Nerve transfer has become a common and often effective reconstructive strategy for proximal and complex peripheral nerve injuries of the upper limb. This case-based discussion explores the principles and potential benefits of nerve transfer surgery and offers in-depth discussion of several established and valuable techniques including: motor transfer for elbow flexion after musculocutaneous nerve injury, deltoid reanimation for axillary nerve palsy, intrinsic re-innervation following proximal ulnar nerve repair, and critical sensory recovery despite non-reconstructable median nerve lesions.Abstract
To compare complication-related reoperation rates following primary arthroplasty for proximal humerus fractures (PHFs) We identified patients aged 50 years and over, who sustained a PHF between 2004 and 2015, from linkable datasets. We used intervention codes to identify patients treated with initial ORIF or arthroplasty, and those treated with ORIF who returned for revision arthroplasty within two years. We used multilevel logistic regression to compare reoperations between groups.Aims
Patients and Methods
The aims of this study were to compare the use of resources, costs, and quality of life outcomes associated with subacromial decompression, arthroscopy only (placebo surgery), and no treatment for subacromial pain in the United Kingdom National Health Service (NHS), and to estimate their cost-effectiveness. The use of resources, costs, and quality-adjusted life-years (QALYs) were assessed in the trial at six months and one year. Results were extrapolated to two years after randomization. Differences between treatment arms, based on the intention-to-treat principle, were adjusted for covariates and missing data were handled using multiple imputation. Incremental cost-effectiveness ratios were calculated, with uncertainty around the values estimated using bootstrapping.Aims
Patients and Methods
Few studies have evaluated the relationship between patients’
pre-operative expectations and the outcome of orthopaedic procedures.
Our aim was to determine the effect of expectations on the outcome
after primary anatomical total shoulder arthroplasty (TSA). We hypothesised
that patients with greater expectations would have better outcomes. Patients undergoing primary anatomical TSA completed the Hospital
for Special Surgery’s Shoulder Expectations Survey pre-operatively.
The American Shoulder and Elbow Surgeons (ASES), Shoulder Activity
Scale (SAS), Short-Form-36 (SF-36), and visual analogue scale (VAS)
for pain, fatigue, and general health scores were also collected
pre-operatively and two years post-operatively. Pearson correlations
were used to assess the relationship between the number of expectations
and the outcomes. Differences in outcomes between those with higher
and lower levels of expectations for each expectation were assessed
by independent samples Aims
Patients and Methods
Intra-articular injections of local anaesthetics (LA), glucocorticoids (GC), or hyaluronic acid (HA) are used to treat osteoarthritis (OA). Contrast agents (CA) are needed to prove successful intra-articular injection or aspiration, or to visualize articular structures dynamically during fluoroscopy. Tranexamic acid (TA) is used to control haemostasis and prevent excessive intra-articular bleeding. Despite their common usage, little is known about the cytotoxicity of common drugs injected into joints. Thus, the aim of our study was to investigate the effects of LA, GC, HA, CA, and TA on the viability of primary human chondrocytes and tenocytes Human chondrocytes and tenocytes were cultured in a medium with three different drug dilutions (1:2; 1:10; 1:100). The following drugs were used to investigate cytotoxicity: lidocaine hydrochloride 1%; bupivacaine 0.5%; triamcinolone acetonide; dexamethasone 21-palmitate; TA; iodine contrast media; HA; and distilled water. Normal saline served as a control. After an incubation period of 24 hours, cell numbers and morphology were assessed.Objectives
Methods
The number of rotator cuff repairs that are undertaken is increasing. Reverse shoulder arthroplasty (RSA) is the procedure of choice for patients with rotator cuff arthropathy. We sought to determine whether patients who underwent rotator cuff repair and subsequent RSA had different outcomes compared with a matched control group who underwent RSA without a previous rotator cuff repair. All patients with a history of rotator cuff repair who underwent RSA between 2000 and 2015 with a minimum follow-up of two years were eligible for inclusion as the study group. Outcomes, including the American Shoulder and Elbow Surgeons (ASES) scores, were compared with a matched control group of patients who underwent RSA without having previously undergone rotator cuff repair.Aims
Patients and Methods
The factors that predispose to recurrent instability and revision
stabilization procedures after arthroscopic Bankart repair for anterior
glenohumeral instability remain unclear. We sought to determine
the rate and risk factors associated with ongoing instability in
patients undergoing arthroscopic Bankart repair for instability
of the shoulder. We used the Statewide Planning and Research Cooperative System
(SPARCS) database to identify patients with a diagnosis of anterior
instability of the shoulder undergoing arthroscopic Bankart repair
between 2003 and 2011. Patients were followed for a minimum of three
years. Baseline demographics and subsequent further surgery to the ipsilateral
shoulder were analyzed. Multivariate analysis was used to identify
independent risk factors for recurrent instability.Aims
Materials and Methods
The glenohumeral joint is the most frequently dislocated articulation, but possibly due to the lower prevalence of posterior shoulder dislocations, approximately 50% to 79% of posterior glenohumeral dislocations are missed at initial presentation. The aim of this study was to systematically evaluate the most recent evidence involving the aetiology of posterior glenohumeral dislocations, as well as the diagnosis and treatment. A systematic search was conducted using PubMed (MEDLINE), Web of Science, Embase, and Cochrane (January 1997 to September 2017), with references from articles also evaluated. Studies reporting patients who experienced an acute posterior glenohumeral joint subluxation and/or dislocation, as well as the aetiology of posterior glenohumeral dislocations, were included.Aims
Materials and Methods
The PROximal Fracture of the Humerus Evaluation by Randomisation
(PROFHER) randomised clinical trial compared the operative and non-operative
treatment of adults with a displaced fracture of the proximal humerus
involving the surgical neck. The aim of this study was to determine
the long-term treatment effects beyond the two-year follow-up. Of the original 250 trial participants, 176 consented to extended
follow-up and were sent postal questionnaires at three, four and
five years after recruitment to the trial. The Oxford Shoulder Score
(OSS; the primary outcome), EuroQol 5D-3L (EQ-5D-3L), and any recent
shoulder operations and fracture data were collected. Statistical
and economic analyses, consistent with those of the main trial were
applied.Aims
Patients and Methods
The objectives of this study were to compare postoperative pain, analgesia requirements, inpatient functional rehabilitation, time to hospital discharge, and complications in patients undergoing conventional jig-based unicompartmental knee arthroplasty (UKA) This prospective cohort study included 146 patients with symptomatic medial compartment knee osteoarthritis undergoing primary UKA performed by a single surgeon. This included 73 consecutive patients undergoing conventional jig-based mobile bearing UKA, followed by 73 consecutive patients receiving robotic-arm assisted fixed bearing UKA. All surgical procedures were performed using the standard medial parapatellar approach for UKA, and all patients underwent the same postoperative rehabilitation programme. Postoperative pain scores on the numerical rating scale and opiate analgesia consumption were recorded until discharge. Time to attainment of predefined functional rehabilitation outcomes, hospital discharge, and postoperative complications were recorded by independent observers.Aims
Patients and Methods
The Walch Type C dysplastic glenoid is characterized by excessive
retroversion. This anatomical study describes its morphology. A total of 29 shoulders with a dysplastic glenoid were analyzed.
CT was used to measure retroversion, inclination, height, width,
radius-of-curvature, surface area, depth, subluxation of the humeral
head and the Goutallier classification of fatty infiltration. The
severity of dysplasia and deficiency of the posterior rim of the
glenoid were recorded.Aims
Patients and Methods
In the initial development of total shoulder arthroplasty (TSA),
the humeral component was usually fixed with cement. Cementless
components were subsequently introduced. The aim of this study was
to compare the long-term outcome of cemented and cementless humeral
components in arthroplasty of the shoulder. All patients who underwent primary arthroplasty of the shoulder
at our institution between 1970 and 2012 were included in the study.
There were 4636 patients with 1167 cemented humeral components and
3469 cementless components. Patients with the two types of fixation
were matched for nine different covariates using a propensity score
analysis. A total of 551 well-balanced pairs of patients with cemented
and cementless components were available after matching for comparison
of the outcomes. The clinical outcomes which were analysed included loosening
of the humeral component determined at revision surgery, periprosthetic
fractures, post-operative infection and operating time.Aims
Patients and Methods
We report the clinical results of glenoid osteotomy in patients
with atraumatic posteroinferior instability associated with glenoid
dysplasia. The study reports results in 211 patients (249 shoulders) with
atraumatic posteroinferior instability. The patients comprised 63
men and 148 women with a mean age of 20 years. The posteroinferior
glenoid surface was elevated by osteotomy at the scapular neck.
A body spica was applied to maintain the arm perpendicular to the
glenoid for two weeks postoperatively. Clinical results were evaluated
using the Rowe score and Japan Shoulder Society Shoulder Instability
Score (JSS-SIS); bone union, osteoarthrosis, and articular congruity
were examined on plain radiographs.Aims
Patients and Methods
Since long-term outcome of teres major tendon transfer surgery
for irreparable posterosuperior rotator cuff (RC) tears is largely
unknown, the primary aim of this study was to evaluate the long-term
outcome of the teres major transfer. We also aimed to report on
the results of a cohort of patients with a similar indication for
surgery that underwent a latissimus dorsi tendon transfer. In this prospective cohort study, we reported on the long-term
results of 20 consecutive patients with a teres major tendon transfer
for irreparable massive posterosuperior RC tears. Additionally,
we reported on the results of the latissimus dorsi tendon transfer
(n = 19). The mean age was 60 years (47 to 77). Outcomes included
the Constant score (CS), and pain at rest and during movement using
the Visual Analogue Scale (VAS).Aims
Patients and Methods
