Subjective Shoulder Value Scores Research Articles

Short-stem uncemented anatomical shoulder replacement for osteoarthritis in patients older than 70 years: is it appropriate?

BackgroundDespite a new trend to systematically use reverse shoulder arthroplasty (RSA) in elderly population regardless of the indication, total anatomical shoulder arthroplasty can get good functional results in this population. The purpose of this study was to evaluate clinical and radiological outcomes of uncemented short-stem anatomic total shoulder arthroplasty (TSA) for primary glenohumeral osteoarthritis in patients older than 70 years and to compare these results to a matched population with an uncemented short-stem RSA.MethodsIn this retrospective monocentric study, clinical outcomes were based on constant score (Cst), subjective shoulder value (SSV) score, and range of motion. The aim of radiographic analysis was to identify glenoid component loosening and humeral bone remodeling around the uncemented short stem.ResultsAt an average follow-up of 44 ± 12.5 months, 32 uncemented short-stem TSA in 31 patients with a minimum of 2 years of follow-up were included and were compared to 32 uncemented RSA. Fifty three percent of the patients had “a forgotten prosthesis”. ROM was significantly improved in all cases. Cst reached 73 ± 9 pts and SSV 90 ± 10.8% (P < .001). In 8 patients with repairable supraspinatus tendon tears, clinical outcomes were not statistically different from patients with an intact rotator cuff: Cst (77 ± 6.2 points vs 72 ± 9.6 points, P = .3) and SSV (88 ± 11.5% vs. 91 ± 10.5%; P = .59). The type of glenoid wear (A vs B) did not influence the constant score: 73 ± 9 points versus 74 ± 11 points respectively; P = .81. Despite a complication rate of 6% (n = 2), no prosthesis revision was performed. At last follow-up, range of motion was better in the TSA group compared to the RSA group for internal (7.8 ± 1.3 vs 6.25 ± 2; P = .001) and external (47 ± 14 vs 24 ± 21; P < .001) rotations. The postoperative SSV score was also better in the TSA group (91.3 ± 10% vs 82.2 ± 13%; P = .002).ConclusionsAt medium-term, uncemented short-stem anatomic TSA in patients older than 70 years provided satisfactory clinical results. Patients have forgotten their prosthesis in over 50% of cases. This prosthetic design is still indicated in this patient population in case of primary osteoarthritis with a functional rotator cuff with an almost normal rotator cuff muscle trophicity.

Results after Revision Arthroscopic Rotator Cuff Repair: A Prospective Multi-Center Analysis

Primary arthroscopic rotator cuff repair has shown to provide reliable clinical results with a low re-tear rate. Rotator cuff re-tears following surgical repair are associated with poor shoulder function and unsatisfactory clinical results. Data regarding the role of revision arthroscopic rotator cuff repair (RARCR) are sparse. Hence, this study aimed to investigate the clinical and radiological results following RARCR. It was hypothesized that (1) RARCR would lead to an improved clinical outcome and that (2) the clinical results would be dependent on tendon integrity at two years. During a 3-year period, 100 patients who underwent RARCR were prospectively enrolled in this multi-center study of ten European shoulder centers. Clinical results were evaluated pre-operatively, at six months and at two years by the Constant Score (CS), the Oxford Shoulder Score (OSS) and the Subjective Shoulder Value (SSV). Tendon integrity was analyzed by MRI at two years using the Sugaya classification. 13 patients (13%) were lost to follow-up. All clinical scores improved significantly during the study period (CS from 44±16 preoperatively to 58±22 at six months to 69±19 points at two years; OSS from 27±8 preoperatively to 36±11 at six months to 40±9 points at two years; SSV from 43±18% preoperatively to 66±24% at six months to 75±22% at two years; p < .01). At two years, a re-tear rate of 51.7% and a surgical revision rate of 12.6% were observed. While the Sugaya score improved from 4.5±0.9 preoperatively to 3.7±1.4 at two years, tendon integrity could not be correlated with better outcome scores. Prior open rotator cuff repair, involvement of the subscapularis tendon and medial cuff failure were correlated with poorer SSV scores at two years (p < .05). While RARCR leads to an improved clinical outcome, re-tears are frequently observed at a mid-term follow-up. Patients with re-tears, however, do not necessarily have poorer shoulder function than those with healed tendons. Patient satisfaction was lower when the primary surgery was performed by an open technique, when an associated lesion of the subscapularis was present and when the rotator cuff re-tear was located at the musculotendinous junction.

Outcomes of the Star Repair for Large and Massive Rotator Cuff Tears: A Modified Triple-Row Technique.

Background:Large and massive rotator cuff repairs constitute a true challenge for arthroscopic shoulder surgeons. Retear rates as high as 20% have been reported after arthroscopic double-row and suture-bridge techniques used for these tears.Hypothesis:A modified triple-row repair will provide satisfactory clinical results with lower risk for retear.Study Design:Case series; Level of evidence, 4.Methods:Between March 2016 and August 2017, a total of 52 patients with large and massive rotator cuff tears received a modified triple-row cuff repair. A middle repositioning anchor was inserted between the medial and the lateral rows. The middle anchor sutures were loaded to lateral knotless anchors in a star-shaped configuration. Functional evaluation was performed using the American Shoulder and Elbow Surgeons score, University of California, Los Angeles score, Constant-Murley score, and Simple Shoulder Test. Subjective evaluation was carried out using a visual analog scale for pain and a subjective shoulder value score. Health-related as well as disease-specific quality-of-life scores were also used. Retear rates were assessed by means of musculoskeletal ultrasonography. Patients were evaluated for a minimum of 24 months.Results:This study included 34 female and 18 male patients with a mean age of 57.17 ± 6.7 years. There were 35 patients (67.3%) with large tears and 17 patients (32.7%) with massive tears. Significant improvement from preoperative values was seen in all functional and subjective scores (P < .001). The mean forward flexion was 163° ± 9.7°, and the mean lateral abduction was 159.4° ± 9.4°. All patients had excellent scores on the general health-related and disease-specific quality-of-life scales. No retears were reported at the end of the follow-up period.Conclusion:The star-shaped, modified triple-row cuff repair is a valid and effective solution for surgical management of large and massive rotator cuff tears, providing excellent results and low risk for retears.

Patient Satisfaction After Total Shoulder Arthroplasty.

Although patient-reported outcome measures use objective evaluations of impairment to focus on subjective responses, these measures may not necessarily reflect patient satisfaction with the outcome or the care provided. The goal of this study was to systematically review the available literature to assess patient satisfaction after total shoulder arthroplasty. Two investigators systematically reviewed the MEDLINE database for articles on satisfaction after this procedure. This study included 47 articles. The most commonly used method for assessing satisfaction was an ordinal scale (27 studies, 57.4%). Of the studies, 27 (57.5%) differentiated between patient satisfaction with the care provided and with the outcome achieved. Reported satisfaction rates after anatomic total shoulder arthroplasty ranged from 75% to 100%. For the included studies, increasing age, workers' compensation status, depression, opioid use, and visual analog scale pain score were the only preoperative factors that were significantly associated with worse postoperative satisfaction. Postoperative American Shoulder and Elbow Surgeons score, Simple Shoulder Test score, Subjective Shoulder Value score, Short Form-36 mental component score, range of motion, visual analog scale pain score, and ability to perform activities of daily living showed a significant association with postoperative satisfaction. Studies of satisfaction after total shoulder arthroplasty are of low evidence levels. Although overall patient satisfaction is high, there is no standardized method for measuring satisfaction. For the identified studies, the most common assessment method was an ordinal scale that consists of qualitative values representing increasing levels of satisfaction. Orthopedic surgeons are increasingly expected to demonstrate the value of procedures, and a uniform and validated method of assessing patient satisfaction is needed. [Orthopedics. 2020;43(6):e492-e497.].

Revision guided suture-button bone block stabilization of the shoulder in the presence of significant retained glenoid metalwork

AimPositioning and fixation of the bone block during revision anterior stabilization of the shoulder, in the presence of significant retained glenoid metalwork, can be challenging. We present the results of a series of patients who underwent a revision bone block procedure secured with double suture buttons using a drill guide system, the position of which was calculated from a preoperative computed tomography (CT) scan.Materials and methodsWe undertook a revision bone block stabilization of the shoulder, using a guided double suture-button fixation, in 10 patients with significant retained glenoid metalwork from previous procedures. A preoperative CT scan was used to determine a position for the guide to allow a safe drill trajectory that would avoid any retained metalwork. A coracoid transfer was undertaken in 4 patients and an Eden-Hybinette in 6. Patients were assessed preoperatively and at final follow-up clinically and using the Oxford Shoulder Instability Score and the Subjective Shoulder Value score. Bone block position and healing was assessed by a CT scan at 6 months. The median follow-up was 36 months (range, 24-47 months).ResultsThere were 3 female and 7 male patients with a median age of 24.5 years (17-49 years). At final follow-up, the mean Oxford Shoulder Instability Score had decreased from 25.9 (range, 21-35) to 5.8 (range, 3-14) (P < .005). The mean Subjective Shoulder Value score had risen from 87.1 (range, 10-60) to 80 (range, 60-90) (P < .05). All of the patients considered their shoulder to be stable apart from 1 patient. There had been no redislocations. The bone block positioned in the glenoid lower quadrant had healed for all of the patients on CT at 6 months.ConclusionGuided suture-button fixation of the bone block during revision anterior stabilization of the shoulder, in the presence of significant retained glenoid metalwork, provides a satisfactory outcome in terms of shoulder stability, graft position, and healing.

Shoulder Terrible Triad: Classification, Functional Results, and Prognostic Factors.

The shoulder terrible triad (STT) is a traumatic anterior shoulder dislocation, associated with rotator cuff (RC) tear and nerve injury from the brachial plexus. This study aimed to describe the functional results and prognostic factors of surgery in patients with STT. Thirty consecutive patients with acute STT were included at the same institution. All patients were examined with x-rays, MRI, and electromyography. Surgical treatment in the acute setting was indicated to address an RC injury or a displaced greater tuberosity fracture. Variables registered on the day of surgery were preoperative Constant and Western Ontario Rotator Cuff (WORC) scores and injury pattern. At final discharge, Constant, American Shoulder and Elbow Surgeons (ASES), WORC, and subjective shoulder value scores were recorded by an independent evaluator. Twenty-seven patients underwent a complete follow-up. The dominant arm was affected in 50% of cases. The mean follow-up was 27 (12 to 43) months. The mean WORC and Constant scores improved from 1,543 to 1,093 (P = 0.015) and 31 to 54 (P = 0.003), respectively. The ASES and subjective shoulder value scores at the end of the follow-up were 60 and 56 points, respectively. RC tears and nerve injuries that did not involve the axillary or suprascapular nerves were associated to better results than greater tuberosity fractures and injuries to the axillary or suprascapular nerves, respectively, in WORC (P = 0.028), Constant (P = 0.024), and ASES scores (P = 0.035). Preoperative WORC and Constant scores were independent prognostic factors. The most frequent patterns include complete RC tears, anterior capsular injuries, and an axillary nerve injury. Patients had improved functional scores at the end of follow-up after surgery. Better functional results were correlated to RC tears, injuries to nerves with innervation distal to the shoulder, and higher preoperative Constant and WORC scores.

Radiological and clinical evaluation of synthetic reinforcement in arthroscopic repair of complete degenerative rotator cuff tears

Background:Rotator cuff tear is the most common shoulder pathology in adults over 45 years of age. In most instances they are chronic and degenerative. The high rate of re- tears after primary repair has led to the use of reinforcement systems such as patches. The objective of this study was to evaluate the effectiveness of a synthetic poly-4-hydroxybutyrate (P4HB) reinforcement patch in arthroscopic repair of degenerative rotator cuff tears.Methods:sixty patients with degenerative, reducible, full thickness supraspinatus tear were repaired with an arthroscopic single-row technique with or without the BioFiber® reinforcement system (Wright medical). A clinical evaluation with measurement of active range of motion, calculation of Constant and Subjective Shoulder Value (SSV) scores and ultrasound evaluation of healing were performed one year postoperatively.Results:Thirty patients were treated with a patch and thirty others formed the control group without a patch. The postoperative adjusted Constant score was 102 % in the patch group (PG) and 101 % in the control group (CG) (P = 0.6670). The postoperative SSV score was 81% in the PG and 88% in the CG (P = 0.029). The ultrasound healing rate was better in the PG and there was no re-tear in this group (P = 0.049).Conclusion:The interposition of the P4HB BioFiber® patch does not seem to provide any added functional value despite the effectiveness in terms of healing in the repair of degenerative, reducible complete tear of the supraspinatus tendon.

Faut-il synthéser les fractures de l’épine de l’omoplate après prothèse d’épaule inversée chez le patient âgé ?

PurposeScapular spine fractures sustained after reverse shoulder arthroplasty (RSA) are debilitating for elderly patients with osteoporosis. We examined the 1-year postoperative outcomes of open reduction and internal fixation (ORIF) in a small case-series, and hypothesised that patients undergoing surgical treatment for post-RSA scapular spine fractures would improve in function and pain. MethodsFive consecutive RSA patients within our shoulder arthroplasty register who sustained a scapular spine fracture underwent ORIF using a double-plating technique. Standard radiographs and clinical/patient-rated assessments of Constant-Murley (CS), Shoulder Pain And Disability Index (SPADI), Subjective Shoulder Value (SSV) and visual analogue scale (VAS) pain were made up to 12 months post-ORIF. Patients were also asked to rate their satisfaction since the surgery. Post-ORIF complications were documented. All post-RSA data were used as a baseline measure for comparison with post-fracture outcomes. ResultsMean CS, SPADI and SSV scores as well as pain were similar to pre-fracture scores. All patients improved in function and pain, and would undergo the same procedure again. Individual cases of iatrogenic pneumothorax and screw loosening were reported. ConclusionsORIF is a viable option with adequate improvements in function and pain for elderly patients with debilitating scapular spine fractures after RSA.

Does ORIF of rare scapular spine fractures sustained after reverse shoulder arthroplasty benefit elderly patients? A case-series appraisal

PurposeScapular spine fractures sustained after reverse shoulder arthroplasty (RSA) are debilitating for elderly patients with osteoporosis. We examined the 1-year postoperative outcomes of open reduction and internal fixation (ORIF) in a small case-series, and hypothesised that patients undergoing surgical treatment for post-RSA scapular spine fractures would improve in function and pain. MethodsFive consecutive RSA patients within our shoulder arthroplasty register who sustained a scapular spine fracture underwent ORIF using a double plating technique. Standard radiographs and clinical/patient-rated assessments of Constant–Murley (CS), Shoulder Pain And Disability Index (SPADI), Subjective Shoulder Value (SSV) and visual analogue scale (VAS) pain were made up to 12months post-ORIF. Patients were also asked to rate their satisfaction since the surgery. Post-ORIF complications were documented. All post-RSA data were used as a baseline measure for comparison with post-fracture outcomes. ResultsMean CS, SPADI and SSV scores as well as pain were similar to pre-fracture scores. All patients improved in function and pain, and would undergo the same procedure again. Individual cases of iatrogenic pneumothorax and screw loosening were reported. ConclusionsORIF is a viable option with adequate improvements in function and pain for elderly patients with debilitating scapular spine fractures after RSA.

Patient Outcomes After Revision of Anatomic Total Shoulder Arthroplasty to Reverse Shoulder Arthroplasty for Rotator Cuff Failure or Component Loosening: A Matched Cohort Study.

To compare outcomes after conversion of anatomic total shoulder arthroplasty (aTSA) to reverse total shoulder arthroplasty (RTSA) and a matched cohort. Patients converted from aTSA to RTSA for rotator cuff failure or component loosening and a primary RTSA matched cohort were retrospectively identified from a prospective database. Demographics and preoperative and postoperative outcomes were obtained and compared. Age, sex, body mass index, follow-up length, and preoperative function were similar between revision (n = 35) and primary (n = 70) groups. At final follow-up, visual analog scale pain (2.4 ± 2.8 versus 1.7 ± 2.8; P = 0.24) and American Shoulder and Elbow Surgeons (68 ± 26 versus 76 ± 24; P = 0.14) scores were similar. The revision group had worse subjective shoulder value scores (63 ± 30 versus 79 ± 21; P = 0.002), satisfaction (74% versus 90%; P = 0.03), and more complications (31% versus 13%; P = 0.02). Revision of aTSA to RTSA for component loosening or rotator cuff failure results in function comparable to primary RTSA; however, more complications, worse subjective shoulder value scores, and lower patient satisfaction should be expected. Level III, retrospective comparative.

Rate of Improvement in Outcomes Measures After Reverse Total Shoulder Arthroplasty: A Longitudinal Study With 2-Year Follow-up

BackgroundFew studies report rate of improvement following reverse total shoulder arthroplasty (RTSA) in a single cohort. The purpose of this study was to compare functional scores following RTSA across postoperative time points in patients who have follow-up scores available at all selected time points.MethodsA prospective database was retrospectively queried for patients with functional outcome data from preoperatively and after RTSA at 3 to 6 months, 1 year, and 2 years, excluding any patients with data missing at these points. All patients included had measures from every time point. Collected outcomes included American Shoulder and Elbow Surgeons (ASES), visual analog scale pain, subjective shoulder value (SSV), and range of motion.ResultsOutcomes from 173 shoulders were analyzed. Average age was 68 ± 9 years, 68% were females, and 15% were revision cases. The average preoperative ASES score (33 ± 17) improved to 73 ± 18 at 3 to 6 months, 80 ± 19 at 1 year, and 81 ± 19 at 2 years after RTSA. Only outcomes at 1 and 2 years were not significantly different ( P = 1.0). SSV scores and forward elevation followed this pattern, with large improvements in the first 3 to 6 months, then reaching a plateau at 1 year. External and internal rotations did not improve by 3 to 6 months, but did significantly improve by 1 year, and remained stable through 2 years. Pain scores improved from 6.8 points before surgery to roughly 1.3 points at all subsequent time points.ConclusionsPatients undergoing RTSA can expect significant reductions in pain and the majority of their functional gains to occur in the first 6 months after surgery. At 12 months after RTSA, the average patient will achieve maximal improvement.

Three- and four-part displaced proximal humeral fractures in patients older than 70 years: reverse shoulder arthroplasty or nonsurgical treatment?

The objective of our study was to evaluate the results of surgical treatment by reverse shoulder arthroplasty (RSA) compared with nonsurgical treatment after 2 years of follow-up in patients aged 70 years or older with displaced 3-part or 4-part proximal humeral fractures. Two groups were formed: the RSA group (n = 28) and the nonsurgical group (n = 32). Minimum follow-up was 2 years. We included patients with 3-part or 4-part fractures according to the Neer classification. Main outcome measures were the Constant-Murley score, the 11-item version of the Disabilities of the Arm, Shoulder and Hand score, and the Subjective Shoulder Value score. An autonomy score, a cognitive assessment score, and a pain score were also measured. Clinical features in the 2 groups were not significantly different. The Constant-Murley mean score was significantly higher for the RSA group (82.1% vs. 76.8%; P = .03). Amplitudes were all higher in favor of the RSA group (P < .02). There was no significant difference in mean score on the 11-item version of the Disabilities of the Arm, Shoulder and Hand score, the preoperative and postoperative Subjective Shoulder Value score, the autonomy score, the cognitive assessment score, or the pain score in both groups at the last follow-up. The complication rate was higher for the RSA group. These results suggest that RSA treatment of proximal humeral fractures with 3-part or 4-part displaced fragments in elderly patients provides better functional outcomes than does nonsurgical treatment. However, the observed clinical difference was relatively small. This solution must be proposed only to patients who have a significant functional demand.

Arthroscopy-assisted Treatment of Displaced Distal Clavicle Fractures Utilizing Curved Buttons and Suture Tape With a Single Coracoclavicular Tunnel.

Distal third clavicle fractures are associated with high rates of nonunion. Acceptable healing rates have been reported; however, complications and the need for additional procedures are a concern. The purpose of this study was to evaluate the functional outcomes and healing rates of an arthroscopy-assisted technique for fixation of unstable distal third clavicle fractures. Seven patients presenting to a single surgeon with displaced distal clavicle fractures were included. A curved suspensory button and suture tape construct with a single coracoclavicular tunnel was used. Visual Analog Scale, American Shoulder and Elbow Surgeons scores, Simple Shoulder Test, and Subjective Shoulder Value scores were analyzed preoperatively and at final follow-up. Radiographic evidence of union, maintenance of reduction and complications were recorded. All patients were available for 1-year follow-up. Mean Visual Analog Scale pain score improved from 6.1±1.1 to 1.1±1.0 (P=0.022). American Shoulder and Elbow Surgeons scores increased from 40.3±17.2 to 86.7±13.7 (P≤0.001). The mean Simple Shoulder Test score increased from 2.7±1.1 to 11.0±1.8 (P≤0.001). The Subjective Shoulder Value improved from 41.6±19.1 to 91.4±7.6 (P=0.210). Fracture united in 6 of 7 patients and reduction was maintained in all patients. Six patients were satisfied and returned to previous activity level. Arthroscopy-assisted fixation of unstable displaced distal clavicle fractures demonstrates improved functional outcomes and high patient satisfaction. This construct avoids many of the previously reported complications associated with other methods of fixation, while minimizing the amount of soft tissue dissection.

Open reduction and internal fixation with plating is beneficial in the early recovery stage for displaced midshaft clavicular fractures in patients aged 30-65 years old.

Objectives:Midshaft clavicular fractures are increasingly treated operatively rather than nonoperatively. Studies have shown mixed results for both types of treatment. The aim of this study was to compare the early-stage functional status associated with open reduction and internal fixation (ORIF) with plating and that associated with conservative treatment for displaced midshaft clavicular fractures.Materials and Methods:A single-center retrospective review of the results of 120 cases of displaced midshaft clavicular fractures in patients aged 30–65 years old was conducted. The primary outcome was fracture union status at 6 months. Other outcomes were subjective shoulder value (SSV) scores, visual analog scale (VAS) scores, and radiographic shortening at 6 weeks, 3 months, and 6 months. The complication rates in the operative and nonoperative groups were recorded.Results:The delayed union rate at 6-month postoperatively and VAS scores at 6 weeks, 3 months, and 6 months postinjury were significantly higher in the conservative treatment group than in the ORIF group. SSV scores were significantly improved at 6-month postinjury in the ORIF group.Conclusions:This is the first study to discuss the importance of early-stage functional restoration after ORIF with plating for displaced midshaft clavicular fractures. This surgery leads to lower pain complications in the earlier stages of bone healing and lower delayed union rates compared with conservative treatment, in patients aged 30–65 years old.

Preliminary Results of Arthroscopic Superior Capsule Reconstruction with Dermal Allograft

The purpose of this study was to evaluate the short-term outcomes of arthroscopic superior capsule reconstruction (SCR) with dermal allograft for the treatment of irreparable massive rotator cuff tears (MRCTs). A multicenter study was performed on patients undergoing arthroscopic SCR for irreparable MRCTs. The minimum follow-up was 1year. Range of motion and functional outcome according to visual analog scale (VAS) pain, American Shoulder and Elbow Surgeons (ASES) score, and subjective shoulder value (SSV) score were assessed preoperatively and at final follow-up. Radiographs were used to evaluate the acromiohumeral interval (AHI). Fifty-nine patients with a mean age of 62.0years had a minimum follow-up of 1year. Twenty-five patients (42.4%) had a prior rotator cuff repair. Forward flexion improved from 130° preoperative to 158° postoperative, and external rotation improved from 36° to 45°, respectively (P < .001). Compared with preoperative values, the VAS decreased from 5.8 to 1.7, the ASES score improved from 43.6 to 77.5, and the SSV score improved from 35.0 to 76.3 (P < .001). The AHI was 6.6mm at baseline and improved to 7.6mm at 2weeks postoperatively but decreased to 6.7mm at final follow-up. Based on postoperative magnetic resonance imaging, 45% (9 of 20) of the grafts demonstrated complete healing. Forty-six (74.6%) cases were considered a success. Eleven patients (18.6%) underwent a revision procedure including 7 reverse shoulder arthroplasties. Arthroscopic SCR using dermal allograft provides a successful outcome in approximately 70% of cases in an initial experience. The preliminary results are encouraging in this difficult to manage patient population, but precise indications are important and graft healing is low in our initial experience. Level IV, case series.

Natural history of medial clavicle fractures

BackgroundFractures of the medial third of the clavicle comprise less than 3% of all clavicle fractures. The natural history and optimal management of these rare injuries are unknown. The aim of our study is to describe the demographics, management and outcomes of patients with medial clavicle fractures treated at a Level 1 Trauma Centre. MethodsA retrospective review was conducted of patients presenting to our institution between January 2008 and March 2013 with a medial third clavicle fracture. Clinical and radiographic data were recorded including mechanism of injury, fracture pattern and displacement, associated injuries, management and complications. Functional outcomes were assessed using the Glasgow Outcome Scale Extended (GOS-E) scores from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR). Shoulder outcomes were assessed using two patient reported outcomes scores, the American Shoulder and Elbow Society Score (ASES) and the Subjective Shoulder Value (SSV). ResultsSixty eight medial clavicle fractures in 68 patients were evaluated. The majority of patients were male (n=53), with a median age of 53.5 years (interquartile range (IQR) 37.5–74.5 years). The most common mechanism of injury was motor vehicle accident (n=28). The in-hospital mortality rate was 4.4%.The fracture pattern was almost equally distributed between extra articular (n=35) and intra-articular (n=33). Fifty-five fractures (80.9%) had minimal or no displacement. Associated injuries were predominantly thoracic (n=31). All fractures were initially managed non-operatively, with a broad arm sling.Delayed operative fixation was performed for painful atrophic delayed union in two patients (2.9%). Both patients were under 65 years of age and had a severely displaced fracture of the medial clavicle. One intra-operative vascular complication was seen, with no adverse long-term outcome.Follow-up was obtained in 85.0% of the surviving cohort at an average of three years post injury (range 1–6 years). The mean ASES score was 80.3 (SD 24.8, range 10–100,), and the mean SSV score was 77.0 (SD 24.6, range 10–100). ConclusionSixty eight patients with medial clavicle fractures were identified over a 5year period, with excellent functional results seen following conservative management.

Intervention de Latarjet à ciel ouvert pour échec de Bankart Arthroscopique

IntroductionThis retrospective study assessed the functional results of open Latarjet operation for recurrence of instability after arthroscopic Bankart repair in a consecutive series of patients. Patients and methodsFifty-two patients (mean age 28.4 [range 17–62] years, 45 men) were operated on using open Latarjet operation after one (n=46) or two (n=6) failed arthroscopic Bankart repairs. The indication for revision surgery was recurrent dislocation or subluxation. Fifty patients had a Hill-Sachs lesion and 32 patients had glenoid bone lesions on plain radiographs. No attempt was made to grade the severity of bony pathology. Functional outcome and stability of 49 shoulders were assessed after an average follow-up of 38 (range 24–85) months using Western Ontario Shoulder Instability (WOSI) score, Oxford shoulder instability score, and subjective shoulder value (SSV). ResultsForty-two patients had a stable shoulder at follow-up. Seven of 49 (14%) had symptoms of instability; one patient had recurrent dislocation, and six patients had subluxations. Mean WOSI, Oxford, and SSV scores were 83.9, 19.9, and 84.9, respectively. All scores were significantly better in patients who had a stable shoulder compared with those who had an unstable shoulder (WOSI 86.8 vs. 64.3; Oxford 18.2 vs. 30.8; and SSV 88.3 vs. 61.7; P<0.01). One patient needed a reoperation. There were no intraoperative or postoperative complications. ConclusionsOpen Latarjet operation is a good option for failed arthroscopic Bankart repair. The instability recurrence rate is acceptable and the reoperation rate was low. Level of evidenceLevel IV, retrospective case series.

Open Latarjet procedure for failed arthroscopic Bankart repair

IntroductionThis retrospective study assessed the functional results of open Latarjet operation for recurrence of instability after arthroscopic Bankart repair in a consecutive series of patients. Materials and methodsFifty two patients (mean age 28.4 [range 17–62] years, 45 men) were operated on using open Latarjet operation after one (n=46) or two (n=6) failed arthroscopic Bankart repairs. The indication for revision surgery was recurrent dislocation or subluxation. Fifty patients had a Hill-Sachs lesion and 32 patients had glenoid bone lesions on plain radiographs. No attempt was made to grade the severity of bony pathology. Functional outcome and stability of 49 shoulders were assessed after an average follow-up of 38 (range 24–85) months using Western Ontario Shoulder Instability (WOSI) score, Oxford shoulder instability score, and subjective shoulder value (SSV). ResultsForty-two patients had a stable shoulder at follow-up. Seven of 49 (14%) had symptoms of instability; one patient had recurrent dislocation, and six patients had subluxations. Mean WOSI, Oxford, and SSV scores were 83.9, 19.9, and 84.9, respectively. All scores were significantly better in patients who had a stable shoulder compared with those who had an unstable shoulder (WOSI 86.8 vs. 64.3; Oxford 18.2 vs. 30.8; and SSV 88.3 vs. 61.7; P<0.01). One patient needed a reoperation. There were no intraoperative or postoperative complications. ConclusionsOpen Latarjet operation is a good option for failed arthroscopic Bankart repair. The instability recurrence rate is acceptable and the reoperation rate was low. Level of evidenceLevel IV, retrospective case series.

Reverse shoulder arthroplasty as salvage for failed prior arthroplasty in patients 65 years of age or younger

This study examined outcomes and complications in young patients undergoing revision reverse total shoulder arthroplasty (RTSA) for failed prior total shoulder arthroplasty or hemiarthroplasty and compared them with those of an age-matched cohort undergoing primary RTSA. RTSA as a revision for failed shoulder arthroplasty was performed on 36 patients younger than 65 years. Follow-up was available for 32 patients at an average of 55.3 months. Results were compared with those of an age-matched cohort of 37 patients (33 available for follow-up; average, 54.7 months) undergoing primary RTSA. Average age for both groups was 59.3 years. Outcomes were compared before and after revision surgery and between cohorts. Preoperative visual analog scale (VAS) for pain and subjective shoulder value (SSV) scores were similar in both groups, 7.3 of 10 and 24%, respectively, before revision, and 7.0 of 10 and 19% before primary RTSA (P = .3). Postrevision VAS and SSV scores improved to 1.4 of 10 and 60% (P < .0001). Average American Shoulder and Elbow Surgeons and Simple Shoulder Test scores after revision were 69.7 and 58.8, with 9 complications (28.1%; 6 major and 3 minor). VAS and SSV scores improved to 2.1 of 10 and 76% after primary RTSA (P < .0001). American Shoulder and Elbow Surgeons and Simple Shoulder Test scores after primary RTSA were 74 and 67.3, with 6 complications (18.2%; 5 major and 1 minor). Only the postoperative SSV score was statistically different in comparing primary and revision RTSA (P < .05). RTSA is effective in reducing pain and improving function after failed arthroplasty in young patients, but complication rates are high and expectations should be managed appropriately. Subjective outcome scores are worse than those for age-matched patients undergoing primary RTSA, but pain, functional scores, and complication rates are similar.

Percutaneous pinning of three- or four-part fractures of the proximal humerus in elderly patients in poor general condition: MIROS® versus traditional pinning

Elderly subjects often have fractures of the proximal humerus, which may be difficult to manage in patients in poor general condition. The MIROS is a new percutaneous pinning device allowing correction of angular displacement and stable fixation of fracture fragments. We evaluated the results of percutaneous fixation of three- or four-part fractures of the proximal humerus of patients in the American Society of Anesthesiologists physical status three or four treated either with MIROS or traditional percutaneous pinning (TPP). A total of 31 patients treated with MIROS and 27 undergoing TPP were enrolled in the study. Pre-operatively anteroposterior and transthoracic or axillary radiographs were obtained in all cases and computed tomography scans in patients with the most complex fractures. Follow-up evaluations were carried out at three, six, 12 and 16weeks, and sixmonths, oneyear and two years postoperatively, using the Constant Score (CS) and subjective shoulder value (SSV) methods. Of the 58 patients, 52 could be evaluated at all follow-ups. In both three- or four-part fractures there were significantly higher CS and SSV scores in the MIROS compared to the TPP group at all the late follow-ups. Lower rates of deep infection, pin tract infection and pin mobilisation were found in the MIROS group (p < 0.001). In both groups there was a significant association between the final result (CS) and either the type of fracture or complications (p < 0.001). The MIROS resulted in better clinical results and less complications than TPP in elderly patients. This method, however, may not be indicated for younger patients in good general condition.