Murley Score Research Articles

Combined Cuff Repair And superior Capsular Reconstruction reinforcement (CRACR) in patients with massive rotator cuff (re)tears. A Minimum 2-year clinical and radiological follow-up.

Due to the aging population, the number of symptomatic degenerative rotator cuff tears has increased substantially and some are challenging to repair due to poor tendon quality with significant retraction. In order to optimize repair integrity and function, rotator cuff repair reinforcement with a superior capsule reconstruction has been proposed. This study presents the results of a technique combining cuff repair and capsular reconstruction (CRACR) using acellular dermal allograft in patients with massive rotator cuff tears and retears. From December 2017 to July 2019 50 consecutive patients with previous failed rotator cuff repairs or primary surgery on poor tendon quality defined as massive rotator cuff tear (full thickness rotator cuff tears with 2 or more tendons involved), were treated with the CRACR technique and enrolled prospectively. Contraindications for the CRACR procedure were Hamada stage ≥ 3 cuff tear arthropathy and patient's preference for reverse total shoulder arthroplasty. Patients were reviewed at 3, 6, 12 and 24 months (American Shoulder and Elbow Surgeons (ASES) scores, Constant Murley Scores (CMS), Visual Analogues Scores (VAS), Oxford Shoulder Score (OSS), QuickDASH (QD)). Postoperative MRI scans were requested at 6 weeks, 3 months, 6 months, 12 months, and 24 months postoperatively to assess repair integrity. Mean age at surgery was 58.0 years (SD 8.1, range 41-79). Of the 50 patients, 14 patients (28.0%) had previous failed rotator cuff repair. From the 36 primary cases, 28 (77.8%) had massive rotator cuff tears and one (2.8%) a perioperative irreparable tear, while 28 (77.8%) patients had a subscapularis tear. At 2 years of follow-up all scores improved significantly (VAS 6.3 to 1.5; ASES 34.0 to 79.0; CMS 30.9 to 68.0; OSS 23.3 to 40.1; QD 56.2 to 20.3; all p<0.001). MRI scans were conducted at a mean of 14.4 months (SD 7.0, range 3-26) after surgery showing 6 isolated SCR failures and 5 isolated rotator cuff retears. In the short term the rotator cuff repair and superior capsular reconstruction reinforcement (CRACR) technique is a valid option for patients with massive rotator cuff tears and retears with a high chance of a postoperative retear due to poor tendon quality. Clinical results and repair integrity is promising. Longer term follow-up is ongoing to establish the efficacy of this procedure.

Three-dimensional evaluation of stem placement accuracy with the conventional guide in reverse shoulder arthroplasty and its relevance to clinical outcomes

BackgroundPlacement of retroversion stem (RS) is important in reverse shoulder arthroplasty (RSA). A conventional guide, based on the forearm, has been used for stem placement; however, only a few studies have reported the accuracy of stem placement using conventional guides. In this study, a three dimensional (3D) postoperative evaluation software was used to investigate the accuracy of RS placement using a conventional guide and its effect on postoperative outcomes. MethodsThis retrospective study was performed by a single surgeon (a board-certified specialist with more than 15 years' experience in performing RSA) using the Exactech Equinoxe Reverse Shoulder System (Exactech Inc., Gainesville, FL, USA). Forty-nine patients who were followed up for at least 2 years were included. The target RS angle of the humeral component was set to 20°. Postoperative implant placement, including RS, was assessed with a 3D planning software using computed tomography (CT) images obtained postoperatively. Postoperative range of motion and its relationship with clinical outcomes were also evaluated as clinical assessment. Furthermore, a sub-analysis was performed comparing the 0–20° RS group with the other groups. ResultsThe mean postoperative RS was 13.2 ± 11.9° and was placed within 0–20° in 31/49 patients (63.3%). A correlation was observed between postoperative external rotation (ER) and RS (r=0.30, p=0.03). In a further sub-analysis, the Constant–Murley score was significantly higher in the 0–20° RS group (p=0.03). ConclusionPlacement of the RS using a conventional guide varied from the target position. RS correlated with postoperative ER, and RS within 0–20° significantly improved clinical outcomes. These results suggested that accurate placement of the RS may improve clinical outcomes. Therefore, the development of surgical assistive technologies for accurate placement is necessary to ensure accurate stem placement to avoid human error.

Comparison of arthroscopic-assisted mini open and all arthroscopic repair methods in small to large size rotator cuff tears

Aim: This study aimed to compare the functional and clinical results of all arthroscopic (AA) and arthroscopic-assisted mini open (AAMO) rotator cuff tear (RCT) repair methods with a minimum 2 years follow-up. Methods: In this retrospective study, patients who operated with the AA repair method were included in group 1 and patients who operated with AAMO RCT repair method were included in group 2. Between January 2018 and June 2021. All patients were evaluated with shoulder range of motion (ROM), the Disabilities of the Arm, Shoulder and Hand (DASH), Constant Murley Score (CMS) and visual analog scale (VAS) pain score preoperatively and postoperatively. Postoperative evaluation was made on the 3rd, 6th, 12th, and 24th months. In addition, the length of hospital stay, and surgery time were evaluated. Results: Eighty patients (48 female, 32 male) were included in group 1, who were treated with the AA technique. Sixty-seven patients (28 male, 39 female) were included in group 2, who were treated with the AAMO technique. The average follow-up time was 29,36 ±3,48 months for group 1, 28,12±2,87 months for group 2. No significant difference was detected between group 1 and group 2 for length of hospital stay and follow-up time (p&gt;0,05). At the postoperative 3rd-month follow-up measurements, a statistically significant difference was determined between group 1 and group 2 for abduction, flexion measurements, VAS score, and DASH score (p=0,03, p=0,04, p=0,02, p=0,01 respectively). At the 24th month postoperative follow-up, statistically no significant difference was determined between groups 1 and 2 in terms of ROM, VAS, and functional scores. Conclusion: In the early recovery period, AA repair provides better ROM, DASH, and VAS scores. However, in long-term follow-up, no significant difference was detected in AA and AAMO repair in terms of functional results, ROM, and VAS scores.

Minimally Invasive Plate Osteosynthesis with Mini-Open Technique and Supraclavicular Nerve Preservation Reduces Postoperative Numbness in Acute Displaced Midshaft Clavicle Fracture

Background: Minimally invasive plate osteosynthesis (MIPO) for clavicular shaft fracture yields favorable functional outcomes and results in less surgery-related soft tissue injury than other techniques. Anterior chest and shoulder skin numbness, a common complication after open reduction and plate fixation, is related to injury to the supraclavicular nerves. We propose MIPO combined with a mini-open approach without fluoroscopy for nerve preservation to minimize the risk of postoperative numbness compared with traditional open plating without nerve preservation. Methods: A total of 59 patients were retrospectively identified, with a follow-up period of 6 months. Thirty-two patients underwent MIPO with mini-open and nerve preservation technique (MIPO group), and 27 patients underwent traditional open plating without nerve preservation (open group). Constant–Murley shoulder outcome score, operation time, wound length, skin numbness, and number of implant removals were compared between the groups. Results: The MIPO group had significantly lower rates of anterior chest and shoulder skin numbness than the open group (MIPO: 12.5% vs. open: 55.6%; p &lt; 0.001). Operation time was significantly longer in the MIPO group than in the open group (MIPO: 109.38 ± 18.83 vs. open: 81.48 ± 18.85; p &lt; 0.001). Wound length was significantly shorter in the MIPO group than in the open group (MIPO: 4.73 ± 0.79 vs. open: 9.76 ± 1.64; p &lt; 0.001). Both groups had similarly excellent Constant–Murley shoulder scores. There were significantly fewer implant removals in the MIPO group than in the open group (MIPO: 6.3% vs. open: 25.9%; p = 0.036). Neither group experienced any infection, implant failure, or nonunion. Conclusions: Our technique combining MIPO with the mini-open approach and supraclavicular nerve preservation yields a lower incidence of skin numbness than traditional open plating without nerve preservation.

Assessment of Clinical and Functional Outcomes of the Proximal Humerus Internal Locking Compression Plate in Different Neer’s Types of Proximal Humeral Fracture: A Prospective Observational Study

Abstract Background: Over the years, various fixation methods have been developed for managing unstable proximal humerus fractures (PHFs), including conservative and surgical approaches like tension band wiring, suture fixation, intramedullary nailing, hemiarthroplasty, fixed-angled locking plates, and proximal humerus internal locking system (PHILOS) plating. Each method claims superior effectiveness as a fixation device. Aims: The study evaluated the functional outcome of the PHILOS in different parts of the PHF using the Constant–Murley score (CMS), which measures post-operative pain, daily activity ability, limb range of motion (ROM), and strength. Materials and Methods: A prospective observational study of 50 participants aged 16 years and above at Rajasthan Hospitals in Ahmedabad, conducted from July 2020 to July 2022, examined the use of the PHILOS for PHF treatment. Results: The results revealed that two-part fractures had a significantly higher mean CMS (72.4 ± 10.8) compared with three-part (60.8 ± 8.1) and four-part (59.3 ± 5.3) fractures. The P value of 0.0003 indicated that the difference in CMS score between two and three or four parts of PHF after fixing them with PHILOS was statistically significant. Conclusion: The study concludes that using a locking plate for PHFs consistently leads to positive clinical and functional outcomes, including improved CMS, daily living activities, and ROM.

A clinical study on robot navigationassisted intramedullary nail treatment for humeral shaft fractures

BackgroundThe purpose of this study was to evaluate the advantages of robot navigation system-assisted intramedullary nail treatment for humeral shaft fractures and compare it’s efficacy with that of traditional surgical intramedullary nail treatment.Materials and methodsThis was a retrospective analysis of patients with humeral shaft fractures who received intramedullary nail treatment at our centre from March 2020 to September 2022. The analysis was divided into a robot group and a traditional surgical group on the basis of whether the surgery involved a robot navigation system. We compared the baseline data (age, sex, cause of injury, fracture AO classification, and time of injury-induced surgery), intraoperative conditions (surgery time, length of main nail insertion incision, postoperative fluoroscopy frequency, intraoperative bleeding), fracture healing time, and shoulder joint function at 1 year postsurgery (ASES score and Constant–Murley score) between the two groups of patients.ResultsThere was no statistically significant difference in the baseline data or average fracture healing time between the two groups of patients. However, the robotic group had significantly shorter surgical times, longer main nail incisions, fewer intraoperative fluoroscopies, and less intraoperative blood loss than did the traditional surgery group (P < 0.001).ConclusionRobot navigation system-assisted intramedullary nail fixation for humeral shaft fractures is a reasonable and effective surgical plan. It can help surgeons determine the insertion point and proximal opening direction faster and more easily, shorten the surgical time, reduce bleeding, avoid more intraoperative fluoroscopy, and enable patients to achieve better shoulder functional outcomes.

Correlation of radiological parameters with functional outcomes post fixation with proximal humerus locking plates.

Proximal humerus fractures account for 4-5% of all fractures in adults and affect females more than males. With the advent of special locking plates, the treatment trend has shifted more towards a surgical approach. These methods have produced good results but very high complications rates have been reported in the literature. This study was undertaken to analyse the radiological parameters which reflect towards a favourable long term functional outcome in order to advance the surgical fixation skills for managing fractures of the proximal part of the humerus. 83 study participants with proximal humerus fracture fixed using proximal humerus locking plates were retrospectively analysed. The radiological parameters studied were neck shaft angle, head shaft angle, head diameter, head height, greater tuberosity to articular surface distance and reduction of the medial hinge with or without placement of calcar screw. The functional parameters assessed were the Constant Murley Score and range of movements of the shoulder joint. The patients were not followed further for the purpose of the study. The mean Constant Murley Score for the participants was 80.75 ± 8.09 (range 60-90). The participants with good to excellent CM Score had a significantly higher neck shaft angle (107.47 ± 9.74 v/s 124.16 ± 10.68) and (-0.28 ± 0.85 v/s 2.37 ± 2.28), head shaft angle (23.09 ± 4.82 v/s 31.76 ± 7.76), head diameter (40.08 ± 8.63 v/s 45.15 ± 4.73), head height (18.77 ± 1.96 v/s 20.69 ± 2.76) and greater tuberosity to articular surface distance (-0.28±0.85 v/s 2.37±2.28) as compared to the patients with satisfactory and worse CM Score. The patients with a higher neck shaft angle and a maintained subacromial space had a better range of shoulder abduction. A higher rate of valgus collapse was seen with an inadequate medial hinge reduction. The radiological parameters which can predict towards a good functional outcome are a higher neck shaft angle and head shaft angle, a larger head diameter and head height, a superior position of the greater tuberosity in relation to the articular surface and a good medial hinge reduction.

Non-union of the greater tuberosity in patients undergoing reverse total shoulder arthroplasty for proximal humerus fracture: Is it associated with worse outcomes?

4-part proximal humerus fractures are complex injuries that are often associated with comminution of the greater tuberosity. The purpose of this study is to evaluate the functional outcomes of 4-part humerus fractures that are treated with reverse total shoulder arthroplasty (rTSA) and correlate these outcomes with the healing status of the greater tuberosity. A retrospective observational study was performed including 65 patients who underwent rTSA following a 4-part proximal humerus fracture. These patients were categorized into 3 groups according to the healing status of the greater tuberosity: patients with healed greater tuberosity in an anatomical position (group A, n = 43), patients with non-union of the greater tuberosity but in anatomical position (group B, n = 14), and patients with resorption or non-union of the greater tuberosity not in anatomical position (group C, n = 8). The Constant-Murley score and range of motion were recorded for each patient at 12months postoperatively. The clinical and radiographical outcomes of the 3 groups were compared. Patients with healed greater tuberosity (group A) had higher range of motion compared to patients with greater tuberosity migration or reabsorption (group C) regarding forward flexion (130° vs 80°, p < 0.001), abduction (110° vs 65°, p < 0.001) and external rotation (20° vs 10°, p = 0.004). However, no significant changes regarding forward flexion (130° vs 125°, p = 0.67), abduction (110° vs 100°, p = 0.60) and external rotation (20° vs 25°, p = 0.37) were noted between patients with healed greater tuberosity (group A) and those with non-united greater tuberosity that remained attached to the humeral prosthesis (group B). Similarly, Constant- Murley score was similar between patients of group A and group B (65.0 vs 61.5, p = 0.53), while it was higher in patients of group A compared to those of group C (65.0 vs 39.0, p = 0.053). The outcomes of this study indicate that reliable recovery regarding range of motion and functional status can be achieved in patients who undergo rTSA due to 4-part proximal humerus fractures, as long as the greater tuberosity remains in close proximity to the humeral prosthesis, even if it has signs of non-union with no continuity to the adjacent humerus.

Comparison of Functional Outcome of Proximal Humerus Management with K-Wire versus PHILOS Plate

Background: Background: Proximal humerus fractures account for approximately 4% of all fractures and 26% of humeral fractures. While conservative treatment is often recommended, surgical management remains debated, particularly with the use of percutaneous pinning and PHILOS plating.Objective: To compare the functional outcomes of proximal humerus fractures managed with percutaneous pinning versus PHILOS plating using Constant and Murley’s score.Methods: This prospective, randomized controlled trial was conducted at Services Hospital, Lahore, over 18 months. A total of 128 patients were randomized into two groups: Group A (Percutaneous Pinning, n=64) and Group B (PHILOS Plating, n=64). Demographic data were recorded, and functional outcomes were assessed using Constant and Murley’s score at the 24th week. Data analysis was performed using SPSS 25, with independent t-tests and chi-square tests applied, considering p&lt;0.05 significant.Results: The mean Constant and Murley score were 84.58 ± 8.561 in Group A and 86.48 ± 7.622 in Group B (p=0.186). Favorable outcomes were seen in 34.4% (n=44) in Group A and 42.2% (n=54) in Group B (p=0.037).Conclusion: PHILOS plating proved a higher rate of favorable outcomes compared to percutaneous pinning, suggesting its preferable use for proximal humerus fracture management.

Functional Outcome of Acromioclavicular joint dislocation Type III injuries treated with Hook Plate

The acromioclavicular joint (AC) dislocation is a complex injury due to the disruption of ligaments and joints, leading to instability and pain. Rockwood type III injuries remain controversial, so clinical evaluation should be taken into consideration before deciding the treatment modalities. The study aimed to evaluate the functional outcome of AC joint dislocation type III injuries treated with a hook plate. A total of 30 patients with AC Joint Dislocation Type III injuries were treated with open reduction and fixation with hook plate during a period of 18 months. The functional outcome was evaluated using constant murley score, the mean score of which was 82 (58-96). There were 7 (23.33%) cases of plate impingement and the symptoms was improved after plate removal. The hook plate is a good fixation device for the treatment of AC joint dislocation -Rockwood type III injuries with minimal complications, as it is a simple procedure, with good functional outcome, without ligamentous procedure and the only drawback is second surgery for implant removal.

Clinical effect of modified anterolateral acromioplasty in rotator cuff repair under shoulder arthroscope

Objective: To compare the clinical effect of modified anterolateral and traditional acromioplasty in arthroscopic rotator cuff repair. Methods: The clinical data of 92 patients with total rotator cuff tears admitted to the Department of Joint Surgery of Jinhua Central Hospital from January 2016 to December 2019 were retrospectively analyzed. Of the patients, 42 were male, 50 were female, with a mean age of (57.1±13.2) years. Among them, 42 patients underwent traditional acromioplasty during arthroscopic rotator cuff repair (traditional group), and 50 underwent modified anterolateral acromioplasty (modified group). The preoperative and postoperative shoulder function of the patients in the two groups were evaluated and compared by using the University of California Los Angeles (UCLA), the rating scale of the American Shoulder and Elbow Surgeons (ASES), and the constant Murley shoulder score scale. And the preoperative and postoperative pain of patients was evaluated with visual analog scale (VAS). The incidence of rotator cuff retears 12 months after operation was counted. Results: There was no statistically significant differences in general information such as gender, age, affected side and course of disease between the two groups before the surgery (all P<0.05). All patients were followed up for (12.9±1.1) months. There was no significant differences in the UCLA score (31.4±3.0 vs 32.0±2.5), ASES score (13.1±0.7 vs 13.3±0.6), Constant Murley shoulder score (92.1±6.6 vs 94.3±4.6) and VAS score (1.5±0.8 vs 1.2±1.1) between the traditional group and the modified group 12 months after the operation (all P>0.05). The preoperative CSA (36.0°±1.7°) in the traditional group did not differ significantly from that at 12 months postoperatively (35.5°±1.2°) (P=0.270); the postoperative CSA at 12 months (30.8°±2.5°) in the modified group was significantly smaller than that before the operation (36.5°±1.9°), and also was smaller than that in the traditional group 12 months after the operation (35.5°±1.2°) (both P<0.05). At 12 months after operation, the rate of rotator cuff tears in the traditional group and modified group was 16.7% (7/42) and 4.0% (2/50), respectively (P=0.045). Conclusions: Traditional and modified anterolateral acromioplasty in treating total rotator cuff tears using arthroscopic rotator cuff repair can significantly improve shoulder joint function. However, modified anterolateral acromioplasty significantly reduces the CSA value and decreases the incidence of rotator cuff re-tears.

Rotator cuff repair: Sleep disturbance significantly improves after arthroscopic tendon repair.

The aim of this study was to quantify sleep quality and define its evolution in patients treated for rotator cuff tears (RCTs) with arthroscopic rotator cuff repair (ARCR) and to understand its correlation with patients' depression and anxiety. The patients were part of the 'ARCR_Pred cohort study', a prospective multicentre cohort of ARCR patients. adult, RCT diagnosed by magnetic resonance imaging, treated by primary ARCR. irreparable tears, revision operations, open or mini-open reconstructions, pregnancy. Subjective sleep quality (prevalence and level of disturbance) was analysed. Psychological characteristics (PROMIS Sf questionnaire) and functional outcomes (Constant and Murley Score and Oxford Shoulder Score) were investigated. A gender-based analysis was performed as well. Patients were evaluated before the operation and prospectively at 6 and 12 months. Of the 973 patients, 611 (62.8%) were men, with the mean age being 57.3 ± 9.4 years (range, 21-84). A high prevalence of sleep disturbances was found before ARCR (88.4%), with 59% of the patients complaining of disturbance every night. Sleep disturbances progressively improved at 6 (37.2%) and 12 months (22.0%). Also, nocturnal pain (frequency of night disturbed by pain) progressively improved from 94.3% to 62.4% and then 37.9%. For depression and anxiety, a statistically significant difference (p < 0.05) was retrieved among every group (undisturbed, occasionallyand always disturbed) at all follow-ups. On the other hand, the post-op improvement led to a decrease in anxiety and depression levels passing from 50.1 and 51.4 points at baseline to 45.0 and 45.4 at 12 months, respectively. Women had statistically worse sleep quality at 6 and 12 months (41% vs. 36% and 27% vs. 19%, respectively) (p < 0.05). RCTs cause a high prevalence of sleep disturbance and nocturnal pain, which progressively resolves after an arthroscopic tendon repair. Women have a higher risk than men of presenting disturbed sleep quality. Level III, prognostic cohort study.

Acromioclavicular joint dislocation with loop double endobutton fixation assisted by orthopaedic surgery robot positioning system

ObjectiveAcute acromioclavicular (AC) joint dislocation is a common orthopedic injury that can significantly impair shoulder function and reduce quality of life. Effective treatment methods are essential to restore function and alleviate pain. To investigate the short-term clinical efficacy of the minimally invasive closed-loop double endobutton fixation assisted by orthopaedic surgery robot positioning system (TiRobot) in the treatment of AC joint dislocation, and to evaluate its feasibility and safety.MethodsThe clinical data of 19 patients with AC joint dislocation who underwent treatment with closed-loop double Endobutton fixation assisted by TiRobot between May 2020 and December 2022 were retrospectively analyzed. Visual Analog Scale (VAS) pain scores, the Constant Murley Score (CMS), and shoulder abduction range of motion were assessed and compared preoperatively and at the last follow-up. Computed tomography (CT) parameters of the acromioclavicular joint, including acromioclavicular distance (ACD), the distance between the upper and lower Endobutton (DED), the horizontal distance between the anterior edge of the distal clavicle and the anterior edge of the acromion (DACC), the diameter of the clavicular tunnel (DCT), and coracoid tunnel diameter (DC), were compared at 2 days, and 1 month after surgery, as well as at the last follow-up, along with the evaluation of intraoperative and postoperative complications.ResultsThe postoperative VAS, CMS, and shoulder-abduction range of motion were significantly improved compared with the preoperative (all, P<0.05). The statistical analysis showed no significant difference in the CT image parameters of the acromioclavicular joint at 2 days and 1 month after surgery(all, P>0.05). Comparisons of DCT and DC revealed statistically significant differences between the last follow-up and 1 month after surgery (P<0.05), and no statistically significant difference was found in ACD, DED, and DACC(all, P>0.05). There were no complications such as infection or vascular or neurological damage, no cases of rostral or clavicle fractures, loss of reduction, heterotopic ossification, shoulder stiffness, and no loosening or breaking of internal fixations.ConclusionClosed-loop double endobutton internal fixation assisted by TiRobot is an ideal method for the treatment of acute acromioclavicular (AC) joint dislocation. This method has the advantages of relatively simple operation, more accurate localization of bone tunnel during operation, less surgical trauma, and good recovery of shoulder function.

Effect of electroacupuncture combined with rehabilitation techniques on shoulder function in patients with rotator cuff injuries.

The rotator cuff is located below the acromion and deltoid muscles and comprises multiple tendons that wrap around the humeral head, maintaining shoulder joint stability. To explore the effect of electroacupuncture combined with rehabilitation techniques on shoulder function in patients with rotator cuff injuries. We selected 97 patients with rotator cuff injuries treated in the People's Hospital of Yuhuan from February 2020 to May 2023. Patients were grouped using the envelope method. After treatment, the study group's treatment effective rate was 94.90% (46/49 patients), significantly higher than that in the control group (79.17%, 38/48 cases; P < 0.05). Before treatment, there was no difference in Constant Murley Score (CMS) scores, shoulder mobility, or 36-Item Short Form Health Survey (SF-36) scale scores (P > 0.05). Compared with those before treatment, the CMS scores (including pain, daily living ability, shoulder mobility, and muscle strength), all aspects of shoulder mobility (forward flexion, posterior extension, external rotation, internal rotation), and SF-36 scale scores (including physiological, psychological, emotional, physical, vitality, and health status) were higher in both groups after treatment and significantly higher in the study group (P < 0.05). There was no difference in the occurrence of complications between the two treatment groups (P > 0.05). Electroacupuncture combined with rehabilitation techniques has a good treatment effect on patients with rotator cuff injuries, helps accelerate the recovery of shoulder function, improves the quality of life, and is highly safe.

A comparative study of functional outcome of percutaneous kirschner wire fixation versus philos plating of proximal humerus fractures

: Proximal humerus fractures, accounting for approximately 5% of all fractures, pose a significant challenge in orthopedic management due to their complex anatomy and diverse fracture patterns. Treatment options range from conservative methods to various surgical interventions, each with its pros and cons. This study specifically compares two commonly employed surgical techniques: Open reduction &amp; internal fixation with PHILOS plate and percutaneous k-wire fixation with/without external clamps. This study aims to address the effectiveness of each technique by evaluating functional outcomes using validated scoring systems like the Constant-Murley Score. To assess the functional outcomes of two surgical treatment methods (K-wire application and PHILOS plate fixation) for proximal humerus fractures. : A randomized prospective study was conducted on patients coming to the Orthopaedics outpatient department or casualty of tertiary care hospital for a duration of 1 year from Dec 2022 to Nov 2023. A total of 18 patients were included in the study. The mean Constant- Murley Score (CMS) was 81 +/- 6.13 for the PHILOS plating group and 76.88 +/- 7.37 for the K-wire treated group with a p-value of 0.08. The results for CMS were excellent in 22.2% of patients and good in 66.7% of patients in PHILOS treated group and excellent for 11.11%, good for 66.67% and satisfactory for 22.2% in the K-wire treated group. Both groups achieved satisfactory functional outcomes with CM Score at the final follow-up. Both techniques achieved favorable outcomes, with a majority of patients in both groups (88.89% for PHILOS and 77.78% for K-wire) achieving good to excellent results based on the CMS scores.

The efficacy of myofascial release at the cervicothoracic region in patients with rotator cuff repairs: A randomized controlled pilot study

BackgroundCoactivation between tonic and phasic muscles is essential for correct posture and movement. Impaired movement patterns and postural changes facilitate the flexor response to protect painful tissue in the injured area. Tone changes between tonic and phasic muscles lead to an imbalance in the rotator cuff (RC) muscles. DesignA randomized controlled pilot study. PurposeThe purpose of this study is to determine the effects of applying myofascial release (MFR) to the muscles in the cervicothoracic region for the treatment of fascia limitations in patients with postoperative RC tear. Materials and methodsA total of 20 patients were randomly divided into 2 groups. The patients in the control group performed exercises, whereas those in the MFR group performed exercises in addition to MFR. Pain intensity, grip strength, pectoralis minor flexibility, Constant Murley Score (CMS), and Short Form-36 (SF-36) score were evaluated. Pain intensity was recorded before and after the MFR sessions. ResultsThere were no significant differences between the groups regarding pain, grip strength, pectoralis minor flexibility, CMS values, or SF-36 score (p > 0.05). There were significant differences in pain levels measured before and after all MFR sessions. Moreover, a significant decrease is shown between the first and last sessions in the MFR group (p < 0.05). ConclusionMFR can be useful, especially in postoperative RC patients who have pain in the early period. Significant reductions in pain intensity after MFR can help prepare patients for exercise and reduce pain-related medication use.

Comparative clinical outcomes and radiological images of clavicle hook plate versus Scorpion Plate® for unstable distal clavicle fractures

BackgroundAlthough various surgical methods are available for unstable distal clavicle fractures, consensus remains lacking on the optimal technique. Therefore, the present retrospective study aimed to compare the clavicle hook plate and Scorpion Plate® in terms of clinical outcomes and radiological findings for unstable distal clavicle fractures. MethodsFifty-seven patients with unstable distal clavicle fractures who underwent treatment using a clavicle hook plate (Group H; 28 patients) or Scorpion Plate® (Group S; 29 patients) were included in the present study. No patients received additional augmentation and all were followed-up for >1 year (mean follow-up, 28 months). Clinical outcomes were operation time, bleeding volume, complications, range of motion (ROM) at 6 months after surgery and final follow-up, and clinical scores (Constant–Murley score and University of California, Los Angeles (UCLA) shoulder score). Radiological outcomes assessed were coracoclavicular distance (CCD), difference in CCD between affected and non-affected sides (ΔCCD), and acromioclavicular subluxation ratio (%ACS) from plain X-rays. The χ2 test and Mann–Whitney U test were used to compare each outcome. ResultsComplications were seen in 3 shoulders (10.7%) in Group H. ROM was significantly worse in Group H at 6 months postoperatively, but no significant differences between groups were evident at final follow-up. Moreover, no significant differences in clinical outcomes were seen between groups. In terms of radiological results, Group H showed greater improvement in CCD and ΔCCD than Group S. Further, %ACS was significantly worse in Group S. ConclusionsThe clavicle hook plate allows reconstruction of a more anatomical position than the Scorpion Plate®, but carries a greater risk of complications. Conversely, the Scorpion Plate® has a low risk of complications, but acromioclavicular subluxation remains. However, no significant differences in ROM or clinical outcomes were apparent at final follow-up.

Predictive Prognostic Factors in Non-Calcific Supraspinatus Tendinopathy Treated with Focused Extracorporeal Shock Wave Therapy: An Artificial Neural Network Approach.

The supraspinatus tendon is one of the most involved tendons in the development of shoulder pain. Extracorporeal shockwave therapy (ESWT) has been recognized as a valid and safe treatment. Sometimes the symptoms cannot be relieved, or a relapse develops, affecting the patient's quality of life. Therefore, a prediction protocol could be a powerful tool aiding our clinical decisions. An artificial neural network was run, in particular a multilayer perceptron model incorporating input information such as the VAS and Constant-Murley score, administered at T0 and at T1 after six months. It showed a model sensitivity of 80.7%, and the area under the ROC curve was 0.701, which demonstrates good discrimination. The aim of our study was to identify predictive factors for minimal clinically successful therapy (MCST), defined as a reduction of ≥40% in VAS score at T1 following ESWT for chronic non-calcific supraspinatus tendinopathy (SNCCT). From the male gender, we expect greater and more frequent clinical success. The more severe the patient's initial condition, the greater the possibility that clinical success will decrease. The Constant and Murley score, Roles and Maudsley score, and VAS are not just evaluation tools to verify an improvement; they are also prognostic factors to be taken into consideration in the assessment of achieving clinical success. Due to the lower clinical improvement observed in older patients and those with worse clinical and functional scales, it would be preferable to also provide these patients with the possibility of combined treatments. The ANN predictive model is reasonable and accurate in studying the influence of prognostic factors and achieving clinical success in patients with chronic non-calcific tendinopathy of the supraspinatus treated with ESWT.

Preoperative handgrip strength can predict early postoperative shoulder function in patients undergoing arthroscopic rotator cuff repair

BackgroundRotator cuff tears (RCTs) are a common musculoskeletal disorder, and arthroscopic rotator cuff repair (ARCR) is widely performed for tendon repair. Handgrip strength correlates with rotator cuff function; however, whether preoperative grip strength can predict functional outcomes in patients undergoing ARCR remains unknown. This study aimed to investigate the correlation between preoperative grip strength and postoperative shoulder function following ARCR.MethodsA total of 52 patients with full-thickness repairable RCTs were prospectively enrolled. Baseline parameters, namely patient characteristics and intraoperative findings, were included for analysis. Postoperative shoulder functional outcomes were assessed using the Quick Disabilities of the Arm, Shoulder, and Hand (QDASH) questionnaire and Constant–Murley scores (CMSs). Patients were followed up and evaluated at three and six months after ARCR. The effects of baseline parameters on postoperative outcomes were measured using generalized estimating equations.ResultsAt three and six months postoperatively, all clinical outcomes evaluated exhibited significant improvement from baseline following ARCR. Within 6 months postoperatively, higher preoperative grip strength was significantly correlated with higher CMSs (β = 0.470, p = 0.022), whereas increased numbers of total suture anchors were significantly correlated with decreased CMSs (β = − 4.361, p = 0.03). Higher body mass index was significantly correlated with higher postoperative QDASH scores (β = 1.561, p = 0.03) during follow-up.ConclusionsHigher baseline grip strength predicts more favorable postoperative shoulder function following ARCR. A preoperative grip strength test in orthopedic clinics may serve as a predictor for postoperative shoulder functional recovery in patients undergoing ARCR.

Open reduction and internal fixation versus minimally invasive plate osteosynthesis of unstable proximal humerus fractures treated with locking plate and intramedullary allograft: A retrospective study

Background This retrospective clinical study aims to compare the functional and radiological outcomes after open reduction and internal fixation versus minimally invasive plate osteosynthesis of unstable proximal humerus fractures treated with both locking plate and intramedullary graft. Methods Forty-seven patients with proximal humerus fractures were treated with either open reduction and internal fixation (25 cases) or minimally invasive plate osteosynthesis (22 cases) and evaluated retrospectively with a minimum follow-up of 12 months. Thirty-one fresh-frozen fibulae and 16 lyophilized tibia allografts were used for augmentation. Change of both neck-shaft angle and humeral head height were evaluated radiologically. Functional outcomes were assessed using Disabilities of the Arm, Shoulder and Hand Score (DASH), Absolute Constant–Murley Score (CSabs), Relative Constant–Murley Score (CSrel), and Individual Relative Constant–Murley Score (CSindiv). Results Follow-up period and age for open reduction and internal fixation/minimally invasive plate osteosynthesis were 27.4 ± 16.2/29.6 ± 17.6 months and 60.5 ± 13.7/66.3 ± 11.7 years. CSabs, CSrel, and CSindiv were 57.3 ± 21.2/52.4 ± 18.9, 73 ± 24.1/73.9 ± 23.4, and 69.6 ± 24.8/64 ± 25.5 for open reduction and internal fixation/minimally invasive plate osteosynthesis, p ≥ 0.409. DASH was 14.8 ± 12.5/18.7 ± 14.5 for open reduction and internal fixation/minimally invasive plate osteosynthesis, p = 0.324. Decrease of neck-shaft angle and humeral head height was 7.8 ± 9.4/8.2 ± 15.6° and 0.6 ± 5.5/1.4 ± 2.6 mm for open reduction and internal fixation/minimally invasive plate osteosynthesis, p ≥ 0.380. Surgical time was 165.8 ± 77.6/84.7 ± 38.1 min for open reduction and internal fixation/minimally invasive plate osteosynthesis, p &lt; 0.001. Conclusions Locked plating with intramedullary graft augmentation of unstable proximal humerus fractures demonstrates similar functional and radiological outcomes when comparing open reduction and internal fixation with minimally invasive plate osteosynthesis. However, minimally invasive plate osteosynthesis is related to significantly shorter surgical time versus open reduction and internal fixation.