Worse Function Scores Research Articles

Is a Pre-Operative MRI Anterolateral Ligament Injury Related to Anterior Cruciate Ligament Reconstruction Failure? A Prospective Cohort Study with Minimum 5 Year Follow Up

Objectives To evaluate the clinical outcomes and failure rate of ACL reconstruction in patients with and without ALL injury diagnosed by magnetic resonance imaging (MRI) at a minimum five year follow up Methods A prospective cohort of patients with acute ACL injury was divided into 2 groups based on the presence (ALL injury group) or absence (Control group) of ALL injury on preoperative MRI. Both groups underwent reconstruction of the ACL with autologous hamstrings grafts. The Lysholm and subjective International Knee Documentation Committee (IKDC) scores, KT-1000 and pivot shift tests, reconstruction failure rate, incidence of contralateral ACL injury, presence of associated meniscal injury and presence of knee hyperextension were evaluated. Results A total of 156 patients were evaluated. No significant preoperative differences were found between the groups. In the postoperative evaluation, patients in the control group had a lower reconstruction failure rate (14.3% vs 4.6%; P = .049) and better clinical outcomes according to the Lysholm scores (85.0 ± 10.3 vs 92.3 ± 6.3; P < .0001). Although the pivot shift was similar, KT-1000 revealed worse results for the ALL injury group (2.8 +/- 1.4 mm) compared to the control group (1.9 +/- 1.3 mm) (p = 0.00018). Patients in the ALL injury group also presented a worsening of the knee instability from two to five years according to the KT-1000 (2.4 +/- 1.6 vs 2.8 +/- 1.4; p=0.038). Conclusion Combined ACL and ALL injuries were associated with significantly less favorable outcomes than were isolated ACL injuries at a minimum follow-up of 5 years after ACL reconstruction. Patients with concomitant ALL injury showed a higher rerupture rate and worse functional scores. Also, knee stability tends to worsen from 2 to 5 years in cases of associated ALL injury.

Effect of Preoperative Anterolateral Ligament Injury on Outcomes After Isolated Acute ACL Reconstruction With Hamstring Graft: A Prospective Study With Minimum 5-Year Follow-up

Background: The potential influence of a preoperative anterolateral ligament (ALL) lesion seen on magnetic resonance imaging (MRI) on the mid- and long-term surgical outcomes of anterior cruciate ligament (ACL) reconstruction is still controversial. Purpose: To evaluate the clinical outcomes and failure rate of isolated ACL reconstruction at a minimum 5-year follow-up in patients with and without ALL injury diagnosed preoperatively using MRI. Study Design: Cohort study; Level of evidence, 2. Methods: A prospective cohort of patients with acute ACL injury was divided into 2 groups based on the presence (ALL injury group) or absence (control group) of ALL injury on preoperative MRI. This is a longer-term follow-up study of a previously published study that had a minimum 2-year follow-up. Both groups underwent anatomic isolated reconstruction of the ACL. The Lysholm and subjective International Knee Documentation Committee scores, KT-1000 arthrometer and pivot-shift tests, reconstruction failure rate, incidence of contralateral ACL injury, presence of associated meniscal injury, and presence of knee hyperextension were evaluated. The evaluation at the 5-year follow-up was also compared with the same patient’s evaluation at 2 years of follow-up. Results: A total of 156 patients were evaluated. No significant differences were found between the groups in the preoperative evaluation. In the postoperative evaluation, patients in the ALL injury group had a higher reconstruction failure rate (14.3% vs 4.6% for the control group; P = .049) and worse clinical outcomes according to the Lysholm scores (85.0 ± 10.3 vs 92.3 ± 6.6; P < .00001). Although the pivot-shift test results were similar, anteroposterior translation using the KT-1000 arthrometer revealed worse results for the ALL injury group (2.8 ± 1.4 mm vs 1.9 ± 1.3 mm; P = .00018). Patients in the ALL injury group also had an increase in KT-1000 arthrometer values from 2 to 5 years (2.4 ± 1.6 vs 2.8 ± 1.4; P = .038). Patients in the control group had no differences in outcomes from 2 to 5 years of follow-up. Conclusion: Combined ACL and ALL injuries were associated with significantly less favorable outcomes than were isolated ACL injuries at a minimum follow-up of 5 years after isolated ACL reconstruction with hamstring autograft. Patients with concomitant ALL injury showed a higher failure rate and worse functional scores. Also, knee stability tended to slightly worsen from 2 to 5 years in cases of associated ALL injury.

Clinical Outcomes After Definitive Treatment of Soft Tissue Sarcoma of the Hand: A Retrospective Cohort Study of 109 Patients

The purpose of this study was to provide updated data on oncologic outcomes following definitive surgical treatment of soft tissue sarcoma of the hand in a cohort of 109 patients, as well as to characterize risk factors for poor oncologic and functional outcomes. We analyzed data from 109 consecutive patients who had definitive surgical treatment for soft tissue sarcoma of the hand performed between 1996 and 2019 by a single surgeon at a sarcoma center. Primary outcomes included functional outcome (assessed by Musculoskeletal Tumor Society scores), disease-free survival (DFS), and overall survival (OS). We compiled descriptive data and used a multivariable linear model to identify factors associated with functional outcomes. Kaplan-Meier methods were used to estimate 5- and 10-year DFS and OS. Patients had a median age of 36 years at presentation. Median follow-up was 6.1 years among patients alive at the end of follow-up. The median Musculoskeletal Tumor Society score was 29; functional outcome was worse among patients with high-grade tumors or complications. Among the 107 patients who became disease-free, there were four local recurrences (one with metastasis), six distant recurrences, and one death without recurrence. All local recurrences were deep tumors (two myxofibrosarcoma and two myxoinflammatory fibrosarcoma). Estimated 5- and 10-year DFS rates were 89% (95% confidence interval [CI]: 83% to 96%) and 88% (95% CI: 80% to 95%). There were seven deaths, and the estimated 5- and 10-year OS rates were 95% (95% CI: 90% to 100%) and 92% (95% CI: 84% to 100%). Larger tumor size and higher stage at diagnosis were associated with shorter DFS and OS in univariable analyses; low event rates precluded multivariable analysis of survival. Aggressive disease-specific surgical and multidisciplinary treatment can yield long DFS and OS, and good functional outcomes. However, complications and high-grade tumors are associated with worse functional scores. Prognostic II.

Association between the upper instrumented vertebra screw angles and proximal junctional complications in patients with de novo degenerative lumbar scoliosis.

The aim of this study was to investigate the impact of upper instrumented vertebra (UIV) screw angles on proximal junctional complications in patients with de novo degenerative lumbar scoliosis (DNDLS). A total of 120 patients with DNDLS who underwent posterior long-segment instrumentation and fusion were included. Patients were divided into a proximal junctional kyphosis/failure (PJK/PJF) group and a non-PJK/PJF group. Radiographic parameters were measured, including UIV screw angle, UIV slope, UIV screw slope, fixed segmental angle (FSA), and spinopelvic parameters. Clinical and radiographic data were compared between the two groups. Multivariate logistic regression was used to analyze the independent risk factors of PJK/PJF. Receiver operating characteristic (ROC) curve analysis was used to determine the threshold value to predict PJK/PJF. Thirty-six patients (30.0%) developed PJK or PJF during follow-up. Patients in the PJK/PJF group had a larger postoperative UIV screw angle, a larger postoperative UIV screw slope, and a larger postoperative PJA. A significant increase was observed in UIV screw angle from immediately postoperative assessment to the final follow-up in two groups (p < 0.001). Multivariate logistic analysis indicated that a larger positive postoperative UIV screw angle was an independent risk factor for PJK/PJF (OR 1.546, 95% CI 1.274-1.877). ROC curve analysis indicated that a UIV screw angle ≥ 1° is more likely to develop PJK/PJF. Compared with group A patients (UIV screw angle < 1°), group B patients (UIV screw angle ≥ 1°) had a higher incidence of PJK, PJF, UIV screw loosening, and worse functional scores at the final follow-up. Avoiding insertion of cranially directed UIV pedicle screws may help prevent the development of PJK and PJF in patients with DNDLS.

Frequency of irritable bowel syndrome in spondyloarthritis: a multicentric cross-sectional study and meta-analysis

ObjectiveTo evaluate the prevalence of symptoms and factors associated with irritable bowel syndrome (IBS) in axial spondyloarthritis (ax-SpA).MethodsIn a cross-sectional multicentric study, consecutive patients with ax-SpA treated with biologics in...

Surgical treatment of the bony mallet thumb: a case series and literature review

IntroductionThe aim of this study was to provide a more precise statement on the outcome after surgical treatment of a bony mallet thumb and possibly give a treatment recommendation regarding the surgical fixation method.Patients and methodsAll patients (n = 16) who underwent a surgical treatment for an acute bony mallet thumb fracture between January 2006 and July 2019 were enrolled. The surgical method, complications, the range of motion, tip pinch, lateral key pinch, overall grip strength, visual analog score, Disability of the Arm, Shoulder and Hand Score, Mayo Wrist Score, Patient-Rated Wrist Evaluation Score, Buck-Gramcko Score and radiologic parameters were evaluated. Further, a comprehensive literature search on PubMed was conducted covering a period from 1956 to 2021 to include all possible matching articles on the treatment of the bony mallet thumb (n = 21 articles).ResultsSurgical treatment was very inhomogenous including indirect and direct K-wire fixation, screw fixation, plate fixation and anchor fixation methods. The IP joint range of motion and thumb strength ranged from 66 to 94% in comparison to the contralateral side. An open reduction led to worse functional scores compared to a closed reduction. Treatment methods in the literature were also very inhomogenous with a very low patient count, often even pooling data of bony mallet thumb fractures with bony mallet finger fractures. The risk for infection was higher in K-wire fixation methods than in open reduction and internal fixation methods.ConclusionThe evidence for the best treatment of a bony mallet thumb fracture is low. On one hand the functional outcome can be inferior using an open reduction approach, but on the other hand, K-wire fixation methods with a closed reduction approach showed a higher risk for infection. Future multi-center research must be conducted to find the best treatment procedure for the best outcome of the patient.

Outcomes After Isolated Acute Anterior Cruciate Ligament Reconstruction Are Inferior in Patients With an Associated Anterolateral Ligament Injury

Background: Isolated reconstruction of the anterior cruciate ligament (ACL) does not reestablish the normal knee biomechanics in cases of associated injuries to the anterolateral structures. Studies evaluating the potential clinical effect of anterolateral ligament (ALL) injury on the treatment of ACL injuries are necessary to validate the findings of biomechanical studies. Purpose: To evaluate the clinical outcomes and failure rate of ACL reconstruction in patients with and without ALL injury diagnosed using magnetic resonance imaging. Study Design: Cohort study; Level of evidence, 2. Methods: A prospective cohort of patients with acute ACL injury was divided into 2 groups based on the presence (ALL group) or absence (no-ALL group) of ALL injury on preoperative magnetic resonance imaging scans. Both groups underwent anatomic reconstruction of the ACL with autologous hamstring tendon grafts. The Lysholm and subjective IKDC scores (International Knee Documentation Committee), KT-1000 arthrometer and pivot-shift test results, reconstruction failure rate, incidence of contralateral ACL injury, presence of associated meniscal injury, and presence of knee hyperextension were evaluated. Results: A total of 182 patients were evaluated. Postoperative mean ± SD follow-up was 33.6 ± 7.1 and 36.1 ± 8.1 months for the ALL and no-ALL groups, respectively. No significant differences were found between the groups in terms of age, sex, knee hyperextension, duration of injury before reconstruction, follow-up time, or associated meniscal injuries. In the preoperative evaluation, the pivot-shift grade was similar, and the ALL group had worse KT-1000 arthrometer values (7.9 ± 1.2 mm vs 7.2 ± 1.1 mm; P < .001). In the postoperative evaluation, patients in the no-ALL group had a lower reconstruction failure rate (10.2% vs 1.4%; P = .029) and better clinical outcomes according to the IKDC subjective (85.5 ± 10.7 vs 89.1 ± 6.6; P = .035) and Lysholm scores (85.9 ± 10.1 vs 92.0 ± 6.3; P < .001). There was no postoperative difference in the KT-1000 or pivot-shift results. Conclusion: Combined ACL and ALL injuries were associated with significantly less favorable outcomes than were isolated ACL injuries at a minimum follow-up of 2 years after ACL reconstruction. Patients with concomitant ALL injury showed a higher rerupture rate and worse functional scores.

Health-related quality of life of long-term advanced melanoma survivors treated with anti-CTLA-4 immune checkpoint inhibition compared to matched controls

Background Checkpoint inhibitors have changed overall survival for patients with advanced melanoma. However, there is a lack of data on health-related quality of life (HRQoL) of long-term advanced melanoma survivors, years after treatment. Therefore, we evaluated HRQoL in long-term advanced melanoma survivors and compared the study outcomes with matched controls without cancer. Material and methods Ipilimumab-treated advanced melanoma survivors without evidence of disease and without subsequent systemic therapy for a minimum of two years following last administration of ipilimumab were eligible for this study. The European Organization for Research and Treatment of Cancer quality of life questionnaire Core 30 (EORTC QLQ-C30), the Multidimensional Fatigue Inventory (MFI), the Hospital Anxiety and Depression Scale (HADS), and the Functional Assessment of Cancer Therapy-Melanoma questionnaire (FACT-M) were administered. Controls were individually matched for age, gender, and educational status. Outcomes of survivors and controls were compared using generalized estimating equations, and differences were interpreted as clinically relevant according to published guidelines. Results A total of 89 survivors and 265 controls were analyzed in this study. After a median follow-up of 39 (range, 17–121) months, survivors scored significantly lower on physical (83.7 vs. 89.8, difference (diff) = −5.80, p=.005), role (83.5 vs. 90, diff = −5.97, p=.02), cognitive (83.7 vs. 91.9, diff = −8.05, p=.001), and social functioning (86.5 vs. 95.1, diff = −8.49, p= <.001) and had a higher symptom burden of fatigue (23.0 vs. 15.5, diff = 7.48, p=.004), dyspnea (13.3 vs. 6.7, diff = 6.47 p=.02), diarrhea (7.9 vs. 4.0, diff = 3.78, p=.04), and financial impact (10.5 vs. 2.5, diff = 8.07, p=.001) than matched controls. Group differences were indicated as clinically relevant. Discussion Compared to matched controls, long-term advanced melanoma survivors had overall worse functioning scores, more physical symptoms, and financial difficulties. These data may contribute to the development of appropriate survivorship care.

Return To Sport Following Stabilization Surgery For Recurrent Patellar Instability In Patients Undergoing Isolated Mpfll Reconstruction Vs. Combined Mpfl Reconstruction And Tibial Tubercle Osteotomy

Objectives: Acute patellar instability is a common and disabling injury among young athletes and the risk of recurrence is as high as 80% in certain populations. The essential lesion of lateral patellar dislocations is MPFL rupture. However, bony risk factors for dislocation have also been identified, including patella alta, trochlear dysplasia, and a lateralized tibial tubercle. Significant debate exists regarding the optimal treatment due to the multifactorial nature of the pathology. Isolated MPFL reconstructions have demonstrated good functional outcomes within the literature. Failure to address bony malalignment has been proposed as a source of failure for these procedures. The addition of realignment techniques, such as tibial tubercle distalizations and medializations has been recommended to improve patellar stability in select patients. There is a paucity of literature on redislocation rates, return to sport, and functional outcomes after patellofemoral stabilization surgery. The purpose of the current study is to compare redislocation rates, return to sport, and functional outcomes between patients undergoing isolated MPFL reconstruction versus patients who have undergone MPFL and TTO as treatment for recurrent patellofemoral instability. It is hypothesized that patients who have undergone isolated MPFL reconstructions will have improved outcomes and return to sport rates compared to combined MPFL reconstruction and TTO. Methods: A retrospective chart review of prospectively collected data from 2014-2017 was conducted to identify consecutive athletes who underwent primary isolated MPFL reconstruction or MPFL reconstruction combined with TTO. Exclusion criteria included concomitant cruciate ligament surgery, multi-ligament surgery, and failed previous surgery. Patient information, including redislocation rate, radiographic data, sporting level, return to sport, previous dislocation rates, and subsequent surgeries were recorded. Generalized estimating equation modeling was used to analyze longitudinal outcome scores (Kujala, IKDC), activity level (HSS, Ped-FABS), and health-related quality of life (KOOS-PS, KOOS-QOL) collected at baseline, 1-year, and 2-year postoperatively. Results: A total of 100 patients were included in the study (71 MPFL; 29 MPFL+TTO). Redislocation rates were low for both MPFL and MPFL+TTO groups (1/70 and 1/28, respectively). No differences were found in reported incidence of post-op dislocation or subluxation (P=0.498 and 191, respectively). Both groups reported a high rate of RTS with MPFL at 87% and TTO at 89% (P&gt;0.999). However, the ability to return to the same or higher level of RTS was significantly higher in MPFL patients (85%) versus TTO (57%) (P=0.009). And for those patients who were able to RTS, the time to RTS was significantly lower in MPFL patients (8.9 months) compared to TTO patients (13.5 months) (P&lt;0.001). Both study groups had significant improvement over time in all functional outcome scores. Patients in the MPFL+TTO group consistently reported with worse functional scores at baseline. Conclusion: Patients undergoing MPFL reconstruction with or without correction of bony malalignment reported significant improvement over time with high return to sport rates and low recurrent dislocation rates. However, patients undergoing MPFL+TTO reported lower scores compared to MPFL patients at baseline and 2-years follow-up.

Rehabilitation protocols in unstable trochanteric fractures treated with cephalomedullary nails in elderly: current practices and outcome.

Optimal rehabilitation treatment after surgery for fixation of unstable trochanteric fractures is challenging in elderly patients. The objective of this study is to analyse the existing literature on available rehabilitation protocols with regards to permitting or restricting early weight bearing following fixation of unstable trochanteric fractures treated by the use of cephalomedullary nails in patients at least 65years of age. A systematic review was performed based on the checklist of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Studies published between 1948 and 2018 on elderly patients with unstable trochanteric fractures treated with cephalomedullary nails that offered information on the postoperative rehabilitation protocol have been selected. Subsequently, the results and complications have been analysed according to the protocols. Fifteen of the 7056 initial articles have been selected for analysis. Authors who did not restrict weight bearing to their patients reported a shorter hospitalization time and a lower orthopaedic complication rate but a greater systemic complication rate, worse functional scores, and a higher reoperation and mortality rates. Those results should be taken with caution because of the heterogeneity of provided clinical information and the fact that none of the included studies considered the different rehabilitation protocols as study variables to analyse its influence on the results. With evidence available to date, there is no clear agreement on the postoperative rehabilitation protocol following fixation of an unstable trochanteric fracture by cephalomedullary nail in the elderly.

1621P - Health-related quality of life of advanced melanoma survivors treated with CTLA-4 immune checkpoint inhibition: A matched cohort study

BackgroundSince the introduction of immune-checkpoint blockade, the overall survival has significantly improved for patients with advanced melanoma. However, to date, there is limited data on patients’ functioning and health-related quality of life (HRQoL), years after active treatment. Therefore, we evaluated these outcomes in advanced melanoma survivors (AMS) and compared these with matched controls. MethodsIpilimumab-treated AMS without systemic treatment for at least 2 years were recruited from 15 hospitals. The primary outcome was HRQoL assessed with the European Organization for Research and Treatment of Cancer quality of life questionnaire-C30 (QLQ-C30). Secondary outcomes were fatigue, anxiety, depression and disease specific HRQoL. Up to 5 controls per AMS were individually matched on age, gender and educational status. Survivors and controls were compared on QLQ-C30 scores using generalized estimating equations. Differences in QLQ-C30 scores were classified as clinically important according to published guidelines. ResultsA total of 89 AMS were evaluated in this study. After last administration of ipilimumab, the mean follow-up (FU) was 45.5 (SD 20.8) months. Comparison with matched controls showed that AMS scored significantly lower on physical (difference (diff) = -5.80, p=.005), role (diff =-5.97, p=.02), cognitive (diff = -8.05, p=.001), and social functioning (diff = -8.49, p=<.001) and higher in symptom burden of fatigue (diff =7.48, p=.004), dyspnea (diff = 6.47, p=.02), diarrhea (diff = 3.78, p=.04) and financial impact (diff = 8.07, p=.001). Comparison between AMS with a FU≥36 and FU<36 months showed that social functioning, global QoL and financial impact scores were higher among the longer term survivors. Group differences in both analyses were clinically relevant. ConclusionsCompared to matched controls, AMS showed overall worse functioning scores and more symptoms of fatigue, dyspnea, diarrhea and financial impact. AMS with a longer FU reported better QoL, but more financial issues. These study results may help to develop interventions to the individual healthcare needs of AMS and contribute to the development of appropriate survivorship care. Legal entity responsible for the studyNetherlands Cancer Institute. FundingBristol-Myers Squibb. DisclosureAll authors have declared no conflicts of interest.

172. Preoperative diagnosis of psychiatric mood disorder is predictive of postoperative course in patients after elective cervical spine surgery

BACKGROUND CONTEXT Numerous studies have described associations between preexisting comorbid psychiatric mood disorders and increased health risks, poor surgical outcomes, and increased health care utilization. PURPOSE The purpose of this study was to investigate the effect of preoperative mood disorders on (1) pre- and postoperative patient-reported outcomes, (2) complications, and (3) pre- and postoperative opioid consumption in patients undergoing elective cervical spine surgery. STUDY DESIGN/SETTING Retrospective chart review. PATIENT SAMPLE A total of 179 consecutive patients who underwent elective cervical spine surgery at a single academic institution from 2014-2016 with 2-year follow-up data. OUTCOME MEASURES Perioperative variables, opioid consumption, visual analog scale (VAS) pain score, Neck Disability Index (NDI), postoperative complications. METHODS Patient preoperative diagnosis of psychiatric mood disorder (eg, depression, anxiety, schizophrenia, bipolar, or dementia), baseline characteristics, medical (nonpsychiatric) comorbidities, operative variables, and surgical complications (eg, superficial and deep infection, wound complication, emergency department (ED) visits, re-admissions, and repeat operations) were recorded. Additionally, preoperative ED visits, pre- and postoperative opioid requirements, total opioid prescription quantities and last date of opioid prescription were collected. Quantitative measurements of pain VAS and disease specific disability score NDI were recorded preoperatively and 3 months after surgery. Continuous variables were compared between those with diagnosed mood disorder and those without psychiatric comorbidity using two-tailed independent t-test, and categorical variables were compared using chi-square or Fisher Exact tests. RESULTS Of the 179 patients involved in this study, 78 (43.5%) had a preoperative diagnosis of comorbid psychiatric mood disorder. Fibromyalgia and irritable bowel syndrome were more common in patients with mood disorders (p=0.01). Patients with mood disorders required a statistically significant higher total number of opioid prescriptions postoperatively (4.6±5.2 vs 2.8±3.9, p=0.002). Patients with psychiatric comorbidity had worse NDI scores at all time points (p=0.04); however, there were no differences in VAS pain scores at any time point between groups (p=0.5). There were no statistical differences between patients with and without mood disorders regarding baseline characteristics, medical (nonpsychiatric) comorbidities, operative variables, surgical complications, preoperative ED visits or prior opioid use (p>0.05). CONCLUSIONS Patients with preoperative psychiatric comorbidities undergoing elective cervical spine surgery should be counseled that they may experience a significantly worse functional score during the perioperative and early postoperative period compared to patients without mood disorders. A preoperative diagnosis of a comorbid psychiatric mood disorder may be a predictor of higher postoperative opioid consumption, therefore, further study is appropriate for optimization of postoperative opioid prescribing practices in these patients. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Fibular head avulsion fractures accompanying operative treated medial tibial plateau fractures

ObjectiveThe aims of this work are to determine how frequently medial tibial plateau fractures are accompanied by fibular head avulsion fractures and evaluate the sensitivity of radiographs detecting them, and also to assess if the presence of fibular fracture is correlated with long-term functional outcome and peroneal nerve damage.Materials and methodsA retrospective chart review of operated patients with medial tibial plateau fractures at level I trauma center during 2002–2008 was performed. From 63 patients imaged preoperatively, 59 had CT and radiographs, three had only CT, and one only radiograph. The presence and fragment size of fibular fracture were retrospectively evaluated. Body mass index (BMI) and functional outcome measurements (the Modified Lysholm knee score and WOMAC) were available for 46 patients.ResultsFourteen out of 63 patients (22.2%) had fibular fractures. Of the 59 patients with both CT and radiographs, 12 had fibular fractures, and of these, nine were seen with both modalities and three only in CT. Functional scores were available for ten patients with fibular fracture. Patients with fibular fracture seen on radiographs had a significantly higher score on WOMAC function (26 vs. 7; p = 0.027). The patients with fibular fractures had also higher BMI (p = 0.035). Of the six patients with peroneal nerve damage, 50% had fibular fracture.ConclusionsIn patients with operatively treated medial tibial plateau fracture, the fibular fractures are relatively common. Detecting it is important, as it may be associated with worse functional scores and peroneal nerve paresis. Some fibular fractures may remain undetected on radiographs, hence preoperative CT is recommended.

Prospective Evaluation of Opioid Consumption Following Cubital Tunnel Decompression Surgery.

Managing postoperative pain is important for patients and surgeons. However, there is concern over opioid dependency. Cubital tunnel decompression is among the most common upper extremity surgeries. Our study aimed to analyze opioid use after cubital tunnel decompression to guide postoperative opioid prescribing. We prospectively collected opioid consumption for 16 consecutive months (February 2016 to June 2017) for cubital tunnel decompression patients. Data on demographics, insurance type, surgery performed, functional questionnaires (Quick Disabilities of the Arm, Shoulder and Hand [QuickDASH]), and electrodiagnostics (electromyography) were collected. Opioid consumption was reported at first postoperative visits. One hundred patients consumed a mean of 50 morphine equivalent units (MEUs) (range, 0-300), or 7 oxycodone 5-mg pills, postoperatively. Cubital tunnel release (CuTR) patients consumed fewer than ulnar nerve transposition (UNT) patients (40.4 vs 62.5 MEUs or 5.4 vs 8.3 pills, P = .08). Patients undergoing submuscular UNT consumed more than CuTR (115.0 vs 40.4 MEUs or 15.3 vs 5.4 pills, p = 0.003) and more than subcutaneous UNT patients (37.8 MEU or 5.0 pills, p = 0.03). Medicare patients consumed less than privately insured (42.7 vs 54.1 MEUs, 5.7 vs 7.2 pills, P = .02) and less than workers' compensation patients (76.8 MEU or 10.2 pills, P = .04). Older patients consumed fewer than younger patients ( P = .03). Postoperative QuickDASH score was positively related to opioid intake ( P = .009). Patients consumed 7 oxycodone 5-mg pills after cubital tunnel decompression. Younger, privately insured, and workers' compensation patients, and those with worse functional scores and those undergoing UNT (specifically the submuscular technique) consumed more opioids.

Diagnosis and treatment of suprascapular neuropathy with massive rotator cuff tear

Objective To evaluate diagnosis and treatment outcomes about suprascapular neuropathy with massive rotator cuff tear. Methods Fifty patients with massive rotator cuff tear underwent arthroscopic surgery from January 2011 to June 2014. The mean age was 51.50±11.50 years with average disease duration 4.60±6.70 months. Preoperative fat infiltration Goutallier grade was 3 cases in grade 0, 18 in grade 1, 18 in grade 2, 9 in grade 3 and 2 in grade 4. Based on medical history, physical examination and electromyogram, six cases were diagnosed with Neuropathy. Compression of scapular transverse ligament and ganglion notch cyst were not founded before and during rotator cuff repairing. Only neurotrophic drugs were admitted after arthroscopy. The clinical outcomes (range of motion, muscle strength in flexion and in rotation, electromyogram, Constant-Murley score, ASES score and VAS) and MRI results were collected. The differences between suprascapular neuropathy and normal group were compared at pre-operation and 2 years after operation. Results There was no complication like axillary nerve injury, infection and instability during the 27.90±6.70 months follow-up. All patients of Goutallier grade 4 (2/2) and partial patients of grade 3(4/9) showed delayed conduction with suprascapular neuropathy. The muscle strength in flexion and bodyside external/internal rotation improved. The VAS decreased from 7.70±2.50 to 1.20±1.80 (t=14.670, P=0.000), and ASES score improved from 45.80±9.50 to 92.50±6.30 (t=-18.450, P=0.000). Furthermore, Constant-Murley score improved from 41.40±8.70 to 90.20±4.70 (t=-20.790, P=0.000). Compared with the normal group, the patients with suprascapular neuropathy showed higher pain and worse functional score preoperatively (P 0.05). Conclusion The incidence of suprascapular neuropathy is 12% (6/50) in patients with massive rotator cuff tear. The preoperative function is worse in patients with neuropathy. Diagnosis for suprascapular neuropathy with massive rotator cuff tear can be based on the pain in posterior superior scapular region, severe infraspinatus muscular atrophy, MRI and EMG. Reversal of suprascapular neuropathy is founded with good curative effects after neurotrophic therapy during short-term follow-up. Arthroscopic release is not needed for patients without suprascapular nerve entrapment. Key words: Rotator cuff; Wounds and injuries; Arthroscopy; Reconstructive surgical procedures; Electrophysiology

A Hybrid Dynamic Stabilization and Fusion System in Multilevel Lumbar Spondylosis.

Background/AimsThe Dynesys-Transition-Optima (DTO) hybrid system was designed to achieve arthrodesis and stabilization in patients with lumbar degeneration. Satisfactory outcomes were demonstrated previously. However, no study has evaluated the effects of using the DTO system in patients with lumbar spondylolisthesis or stenosis. MethodsThis retrospective study included 35 consecutive patients with multilevel lumbar degeneration with or without spondylolisthesis who underwent surgery using the DTO system. Imaging studies included pre- and postoperative radiography, magnetic resonance imaging, and computed tomography. The clinical outcomes were measured by Japanese Orthopedic Association (JOA) scores, Oswestry Disability Index (ODI) scores, and a visual analogue scale (VAS) for back and leg pain. ResultsThirty patients (85.7%) with a mean age of 61.9 years completed the follow-up, with a mean duration of 35.1 months. There were 21 patients in the spondylolisthesis group and 9 in the stenosis group. The spondylolisthesis group had worse functional scores than the stenosis group preoperatively. After DTO surgery, all patients showed significant improvements in clinical outcomes, including VAS for back and leg pain, ODI, and JOA scores (p < 0.05). There were no significant differences in clinical outcomes between the 2 groups. At a 2-year follow-up, lumbar alignment was well maintained in both groups (p = 0.116). There were no significant differences in lumbar alignment between the 2 groups. ConclusionDuring a follow-up period of over 2 years, both patients with spondylolisthesis and those with stenosis showed improvements and similar disability and pain scores after surgery using the DTO system. Lumbar alignment was also well maintained.

The association of body mass index with complications and functional outcomes after surgery for closed ankle fractures.

This study assessed the association of classes of body mass index in kg/m2 (classified as normal weight 18.5 kg/m2 to 24.9 kg/m2, overweight 25.0 kg/m2 to 29.9 kg/m2, and obese ≥30.0 kg/m2) with short-term complications and functional outcomes three to six years post-operatively for closed ankle fractures. We performed a historical cohort study with chart review of 1011 patients who were treated for ankle fractures by open reduction and internal fixation in two hospitals, with a follow-up postal survey of 959 of the patients using three functional outcome scores. Obese patients had more severe overall complications and higher odds of any complication than the normal weight group, with adjusted odds ratio 1.67 (95% confidence interval (CI) 1.08 to 2.59; p = 0.021) and 1.71 (95% CI 1.10 to 2.65; p = 0.016), respectively. In total 479 patients (54.6%) responded to the questionnaire. Obese patients had worse scores on the Olerud and Molander Ankle Score (p < 0.001), Self-Reported Foot and Ankle Questionnaire (p = 0.003) and Lower Extremity Functional Scale (p = 0.01) than those with normal weight. In contrast, overweight patients did not have worse functional scores than those with normal weight. Obese patients had more complications, more severe complications, and worse functional outcomes three to six years after ankle surgery compared with those with normal weight. Cite this article: Bone Joint J 2017;99-B:1389-98.

Analysis of hydrodilatation as part of a combined service for stiff shoulder.

Adhesive capsulitis is a common cause of stiff shoulder and may result in pain and restriction of movement. The study aimed to investigate the role of hydrodilatation of the glenohumeral joint in the management of adhesive capsulitis. Patients referred from the shoulder clinic underwent hydrodilatation under ultrasound guidance. Of 209 referred for hydrodilatation, 163 underwent the procedure and attended follow-up physiotherapy. Outcome measures were available for 118 patients (58 men and 60 women). Mean age of the study group was 52.6 years. There was a statistically significant improvement in both Oxford Shoulder Score (OSS) and Disability Arm Shoulder Hand Scores (Quick DASH) in the first 4 weeks after the procedure, which was maintained but not improved to the end of the study period. Patients presenting with pain, those who had a history of steroid injections and older patients all had worse functional scores at presentation. Diabetes (both Type I and II), previous physiotherapy, length of history and whether pain or stiffness, or both, were the predominant symptom did not have any statistical significance at presentation. These factors were not predictors of any statistically significant improvement in functional scores. Hydrodilatation results in a significant improvement of symptoms in patients with adhesive capsulitis.

Evaluation of functional capacity in individuals with signs and symptoms of musculoskeletal disease: results of the BRAZCO population study (Brazilian COPCORD Study).

The disability caused by the musculoskeletal signs and symptoms affects the quality of life of a population, especially that related to health. The objective of this study is to evaluate the functional capacity of individuals of the Brazilian population who presented musculoskeletal signs and symptoms (MSK-S). The prevalence of MSK-S was evaluated in 5000 individuals (>15 years) in 16 capitals from the five regions of Brazil using the COPCORD Core Questionnaire. Those individuals (n = 2494) that experienced MSK-S and referred some level of disability at the time of the interview were invited to complete the Health Assessment Questionnaire-Disability Index (HAQ-DI). The HAQ-DI scores were compared among regions, and subgroups according to gender, age and type of activity. Three hundred ninety-four (7.9 %) participants reported disability at the time of the interview. The average score of HAQ-DI was 1.09 (SD = 0.71), and the Brazilian region with the highest level of disability was the North region. Among individuals without history of trauma, the disability was higher when the duration of MSK-S was longer. Disability was shown to worsen with increasing age, and the group with 25-34 years showed the lowest scores. Females showed worse functional capacity scores compared to males (p = 0.002). Individuals showed higher degrees of difficulty or were incapable of performing the activities walking, reaching, usual activities and dressing. MSK-S reduce the functional capacity of individuals of the Brazilian general population. The reduction in functional capacity was mainly observed in individuals with chronic musculoskeletal complaints not due to trauma, as well as in female gender and in advancing age.

Does Salter innominate osteotomy predispose the patient to acetabular retroversion in adulthood?

Salter innominate osteotomy has been identified as an effective additional surgery for the dysplastic hip. However, because in this procedure, the distal segment of the pelvis is displaced laterally and anteriorly, it may predispose the patient to acetabular retroversion. The degree to which this may be the case, however, remains incompletely characterized. We asked, in a group of pediatric patients with acetabular dysplasia who underwent Salter osteotomy, whether the operated hip developed (1) acetabular retroversion compared with contralateral unaffected hips; (2) radiographic evidence of osteoarthritis; or (3) worse functional scores. (4) In addition, we asked whether femoral head deformity resulting from aseptic necrosis was a risk factor for acetabular retroversion. Between 1971 and 2001, we performed 213 Salter innominate osteotomies for unilateral pediatric dysplasia, of which 99 hips (47%) in 99 patients were available for review at a mean of 16 years after surgery (range, 12-25 years). Average patient age at surgery was 4 years (range, 2-9 years) and the average age at the most recent followup was 21 years (range, 18-29 years). Acetabular retroversion was diagnosed based on the presence of a positive crossover sign and prominence of the ischial spine sign at the final visit. The center-edge angle, acetabular angle of Sharp, and acetabular index were measured at preoperative and final visits. Contralateral unaffected hips were used as controls, and statistical comparison was made in each patient. Clinical findings, including Harris hip score (HHS) and the anterior impingement sign, were recorded at the final visit. Patients were no more likely to have a positive crossover sign in the surgically treated hips (20 of 99 hips [20%]) than in the contralateral control hips (17 of 99 hips [17%]; p = 0584). In addition, the percentage of positive prominence of the ischial spine sign was not different between treated hips (22 of 99 hips [22%]) and contralateral hips (18 of 99 hips [18%]; p = 0.256). Hips that had a positive crossover or prominence of the ischial spine sign in the operated hips were likely also to have a positive crossover sign or prominence of the ischial spine sign in the unaffected hips (16 of 20 hips [80%] crossover sign, 17 of 22 hips [77%] prominence of the ischial spine sign). At the final visit, five hips (5%) showed osteoarthritic change; one of the five hips (20%) showed positive crossover and prominence of the ischial spine signs, and the remaining four hips showed negative crossover and prominence of the ischial spine signs. There was no significant difference in HHS between the crossover-positive and crossover-negative patient groups nor in the prominence of the ischial spine-positive and prominence of the ischial spine-negative patient groups (crossover sign, p = 0.68; prominence of the ischial spine sign, p = 0.54). Hips with femoral head deformity (25 of 99 hips [25%]) were more likely to have acetabular retroversion compared with hips without femoral-head deformity (crossover sign, p = 0.029, prominence of the ischial spine sign, p = 0.013). Our results suggest that Salter innominate osteotomy does not consistently cause acetabular retroversion in adulthood. We propose that retroversion of the acetabulum is a result of intrinsic development of the pelvis in each patient. A longer-term followup study is needed to determine whether retroverted acetabulum after Slater innominate osteotomy is a true risk factor for early osteoarthritis. Femoral head deformity is a risk factor for subsequent acetabular retroversion. Level III, therapeutic study.