Frozen shoulder is a common condition that affects the working population. The longevity and severity of symptoms often results in great economic burden to health services and absence from work. This prospective cohort study aimed to investigate whether early intervention with arthroscopic capsular release resulted in improvement of symptoms and any potential economic benefit to society. Patients were recruited prospectively. Data was gathered by way of questionnaire to ascertain demographics, previous primary care treatment and absence from work. Oxford Shoulder Score (OSS) was also calculated. Arthroscopic capsular release was performed and further data gathered at four week post-operative follow up. Economic impact of delay to treatment and cost of intervention was calculated using government data from the national tariff which costs different forms of treatment. Statistical analysis was then performed on the results. Twenty five patients enrolled. Mean pre-operative OSS: 37.4 (range 27–58, SD 7.4). Mean post-operative OSS: 15.9 (range 12–22, SD 2.3). P<0.01. Mean improvement in OSS: 21.5 (range 12–38, SD 7.1). The cost of non-operative treatment per patient was £3954. The cost of arthroscopic capsular release per patient was £1861, a difference of £2093. There were no complications. Arthroscopic capsular release improved shoulder function on OSS within four weeks. The cost of arthroscopic capsular release is significantly less than the cost of treating the patients non-operatively. Early surgical intervention may improve symptoms quickly and reduce economic burden of the disease. A randomised controlled trial comparing timings of intervention would further elucidate potential benefits

The aim of this study was to report the incidence of arthrofibrosis of the knee and identify risk factors for its development following a fracture of the tibial plateau. We carried out a retrospective review of 186 patients (114 male, 72 female) with a fracture of the tibial plateau who underwent open reduction and internal fixation. Their mean age was 46.4 years (19 to 83) and the mean follow-up was16.0 months (6 to 80).

A total of 27 patients (14.5%) developed arthrofibrosis requiring a further intervention. Using multivariate regression analysis, the use of a provisional external fixator (odds ratio (OR) 4.63, 95% confidence interval (CI) 1.26 to 17.7, p = 0.021) was significantly associated with the development of arthrofibrosis. Similarly, the use of a continuous passive movement (CPM) machine was associated with significantly less development of arthrofibrosis (OR = 0.32, 95% CI 0.11 to 0.83, p = 0.024). The effect of time in an external fixator was found to be significant, with each extra day of external fixation increasing the odds of requiring manipulation under anaesthesia (MUA) or quadricepsplasty by 10% (OR = 1.10, p = 0.030). High-energy fracture, surgical approach, infection and use of tobacco were not associated with the development of arthrofibrosis. Patients with a successful MUA had significantly less time to MUA (mean 2.9 months; sd 1.25) than those with an unsuccessful MUA (mean 4.86 months; sd 2.61, p = 0.014). For those with limited movement, therefore, performing an MUA within three months of the injury may result in a better range of movement.

Based our results, CPM following operative fixation for a fracture of the tibial plateau may reduce the risk of the development of arthrofibrosis, particularly in patients who also undergo prolonged provisional external fixation.

Cite this article: Bone Joint J 2015;97-B:109–14.

A series of 103 acute fractures of the coronoid process of the ulna in 101 patients was reviewed to determine their frequency. The Regan-Morrey classification, treatment, associated injuries, course and outcomes were evaluated. Of the 103 fractures, 34 were type IA, 17 type IB, ten type IIA, 19 type IIB, ten type IIIA and 13 type IIIB. A total of 44 type-I fractures (86%) were treated conservatively, while 22 type-II (76%) and all type-III fractures were managed by operation.

At follow-up at a mean of 3.4 years (1 to 8.9) the range of movement differed significantly between the types of fracture (p = 0.002). Patients with associated injuries had a lower Mayo elbow performance score (p = 0.03), less extension (p = 0.03), more pain (p = 0.007) and less pronosupination (p = 0.004), than those without associated injuries. The presence of a fracture of the radial head had the greatest effect on outcome. An improvement in outcome relative to that of a previous series was noted, perhaps because of more aggressive management and early mobilisation. While not providing complete information about the true details of a fracture and its nature, the Regan-Morrey classification is useful as a broad index of severity and prognosis.