other end may therefore be unnecessary unless residual instability exists.

Prospective Study of Surgical Management of Midshaft Clavicle Fractures

Introduction: Fractures of the clavicle constitute 2.6% of all fractures, account for 44% of the injuries around the shoulder girdle, approximately 70%–80% of which occur in the middle third. Even when significantly displaced, conventionally these fractures are treated without surgery. Conservative treatments either by sling/figure of eight bandage/clavicular brace are favored by patients, but the results are much inferior to what was reported previously. The present study conducted to operate fresh fracture with displacement >2 cm, nonunion by open reduction and internal fixation (ORIF) with locking plate with or without bone grafting. The objective is relief from pain, restoration of activities as far as possible and better cosmetic appearance. Materials and Methods: Twenty-eight cases of the clavicle in healthy active individuals between 18 and 65 years of age operated between December 2019 and September 2022 in Hazaribag Medical College, Hazaribag, Jharkhand. Patients with minimally displaced fracture were excluded from the study. Fracture is classified by Allman in three groups as middle 1/3rd, distal 1/3rd, and medial 1/3rd. Indications for surgery are either open fracture, vascular injuries, initial displacement >2 cm, nonunion, cosmetically conscious patients. Results: Fifteen cases of fresh, 6 cases of symptomatic delayed union, and 7 cases of nonunion operated with precontoured plate with or without bone grafting. The average hospital stay was 3–7 days. The average time of fracture union was 10 weeks (8–12 weeks). Patients were followed weekly up to 4 weeks and then after 2 and 6 months. The functional outcome according to Constant and Murley score is excellent in 17 (60.7%) patients, good in 10 (35.7%) patients and satisfactory in 1 (3.6%) case. There was no major complication, one patient had superficial infection, deep infection in 1 case, nonunion in 1 case and plate breakage in one patient. Results were compared with cases treated conservatively. Conclusion: In the present era of competition, cosmesis and advancement with least morbidity and excellent results is required. ORIF in selected cases is a very good option in comparison to accept morbidity, cosmetic disfigurement and below-average functional results.

Comparative study between suprascapular nerve block versus platelet rich plasma in the treatment of adhesive capsulitis of shoulder joint

Introduction: Adhesive capsulitis of shoulder is a condition characterised by painful restriction of active and passive glenohumeral range of motion in at least two directions most notably shoulder abduction and external rotation. [1] Therapeutic options for the management of adhesive capsulitis are NSAIDs, intra-articular steroid injections, Suprascapular nerve block (SSNB), platelet rich plasma Injection (PRP), manipulation under general anaesthesia or arthroscopic capsular release. SSNB is an old and effective method for the treatment of adhesive capsulitis. Recently USG guided nerve blocks have been found to be safer and more efficacious compared to blind, landmark guided nerve blocks. PRP is newer modality of treatment in regenerative medicine to enhance the healing process in adhesive capsulitis.AIM: To evaluate & compare the outcome of adhesive capsulitis after either injection of PRP or SSNB. Materials and Methods: Patients with Adhesive capsulitis either received single injection of SSNB (n=45) (40 mg methylprednisolone + 5ml 2% lignocaine) or PRP (n=45) after randomization. All participants were also advised to perform a home based 10 minute exercise therapy after injection. The outcome were measured by using Constant and Murley shoulder score. Participants were evaluated at 0 (post-procedure), 3rd day,1 and 6 month. One way ANOVA-F has been used to compare between groups. Results: PRP showed significant difference in improvement than SSNB. No major adverse effect were seen in both groups. Conclusion: Both treatment modalities are effective with better result in PRP group than SSNB in long term follow-ups.

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.Materials and Methods: A total of 36 patients with diaphyseal fractures of humerus, selected 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 & Hand Score) & Constant-Murley scoring system respectively. Secondary outcomes were intra-operative conditions such as operative time and blood loss and post-operative complications.Results: The mean time of radiological union was 15.7 weeks ranging from14-26 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.Conclusion: Interlocking nailing is a relatively quick, minimally invasive, and biomechanically 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.

Extracorporeal Shock Wave in Combination with Arthroscopy for Calcified Supraspinatus Tendonitis

Objective: Exploring the therapeutic effect of extracorporeal shockwave combined with Arthroscopic Surgery on calcified supraspinatus tendinitis. Materials and Methods: Sixty patients with calcific supraspinatus tendinitis who received treatment in our hospital from June 2022 to June 2023 were randomly divided into two groups. All patients had disease lasting more than 6 months. The control group received extracorporeal shockwave therapy (ESWT), while the observation group, after undergoing arthroscopic debridement of calcific deposits in the joint, began receiving the same ESWT as the control group after 2 weeks. The differences in Visual Analog Scale (VAS) score, University of California at Los Angeles (UCLA) score, and Constant–Murley score between the two groups before and after treatment were recorded and compared. Results: Before treatment, there was no significant difference in VAS score, UCLA score, and Constant–Murley Scale (CMS) score between the two groups of patients (P > 0.05); compared with before treatment, both groups of patients showed a significant decrease in VAS scores after 1 and 2 months of treatment (P < 0.05). After 1 and 2 months of treatment, the VAS scores of the observation group were significantly lower than the ones of the control group (P < 0.05). Compared with before treatment, the UCLA score and CMS score of both groups of patients significantly increased after 1 and 2 months of treatment (P < 0.05). After 1 and 2 months of treatment, the UCLA score and CMS score of the observation group were significantly higher than those of the control group (P < 0.05). Conclusion: The combination of extracorporeal shockwave and arthroscopy has a significant therapeutic effect on calcified supraspinatus tendinitis, helping to improve shoulder joint function and effectively alleviate pain in patients. Keywords: Extracorporeal shockwave, Arthroscopy, Calcifying supraspinatus tendinitis, Shoulder joint function, Pain.

Subgroups and differences of fixation in 3-part proximal humerus fractures.

This study aimed to determine the morphological differences of three-part proximal humerus fractures, the group in which plate screw fixation is most frequently used, and to evaluate the functional and radiological results of the methods applied for different subgroups. Twenty-nine patients (6 males and 23 females) with three-part proximal humerus fractures were in the study, with an average age of 64. The patients were in three groups according to their fracture types. Group 1 included eight patients with valgus impaction fracture. Group 2 included eleven patients with easily achieved stability after reduction. Group 3 consisted of ten patients with procurvatum varus angulation, a significant displacement between fragments, and in whom medial cortical continuity was not maintained without fixation. All patients underwent surgery with a minimally invasive deltoid split approach method and locked ana-tomic plate screw osteosynthesis. In group 1 patients, the space in the area where valgization is present in the head was filled with cortico-cancellous allografts. No grafting or metaphyseal compression took place in Group 2 patients. In group 3 patients, the metaphyseal compression technique was applied to the bone defect area. Cephalodiaphyseal angles (CDA) were measured at the postoperative and final follow-up. The constant Murley score made the functional evaluation. The patients were followed for an average of 27.6 months, and the union was present in all patients for an average of 3.6 months. Early screw migration was present in three patients, and late screw migration was in one patient. There were twenty-four excellent and 5 good results. CDA decreased from 139.42° to 136.13°. A statistically significant difference was present between the values of Groups 2 and 3 in the final control CDA of the groups. In this study, the functional scores of grafting stable valgus-impacted fractures and metaphyseal compression of unstable fractures with insufficient medial support were as good as stable 3-part fractures. Considering neer type 3 fractures should be evaluated with their subgroups, and fixation and stability-enhancing solutions specific to the groups are essential.

Accelerated rehabilitation in treating neer type V distal clavicle fractures using anatomical locking plates with coracoclavicular ligament augmentation

BackgroundThere is still no gold standard treatment for Neer type V distal clavicle fractures. This study was designed to evaluate the therapeutic effects of accelerated rehabilitation in treating Neer type V fractures using anatomical locking plate (ALP) fixation with additional coracoclavicular (CC) ligament augmentation. MethodsIn this retrospective study, patients who underwent ALP fixation with additional suture anchor fixation of acute Neer type V distal clavicle fracture from January 2016 to January 2021 were reviewed. Injury radiography and computed tomography (CT) were performed to determine the Neer classification. All patients performed standardized early rehabilitation exercises after surgery and were followed up for more than 12 months. The Constant–Murley score (CMS); the disabilities of the arm, shoulder, and hand (DASH) questionnaire; visual analog scale (VAS); and the percentage of modified CC distance (MCCD%) were evaluated at the last follow-up. ResultsThirty-two patients were included in this study. The mean follow-up time was 31.1 ± 10.4 months. All patients achieved bone union 6–8 weeks (7.2 ± 0.7 weeks) after surgery and were allowed to return to normal daily life. No surgery-related complications occurred in any case. The MCCD% value at the last follow-up (104.7% ± 8.5%) significantly decreased compared with preoperative MCCD% value (162.8% ± 7.2%) (p < 0.001), indicating that all patients achieved ideal fracture reduction. And all patients obtained satisfactory shoulder joint function with a mean CMS of 97.1 ± 2.6, a mean DASH score of 1.6 ± 1.3, and a mean VAS score of 0.4 ± 0.6. ConclusionThis study has demonstrated that ALP fixation with additional suture anchor fixation is a promising strategy for accelerated rehabilitation in treating patients with Neer type V fracture.

Prospective study to assess functional outcome in proximal humerus fracture treated using philos

Introduction: Proximal humerus fractures are 2nd most common fractures of upper limb and 3rd overall. Proximal humerus fractures which were stable and minimally displaced were treated conservatively, unstable fractures (3 part, 4 part) were treated with ORIF with Plate osteosynthesis. ORIF with PO allows early mobilization with stable fracture construct. Stability is contributed by the fixed angle construct of the prosthesis. This is a prospective study aimed at knowing the functional outcome in proximal humerus fractures treated with PHILOS plating system.Methods: Prospective study done at tertiary center from June 2020 to November 2021.Over a period of 1.5 yrs. All patients were operated by the same surgeon with standard surgical procedure. Total number of patients were 30. They were graded at 3 months and 6 months and 1year using constant murley scoring and VAS scoring.Results: There were 24males and 6 female’s average age being 40.53yrs, right side being most commonly affected side. Average surgical time was 77.8 min (63 to 92min) average surgical time being 77.8min average blood loss being 257ml, average constant murley score was at 3 mo. was 22.5 at 6mo 56.05 at 1yr 73.3 score at 1 year has increased significantly from 3mo to 1yr (p

Arabic Version of the Modified Constant Murley Score

Arabic Version of the Modified Constant Murley Score

Arthroscopic-assisted stabilization of distal clavicle fractures with coracoclavicular ligament injury: does it restore anatomy and function?

Abstract Background Fractures of the lateral-third clavicle are less common than the mid-shaft. However, these lateral thirds are associated with disruption of coracoclavicular (CC) ligaments requiring surgical management for optimal fracture healing and functional outcome. Many surgical techniques have been developed to manage these fractures; however, high failure rates and implant-related complications were reported. This study aims to assess the radiological and functional outcomes of arthroscopic-assisted stabilization of the distal end clavicle in terms of union rate, complications, and shoulder function. Patients and methods A prospective study of 32 patients with distal displaced clavicle fracture combined with CC ligament injury (Neer type IIB, V) who underwent surgery within the first 2 weeks of injury between January 2017 and February 2020. Clinical evaluation was employed postoperatively using the Constant–Murley score. The stability of the acromioclavicular joint in the horizontal and vertical planes was evaluated by the cross-arm test and manual dislocation. Radiological assessment was reviewed by an independent observer who was not a surgical team member at 1 and 2 months postoperatively. Results A series of 32 patients (24 men and eight women) were included. Their mean age was 36 years. Based on the radiological imaging, 20 patients had Neer type-IIB fractures, while 12 showed type-V fractures. Their average union time was 6.12 ± 1.26 weeks (ranged 5–9 weeks), with a mean Constant–Murley score that was 96.1 ± 3.76 (range, 89–100). An average of 6.62 ± 1.82 weeks was needed before returning to prior activities. There were no complications reported. Conclusions Arthroscopic-assisted fixation of the distal end clavicle provides excellent fixation results and restores the native anatomy by reconstructing the torn CC ligament without complications or the need for removal of the implant.

Functional Outcome of Open Latarjet Procedure for Recurrent Anterior Shoulder Dislocation

OBJECTIVES To find the functional outcome of the open Latarjet method for recurrent anterior shoulder dislocation. METHODOLOGY The current retrospective study was conducted at the Orthopedic and Trauma Department of the Khyber Teaching Hospital in Peshawar from September 2020 to August 2021. A total of 31 patients were included in the study, of which 29 were males and 2 were females. A detailed medical history was obtained through physical examination, and all necessary laboratory tests were requested. AP and axillary views of plain X-ray radiographs were taken. We used a CT scan on all the patients to calculate the humeral and glenoid bone loss. We had all patients undergo an MRI to rule out soft tissue pathology. Six months after surgery, the outcome was graded using the Constant Murley Score on a good, good, fair, and poor scale. RESULTS In this study open Latarjet procedure was done in 31 patients with 29 males (93.4%) and two females (6.45%). The right-sided shoulder was involved in 24 (77.14 %) patients, while the left shoulder was involved in 7 patients (22.58%). A bipolar lesion in the shoulder with bone loss was seen on the glenoid side at 17.5% (range 10-25%), and the humeral side was 22.5%. Follow-up was done for six months in which 22 patients had a very good outcome (70.96%), six patients had a good outcome(19.35%), two patients had a fair outcome(6.45%), and one patient had a poor outcome(3.22%). There were no major complications seen like graft fractures, graft malposition, neurovascular compromise, and hardware breakage CONCLUSION Recurrent anterior shoulder instability can be effectively treated with open Latarjet with excellent functional outcomes and a very low complication rate and recurrence.

The association between reverse total shoulder arthroplasty neck-shaft angle on postoperative patient experienced shoulder disability: a retrospective cohort study

The neck-shaft angle (NSA) of the glenoid component used in reverse total shoulder arthroplasty (RTSA) was reduced to improve functional outcomes. This led to a decreased abduction but increased external rotation ability of patients who underwent RTSA. The impact of the decreased NSA on patient-reported shoulder disability is unknown but may have important implications for functional ability. Therefore, the aim of this study was to assess the difference in patient experienced shoulder disability between an NSA of 135° and 155° 12 months after RTSA. In this retrospective cohort study, 109 patients undergoing RTSA were included. In 68 patients, a glenoid component with an NSA of 135° was used and 41 patients received a glenoid component with an NSA of 155°. The primary outcome was Disabilities of the Arm, Shoulder, and Hand (DASH) scores at 12 months and change scores between baseline and 12-month follow-up. Secondary outcomes were complications, Constant Murley Score, Numeric Rating Scale, active forward elevation and external rotation ability. Differences between groups were tested with t-tests or Mann-Whitney U-tests. A mean difference of 10.0 in 12 months postoperative DASH scores between NSA groups was observed in favor of the 135° NSA (P=.004), which did not exceed the Minimal Clinically Important Difference. DASH changes scores did not differ between NSA groups (P=.652). Mean postoperative Constant Murley Score at 12 months was 11.1 higher in the 135° NSA group (P=.013). No differences were observed in complications (P=.721) and postoperative pain (P=.710) between groups. Difference in postoperative external rotation and forward elevation at 12 months was 10° (P=.022) and 20° (P=.046), respectively, in favor of the 135° NSA group, exceeding Minimal Clinically Important Differences. No clinically important difference in patient-reported shoulder disability (DASH) was found between both groups, despite a larger range of motion in the 135° NSA group. This study is the first to show the impact of NSA on patient-reported shoulder disability using the DASH.

Efficacy analysis of a double-Schanz screw external fixator combined with anti-rotating Kirschner wire in the treatment of proximal humerus fractures in skeletally immature patients

ObjectivesThe objective of this study is to evaluate the efficacy of a double-Schanz screw external fixator combined with anti-rotating Kirschner wire in the treatment of displaced Salter–Harris type II proximal humerus fractures in skeletally immature patients.MethodsA retrospective analysis was performed on 22 cases of displaced Salter–Harris type II proximal humerus fractures in skeletally immature patients who were treated with a double-Schanz screw external fixator combined with anti-rotating Kirschner wire. Patients included were the Neer–Horowitz (N–H) type 2, 3, and 4 of fracture. The basic information of the patients was recorded, fracture healing and shoulder range of motion were assessed at the last follow-up visit. The disabilities of the arm, hand (DASH) score and Constant—Murley score of the shoulder were performed to observe the occurrence of complications.ResultsThe mean age at the time of surgery was 12.41 years, and all patients completed a median follow-up of 18.18 months. There were two cases of N–H type 2, 12 cases of N–H type 3, and eight cases of N–H type 4 among the patients. At the last follow-up, all patients were able to achieve pain-free shoulder movement. There was no significant difference in shoulder function between the injured side and the uninjured side. The DASH score mean was 2.43 (95% CI 1.44–3.52). The constant score mean was 98.55 (95% CI 97.73–99.27). All patients returned to their pre-injury daily life and physical activities, and there was no significant difference in bilateral limb length at the last follow-up (p < 0.05). The most common complication of double-Schanz screw external fixator combined with anti-rotating Kirschner wire surgery was pin tract infection, which occurred in 5 cases (22.7%). There were no complications such as deep infections, vascular and nerve damage, failure of fixation, secondary fracture displacement, non-union of fracture, osteonecrosis of the humerus, joint stiffness, rotator cuff weakness and limb deformity.ConclusionThe double-Schanz screw external fixator combined with anti-rotating Kirschner wire is a safe and effective treatment for displaced Salter–Harris type II proximal humerus fractures in skeletally immature patients over the age of 10 years.

The Effect of Strength Training on Undetected Shoulder Pathology in Asymptomatic Athletes: An MRI Observational Study.

Data on the effects of weight training on joint morphology are mostly restricted to muscle gain. However, in many circumstances, it is not stated if there are negative consequences for the joints and their surrounding components. This study was conducted to explore whether long-term excessive resistance training (RT) causes hidden pathological alterations in the shoulder. A total of eleven asymptomatic sportsmen (22 shoulders) underwent clinical and radiological examination of both shoulder joints. All participants had engaged in bodybuilding for at least four years, at least three times per week, and for at least four hours per week. All participants were examined clinically using the Constant Murley Score (CMS), Simple Shoulder Test (SST), UCLA Activity Test, and a specially designed questionnaire. All participants received a bilateral shoulder MRI. The MRI scans were checked for pathology using a checklist. Maximum scores were observed for the SST and UCLA Activity Test. The CMS was 97.7 points on average (range, 87-100). RT had been conducted for a mean of 10.7 years (range, 4-20), for an average of 8.8 h a week (range, 4-12). MRI examinations revealed two supraspinatus tendinopathies (9.1%), one labral change (4.5%), three humeral tuberosity cysts (13.6%), fourteen acromioclavicular (AC) joint hypertrophies (63.6%), five AC joint osteophytes (22.7%), and ten signs of AC joint inflammation (45.5%). The research results show that strength is associated with MRI-documented AC joint pathology. However, it appears that RT may not negatively affect other anatomical structures of the shoulder.

Hyaluronic acid as an alternative treatment option for degenerative rotator cuff tears

Rotator cuff tears have a high prevalence in older people. This research examines the clinical outcome of the non-operative treatment of symptomatic degenerative rotator cuff tears with hyaluronic acid (HA) injections. 72 patients (43 females/29 males), with an average age of 66 years with symptomatic degenerative full- thickness rotator cuff tear, confirmed with arthro-CT, were treated with three intra-articular hyaluronic acid injections and followed on multiple observational moments during a 5-year follow-up using the SF- 36 (Short-Form Health Survey), DASH (Disabilities of the Arm, Shoulder, and Hand), CMS (Constant Murley Score), and OSS (Oxford Shoulder Scale. 54 patients completed the 5-year follow-up questionnaire. 77% of the patients did not require additional treatment for their shoulder pathology, and 89% were treated conservatively. Only 11% of the patients included in this study needed surgery. Between subjects, the analysis revealed a significant difference in response in the DASH (p=0.015) and CMS (p=0.033) when the subscapularis muscle was involved. Intra-articular infiltrations with hyaluronic acid improve pain and shoulder function, especially if the subscapularis muscle is not involved.

Hyaluronic acid as an alternative treatment option for degenerative rotator cuff tears

Rotator cuff tears have a high prevalence in older people. This research examines the clinical outcome of the non-operative treatment of symptomatic degenerative rotator cuff tears with hyaluronic acid (HA) injections. 72 patients (43 females/29 males), with an average age of 66 years with symptomatic degenerative full- thickness rotator cuff tear, confirmed with arthro-CT, were treated with three intra-articular hyaluronic acid injections and followed on multiple observational moments during a 5-year follow-up using the SF- 36 (Short-Form Health Survey), DASH (Disabilities of the Arm, Shoulder, and Hand), CMS (Constant Murley Score), and OSS (Oxford Shoulder Scale. 54 patients completed the 5-year follow-up questionnaire. 77% of the patients did not require additional treatment for their shoulder pathology, and 89% were treated conservatively. Only 11% of the patients included in this study needed surgery. Between subjects, the analysis revealed a significant difference in response in the DASH (p=0.015) and CMS (p=0.033) when the subscapularis muscle was involved. Intra-articular infiltrations with hyaluronic acid improve pain and shoulder function, especially if the subscapularis muscle is not involved.

Hyaluronic acid as an alternative treatment option for degenerative rotator cuff tears.

Rotator cuff tears have a high prevalence in older people. This research examines the clinical outcome of the non-operative treatment of symptomatic degenerative rotator cuff tears with hyaluronic acid (HA) injections. 72 patients (43 females/29 males), with an average age of 66 years with symptomatic degenerative full- thickness rotator cuff tear, confirmed with arthro-CT, were treated with three intra-articular hyaluronic acid injections and followed on multiple observational moments during a 5-year follow-up using the SF- 36 (Short-Form Health Survey), DASH (Disabilities of the Arm, Shoulder, and Hand), CMS (Constant Murley Score), and OSS (Oxford Shoulder Scale. 54 patients completed the 5-year follow-up questionnaire. 77% of the patients did not require additional treatment for their shoulder pathology, and 89% were treated conservatively. Only 11% of the patients included in this study needed surgery. Between subjects, the analysis revealed a significant difference in response in the DASH (p=0.015) and CMS (p=0.033) when the subscapularis muscle was involved. Intra-articular infiltrations with hyaluronic acid improve pain and shoulder function, especially if the subscapularis muscle is not involved.

Outcome of PHILOS Plate Application in Type III and Type IV Proximal Humeral Fracture: Tertiary Level Hospital in Bangladesh

Background: More over 10% of all fractures in people over the age of 70 are in the proximal humerus, making it the third most commonly non-vertebral osteoporotic fracture behind proximal femur and collies' fractures. Many different methods of treatment, including closed reduction with percutaneous K-wire fixation, open reduction with subsequent fixation using Transosseous sutures, tension band wire, T plate, locking plates and screws, intramedullary nails, and prosthetic replacement, have been documented. Objective: The aim of our study was to functionally evaluate the Proximal Humerus Type II and type IV Fracture treated with PHILOS plate with early joint mobilization. To achieve maximum functional activity at shoulder joint. Material and Methods: This prospective study was conducted in the department of orthopedic surgery, Rajshahi Medical College, Bangladesh with Matricentred base Study from January June 2020 to July 2022. A total (n=176) cases of proximal humerus fracture treated by PHILLOS plate. Results: In our study of 179 cases, Male patients predominated female patients 100 (56%) males to 79 (44%) females, and the average age of patients is 39 years with the range being 25–65 years. Road traffic accident and fall from height were the commonest cause of the trauma 71 (39.66%). Neer classification system was used to classify the fractures. During the follow–up functional parameters were assessed using Constant-Murley scoring system. The study shows 60 (33.52%) excellent, 51 (28.49%) good, 24 (13.41%) satisfactory, Adequate 28 (15.64%) and 13 (7.26%) poor results on Constant Murley Score. The most common complications surgical site infection 3 (1.68%). Conclusion: A proximal humerus fracture can be stabilized with the use of a PHILOS plate.

Functional outcome of percutaneous Kirschner wire fixation of proximal humerus fractures

Proximal humerus fractures are prevalent in both elderly and young patients and can be managed with a variety of treatment options ranging from conservative management to arthroplasty. Due to frequent injury to blood supply of humeral head and various other anatomic considerations, no treatment modality gives good results in all patients. 20 patients with proximal humerus fracture were treated with Closed Reduction and K-wire fixation in and were followed up for a period of 6 months. Functional outcome was measured with Constant Murley score and modified UCLA score. Out of 20, 17 patients were available for follow up and final analysis. 9 patients had 3 part, 2 patients had 2 part and 6 patients had 4 part fractures as per Neer’s Classification. According to AO/OTA classification, 13 patients had Type B fracture, 2 had Type A fracture and 2 patients had Type C fracture. Average age of the group was 61.76 years with an average time to union of 6.18 weeks. 13 out of 17 patients had good to excellent results according to Constant Murley score with an average score of 65.47 while 9 out of 17 patients had good to excellent results as per modified UCLA score. Most common complication was loosening of K wires. Closed reduction and K-wire fixation of proximal humerus fracture has satisfactory results with good functional outcome in majority of patients. It has several advantages over open methods of fixation especially in elderly patients as it is less invasive and biological environment of the fracture is maintained. We conclude that Closed Reduction and K-wire fixation is a good alternative to open methods of fixation in treatment of 2 part, 3 part fractures and in certain 4 part fractures.

Anatomically reduced fixation should always be considered when treating B and C proximal epiphyseal humeral fractures

BackgroundProximal humeral fractures are commonly observed in elderly patients. Management of these injuries is controversial. Literature comparing locking plate fixation, arthroplasty, and conservative treatments show no clear advantages for any of these management strategies. Thus far, no study has considered anatomically reduced fractures obtained after locking plate treatment. To clarify the best surgical procedure in middle-aged patients, we considered outcomes and major complications leading to surgical revision following an anatomically reduced fracture fixed with locking plate and reverse shoulder arthroplasty (RSA) in the treatment of type B/C fractures in patients between 50 and 75 years of age.MethodsThis is a retrospective study including 59 patients between 50 and 75 years of age with type B/C proximal humeral fracture treated with RSA or with locking plate fixation (resulting in an anatomical reduction) between January 2010 and December 2018. Preoperative radiographs and computed tomography (CT) were evaluated in all patients. Clinical and radiologic follow-up was performed using range of motion (ROM), the Constant–Murley Score (CMS), the Oxford Shoulder Score (OSS), the Simple Shoulder Test (SST), the Subjective Shoulder Value (SSV), and visual analog scale (VAS). Major complications were considered.Results In the plate fixation group, ROM, CMS, SST, and VAS were higher than in the RSA group. Lower complication rates compared with the literature were observed in both groups. Anatomically reduced fracture fixed with plate and screw could outperform RSA in terms of outcome. In second-level centers where traumatology is performed by surgeons with great expertise in upper limb trauma, the choice between plate fixation and reverse arthroplasty should be made during surgery.ConclusionAnatomically reduced fractures showed better outcomes compared with RSA in type B/C fractures. Surgeons should always try to perform a reduction of the fracture in order to understand if a plate fixation could be feasible. If it is impossible to perform an anatomical reduction, we suggest to consider RSA. This is a retrospective observational study.