Aims. This study aimed to gather insights from elbow experts using the Delphi method to evaluate the influence of patient characteristics and fracture morphology on the choice between operative and nonoperative treatment for coronoid fractures. Methods. A three-round electronic (e-)modified Delphi survey study was performed between March and December 2023. A total of 55 elbow surgeons from Asia, Australia, Europe, and North America participated, with 48 completing all questionnaires (87%). The panellists evaluated the factors identified as important in literature for treatment decision-making, using a Likert scale ranging from "strongly influences me to recommend nonoperative treatment" (1) to "strongly influences me to recommend operative treatment" (5). Factors achieving Likert scores ≤ 2.0 or ≥ 4.0 were deemed influential for treatment recommendation. Stable consensus is defined as an agreement of ≥ 80% in the second and third rounds. Results. Of 68 factors considered important in the literature for treatment choice for coronoid fractures, 18 achieved a stable consensus to be influential. Influential factors with stable consensus that advocate for operative treatment were being a professional athlete, playing overhead sports, a history of subjective dislocation or subluxation during trauma, open fracture, crepitation with range of movement, > 2 mm opening during varus stress on radiological imaging, and having an anteromedial facet or basal coronoid fracture (O’Driscoll type 2 or 3). An
Rotator cuff tears are common in middle-aged and elderly patients. Despite advances in the surgical repair of rotator cuff tears, the rates of recurrent tear remain high. This may be due to the complexity of the tendons of the rotator cuff, which contributes to an inherently hostile healing environment. During the past 20 years, there has been an increased interest in the use of biologics to complement the healing environment in the shoulder, in order to improve rotator cuff healing and reduce the rate of recurrent tears. The aim of this review is to provide a summary of the current evidence for the use of forms of biological augmentation when repairing rotator cuff tears. Cite this article:
The current evidence comparing the two most common approaches for reverse total shoulder arthroplasty (rTSA), the deltopectoral and anterosuperior approach, is limited. This study aims to compare the rate of loosening, instability, and implant survival between the two approaches for rTSA using data from the Dutch National Arthroplasty Registry with a minimum follow-up of five years. All patients in the registry who underwent a primary rTSA between January 2014 and December 2016 using an anterosuperior or deltopectoral approach were included, with a minimum follow-up of five years. Cox and logistic regression models were used to assess the association between the approach and the implant survival, instability, and glenoid loosening, independent of confounders.Aims
Methods
The aim of this study is to provide a detailed description of cases combining bridging patch repair with artificial ligament “internal brace” reinforcement to treat irreparable massive rotator cuff tears, and report the preliminary results. This is a retrospective review of patients with irreparable massive rotator cuff tears undergoing fascia lata autograft bridging repair with artificial ligament “internal brace” reinforcement technique between January 2017 and May 2018. Inclusion criteria were: patients treated arthroscopically for an incompletely reparable massive rotator cuff tear (dimension > 5 cm or two tendons fully torn), stage 0 to 4 supraspinatus fatty degeneration on MRI according to the Goutallier grading system, and an intact or reparable infraspinatus and/or subscapularis tendon of radiological classification Hamada 0 to 4. The surgical technique comprised two components: first, superior capsular reconstruction using an artificial ligament as an “internal brace” protective device for a fascia lata patch. The second was fascia lata autograft bridging repair for the torn supraspinatus. In all, 26 patients with a mean age 63.4 years (SD 6.2) were included.Aims
Methods
The Mathys Affinis Short is the most frequently used stemless total shoulder prosthesis in the UK. The purpose of this prospective cohort study is to report the survivorship, clinical, and radiological outcomes of the first independent series of the Affinis Short prosthesis. From January 2011 to January 2019, a total of 141 Affinis Short prostheses were implanted in 127 patients by a single surgeon. Mean age at time of surgery was 68 (44 to 89). Minimum one year and maximum eight year follow-up (mean 3.7 years) was analyzed using the Oxford Shoulder Score (OSS) at latest follow-up. Kaplan-Meier survivorship analysis was performed with implant revision as the endpoint. Most recently performed radiographs were reviewed for component radiolucent lines (RLLs) and proximal humeral migration.Aims
Methods
Despite recent advances in arthroscopic rotator cuff repair, re-tear rates remain high. New methods to improve healing rates following rotator cuff repair must be sought. Our primary objective was to determine if adjunctive bone marrow stimulation with channelling five to seven days prior to arthroscopic cuff repair would lead to higher Western Ontario Rotator Cuff (WORC) scores at 24 months postoperatively compared with no channelling. A prospective, randomized controlled trial was conducted in patients undergoing arthroscopic rotator cuff repair. Patients were randomized to receive either a percutaneous bone channelling of the rotator cuff footprint or a sham procedure under ultrasound guidance five to seven days prior to index surgery. Outcome measures included the WORC, American Shoulder and Elbow Surgeons (ASES), and Constant scores, strength, ultrasound-determined healing rates, and adverse events.Aims
Methods
The aim of this study was to explore why some calcar screws are malpositioned when a proximal humeral fracture is treated by internal fixation with a locking plate, and to identify risk factors for this phenomenon. Some suggestions can be made of ways to avoid this error. We retrospectively identified all proximal humeral fractures treated in our institution between October 2016 and October 2018 using the hospital information system. The patients’ medical and radiological data were collected, and we divided potential risk factors into two groups: preoperative factors and intraoperative factors. Preoperative factors included age, sex, height, weight, body mass index, proximal humeral bone mineral density, type of fracture, the condition of the medial hinge, and medial metaphyseal head extension. Intraoperative factors included the grade of surgeon, neck-shaft angle after reduction, humeral head height, restoration of medial support, and quality of reduction. Adjusted binary logistic regression and multivariate logistic regression models were used to identify pre- and intraoperative risk factors. Area under the curve (AUC) analysis was used to evaluate the discriminative ability of the multivariable model.Aims
Methods
Post-traumatic elbow stiffness is a disabling condition that remains challenging for upper limb surgeons. Open elbow arthrolysis is commonly used for the treatment of stiff elbow when conservative therapy has failed. Multiple questions commonly arise from surgeons who deal with this disease. These include whether the patient has post-traumatic stiff elbow, how to evaluate the problem, when surgery is appropriate, how to perform an excellent arthrolysis, what the optimal postoperative rehabilitation is, and how to prevent or reduce the incidence of complications. Following these questions, this review provides an update and overview of post-traumatic elbow stiffness with respect to the diagnosis, preoperative evaluation, arthrolysis strategies, postoperative rehabilitation, and prevention of complications, aiming to provide a complete diagnosis and treatment path. Cite this article:
The Wrightington classification system of fracture-dislocations of the elbow divides these injuries into six subtypes depending on the involvement of the coronoid and the radial head. The aim of this study was to assess the reliability and reproducibility of this classification system. This was a blinded study using radiographs and CT scans of 48 consecutive patients managed according to the Wrightington classification system between 2010 and 2018. Four trauma and orthopaedic consultants, two post CCT fellows, and one speciality registrar based in the UK classified the injuries. The seven observers reviewed preoperative radiographs and CT scans twice, with a minimum four-week interval. Radiographs and CT scans were reviewed separately. Inter- and intraobserver reliability were calculated using Fleiss and Cohen kappa coefficients. The Landis and Koch criteria were used to interpret the strength of the kappa values. Validity was assessed by calculating the percentage agreement against intraoperative findings.Aims
Methods
The purpose of this study was to compare the effectiveness of surgical repair to conservative treatment and subacromial decompression for the treatment of chronic/degenerative tears of the rotator cuff. PubMed, Cochrane database, and Medline were searched for randomized controlled trials published until March 2018. Included studies were assessed for methodological quality, and data were extracted for statistical analysis. The systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.Aims
Materials and Methods
Our aim was to investigate the prevalence of A total of 46 patients undergoing either an arthroscopic capsular
release or stabilisation had biopsies taken from the subcutaneous
fat and capsule of the shoulder at the time of surgery. These samples
were sent for culture in enrichment, and also for Nucleic Acid Amplification
testing. The prevalence of Aims
Patients and Methods
We retrospectively reviewed 89 consecutive patients
(45 men and 44 women) with a mean age at the time of injury of 58
years (18 to 97) who had undergone external fixation after sustaining
a unilateral fracture of the distal humerus. Our objectives were
to determine the incidence of heterotopic ossification (HO); identify
risk factors associated with the development of HO; and characterise
the location, severity and resultant functional impairment attributable
to the presence of HO. HO was identified in 37 elbows (42%), mostly around the humerus
and along the course of the medial collateral ligament. HO was hazy
immature in five elbows (13.5%), mature discrete in 20 (54%), extensive
mature in 10 (27%), and complete bone bridges were present in two
elbows (5.5%). Mild functional impairment occurred in eight patients,
moderate in 27 and severe in two. HO was associated with less extension
(p = 0.032) and less overall flexion-to-extension movement (p =
0.022); the flexion-to-extension arc was <
100º in 21 elbows
(57%) with HO compared with 18 elbows (35%) without HO (p = 0.03).
HO was removed surgically in seven elbows. The development of HO was significantly associated with sustaining
a head injury (p = 0.015), delayed internal fixation (p = 0.027),
the method of fracture fixation (p = 0.039) and the use of bone
graft or substitute (p = 0.02).HO continues to be a substantial
complication after internal fixation for distal humerus fractures. Cite this article:
We retrospectively assessed the value of identifying
impinging osteophytes using dynamic computer simulation of CT scans
of the elbow in assisting their arthroscopic removal in patients
with osteoarthritis of the elbow. A total of 20 patients were treated
(19 men and one woman, mean age 38 years (19 to 55)) and followed
for a mean of 25 months (24 to 29). We located the impinging osteophytes
dynamically using computerised three-dimensional models of the elbow
based on CT data in three positions of flexion of the elbow. These
were then removed arthroscopically and a capsular release was performed. The mean loss of extension improved from 23° (10° to 45°) pre-operatively
to 9° (0° to 25°) post-operatively, and the mean flexion improved
from 121° (80° to 140°) pre-operatively to 130° (110° to 145°) post-operatively.
The mean Mayo Elbow Performance Score improved from 62 (30 to 85)
to 95 (70 to 100) post-operatively. All patients had pain in the
elbow pre-operatively which disappeared or decreased post-operatively.
According to their Mayo scores, 14 patients had an excellent clinical
outcome and six a good outcome; 15 were very satisfied and five
were satisfied with their post-operative outcome. We recommend this technique in the surgical management of patients
with osteoarthritis of the elbow. Cite this article:
The aim of this study was to determine the effect
of radial extracorporeal shock-wave therapy (rESWT) on patients with
chronic tendinitis of the rotator cuff. This was a randomised controlled
trial in which 82 patients (mean age 47 years (24 to 67)) with chronic
tendinitis diagnosed clinically were randomly allocated to a treatment
group who received low-dose rESWT (three sessions at an interval
10 to 14 days, 2000 pulses, 0.11 mJ/mm2, 8 Hz) or to
a placebo group, with a follow-up of six months. The patients and
the treating orthopaedic surgeon, who were both blinded to the treatment,
evaluated the results. A total of 44 patients were allocated to
the rESWT group and 38 patients to the placebo group. A visual analogue
scale (VAS) score for pain, a Constant–Murley (CMS) score and a simple
shoulder test (SST) score significantly improved in both groups
at three and six months compared with baseline (all p ≤ 0.012).
The mean VAS was similar in both groups at three (p = 0.43) and
six months (p = 0.262). Also, the mean CMS and SST scores were similar
in both groups at six months (p = 0.815 and p = 0.834, respectively). It would thus seem that low-dose rESWT does not reduce pain or
improve function in patients chronic rotator cuff tendinitis compared
with placebo treatment. Cite this article:
Lateral epicondylitis, or ’tennis elbow’, is
a common condition that usually affects patients between 35 and
55 years of age. It is generally self-limiting, but in some patients
it may continue to cause persistent symptoms, which can be refractory
to treatment. This review discusses the mechanism of disease, symptoms
and signs, investigations, current management protocols and potential
new treatments. Cite this article:
