The Oxford Shoulder Score (OSS) is a 12-item measure commonly used for the assessment of shoulder surgeries. This study explores whether computerized adaptive testing (CAT) provides a shortened, individually tailored questionnaire while maintaining test accuracy. A total of 16,238 preoperative OSS were available in the National Joint Registry (NJR) for England, Wales, Northern Ireland, the Isle of Man, and the States of Guernsey dataset (April 2012 to April 2022). Prior to CAT, the foundational item response theory (IRT) assumptions of unidimensionality, monotonicity, and local independence were established. CAT compared sequential item selection with stopping criteria set at standard error (SE) < 0.32 and SE < 0.45 (equivalent to reliability coefficients of 0.90 and 0.80) to full-length patient-reported outcome measure (PROM) precision.Aims
Methods
Distal third clavicle (DTC) fractures are increasing in incidence. Due to their instability and nonunion risk, they prove difficult to treat. Several different operative options for DTC fixation are reported but current evidence suggests variability in operative fixation. Given the lack of consensus, our objective was to determine the current epidemiological trends in DTC as well as their management within the UK. A multicentre retrospective cohort collaborative study was conducted. All patients over the age of 18 with an isolated DTC fracture in 2019 were included. Demographic variables were recorded: age; sex; side of injury; mechanism of injury; modified Neer classification grading; operative technique; fracture union; complications; and subsequent procedures. Baseline characteristics were described for demographic variables. Categorical variables were expressed as frequencies and percentages.Aims
Methods
There remains a lack of consensus regarding the management of chronic anterior sternoclavicular joint (SCJ) instability. This study aimed to assess whether a standardized treatment algorithm (incorporating physiotherapy and surgery and based on the presence of trauma) could successfully guide management and reduce the number needing surgery. Patients with chronic anterior SCJ instability managed between April 2007 and April 2019 with a standardized treatment algorithm were divided into non-traumatic (offered physiotherapy) and traumatic (offered surgery) groups and evaluated at discharge. Subsequently, midterm outcomes were assessed via a postal questionnaire with a subjective SCJ stability score, Oxford Shoulder Instability Score (OSIS, adapted for the SCJ), and pain visual analogue scale (VAS), with analysis on an intention-to-treat basis.Aims
Methods
Long-term outcomes following the use of human dermal allografts in the treatment of symptomatic irreparable rotator cuff tears are not known. The aim of this study was to evaluate these outcomes, and to investigate whether this would be a good form of treatment in young patients in whom a reverse shoulder arthroplasty should ideally be avoided. This prospective study included 47 shoulders in 45 patients who underwent an open reconstruction of the rotator cuff using an interposition GraftJacket allograft to bridge irreparable cuff tears, between January 2007 and November 2011. The Oxford Shoulder Score (OSS), pain score, and range of motion (ROM) were recorded preoperatively and at one year and a mean of 9.1 years (7.0 to 12.5) postoperatively.Aims
Methods
The main objective of this study was to examine whether the Oxford Shoulder Score (OSS) demonstrated floor or ceiling effects when used to measure outcomes following shoulder arthroplasty in a large national cohort. Secondary objectives were to assess its pain and function subscales, and to identify independent predictors for patients achieving a postoperative ceiling score following shoulder arthroplasty. Secondary database analysis of the National Joint Registry (NJR), which included 48,270 patients undergoing shoulder arthroplasty, was conducted. The primary outcome measure was the OSS. Secondary outcome measures were the OSS-Function Component Subscale and OSS-Pain Component Subscale. Floor and ceiling effects were considered to be present if > 15% of patients scored either the lowest or highest possible score. Logistic regression analysis was used to identify independent predictors for scoring the highest possible OSS score postoperatively.Aims
Methods
Our aim was to compare the outcome of arthroscopic
release for frozen shoulder in patients with and without diabetes.
We prospectively compared the outcome in 21 patients with and 21
patients without diabetes, two years post-operatively. The modified
Constant score was used as the outcome measure. The mean age of
the patients was 54.5 years (48 to 65; male:female ratio: 18:24),
the mean pre-operative duration of symptoms was 8.3 months (6 to
13) and the mean pre-operative modified Constant scores were 36.6
(standard deviation ( Cite this article:
A total of 92 patients with symptoms for over
six months due to subacromial impingement of the shoulder, who were
being treated with physiotherapy, were included in this study. While
continuing with physiotherapy they waited a further six months for
surgery. They were divided into three groups based on the following
four clinical and radiological criteria: temporary benefit following
steroid injection, pain in the mid-arc of abduction, a consistently positive
Hawkins test and radiological evidence of impingement. Group A fulfilled
all four criteria, group B three criteria and group C two criteria.
A total of nine patients improved while waiting for surgery and
were excluded, leaving 83 who underwent arthroscopic subacromial
decompression (SAD). The new Oxford shoulder score was recorded
pre-operatively and at three and 12 months post-operatively. A total of 51 patients (group A) had a significant improvement
in the mean shoulder score from 18 (13 to 22) pre-operatively to
38 (35 to 42) at three months (p <
0.001). The mean score in
this group was significantly better than in group B (21 patients)
and C (11 patients) at this time. At one year patients in all groups
showed improvement in scores, but patients in group A had a higher
mean score (p = 0.01). At one year patients in groups A and B did
better than those in group C (p = 0.01). Arthroscopic SAD is a beneficial intervention in selected patients.
The four criteria could help identify patients in whom it is likely
to be most effective.
A displaced fracture of the scaphoid is one in
which the fragments have moved from their anatomical position or there
is movement between them when stressed by physiological loads. Displacement
is seen in about 20% of fractures of the waist of the scaphoid,
as shown by translation, a gap, angulation or rotation. A CT scan
in the true longitudinal axis of the scaphoid demonstrates the shape
of the bone and displacement of the fracture more accurately than
do plain radiographs. Displaced fractures can be treated in a plaster
cast, accepting the risk of malunion and nonunion. Surgically the
displacement can be reduced, checked radiologically, arthroscopically
or visually, and stabilised with headless screws or wires. However,
rates of union and deformity are unknown. Mild malunion is well
tolerated, but the long-term outcome of a displaced fracture that
healed in malalignment has not been established. This paper summarises aspects of the assessment, treatment and
outcome of displaced fractures of the waist of the scaphoid.
