The purpose of this study was to examine clinical outcomes of capsular plication using subjective outcome measures and objective clinical examination with emphasis on range of motion. Data of consecutive patients (twenty-five at six months and twenty at twelve months) who required arthroscopic stabilization over a period of three years were retrospectively reviewed. At six and twelve month post-operatively, the disease specific outcome measure, ASES, and relative Constant, showed significant changes in quality of life. There was no loss of external rotation at 0° and 90° of external rotation at one year post-operatively.

The purpose of this study was firstly to assess the effectiveness of capsular plication, in the treatment of instability related pathology, using subjective outcome measures and secondly to look specifically at the effect of this procedure on range of motion.

Suture capsular plication has been advocated as a less invasive technique to reduce symptomatic capsular laxity with less morbidity than traditional open techniques. There is, however, little evidence that this procedure has the same clinical effectiveness as open capsular shift procedures.

Arthroscopic capsular plication improves quality of life (QOL) in patients suffering from shoulder instability without significantly restricting external rotation.

Data of consecutive patients who required arthroscopic stabilization over a period of three years were retrospectively reviewed. Three outcome measures were used; one disease-specific and two shoulder specific measures:

the American Shoulder & Elbow Surgeons standardized shoulder assessment form and,

Analysis involved a paired T test between the means of each outcome measure pre and post-surgery.

Twenty-five patients had complete pre-op and six- month post-op data. Twenty subjects had complete pre-op and twelve- month post-op data. At six month post-operatively, the disease specific outcome, relative Constant, and ASES showed significant improvement in QOL scores (P< 0.000, 0.006, and, 0.004 respectively). At twelve- month post surgery, change in all measures remained statistically significant. There was no loss of range of motion in external rotation at 0° or 90° of abduction between initial and follow up assessments in the clinic.

Funding: This study was supported by the research funds of the Orthopedic & Arthritic Institute, Sunnybrook and Women’s College Health Sciences Centre.

Purpose: Purpose: Prognostic factors for a satisfactory result for repaired tears have been postulated to include patient age and size of tear. The purpose of this study was to examine the impact of rotator cuff tear size on pre-operative and 2 year post-operative perceived functional level of patients undergoing repair of the full-thickness tear.

Methods: Methods: Data of 88 consecutive patients were included in data analysis. Patients were categorized into two groups: small or moderate tear (SMT) group, and large or massive tear (LMT) group. Two self-report measures - the Western Ontario Rotator Cuff Index (WORC), and the American Shoulder and Elbow Surgeons (ASES) evaluation form - were used to examine disability at baseline, and two years after surgery for repair of the rotator cuff. The Constant Murley (CM), which evaluates range of motion, strength and self-report function, was also used at the two time periods. A two-way, repeated measures analysis of co-variance (ANCOVA) compared the two groups across the two times. Covariates were age and gender.

Results: Results: Fifty-two patients (mean age = 56.6±10.4) had small or moderate and 36 (mean age = 66.7±11.3) had large or massive full-thickness tears. The results of all measures at both time periods demonstrated poorer function for the LMT group (pre WORC 31.4, post WORC 59.0; pre ASES 37.0, post ASES 65.0; pre CM 49.3, post CM 69.6) compared to the SMT group (pre WORC 38.2, post WORC 67.2; pre ASES 43.4, post ASES 73.8; pre CM 55.3, post CM 80.7). Both groups had improved function at 2 years post-operatively, but the rate of change was similar in the two groups.

Conclusions: Conclusion: The results of this study indicate that the size of a full-thickness tear of the rotator cuff has an effect on shoulder function both pre and postoperatively, but not on the pattern of recovery.

To determine if immediate closure of open wounds is safe, we examined our results over a five year period. Of the two hundred and ninety-seven open fractures, two hundred and fifty-five (86 %) were closed immediately. Grade III open fractures accounted for 24.2% of cases. The superficial infection rate was 10.9%. The combined deep infection and osteomyelitis rate was 4.7%. Neither region of injury, Gustilo grade, velocity of trauma, nor time to primary closure had a significant influence on the incidence of infection. Primary closure may be a safe practice and could be accepted as a viable treatment plan in the care of most open fractures.

The purpose of this study was to determine if immediate primary closure of open fracture wounds is a safe practice without increased deep infections and delayed/ nonunions?

There was neither an increase in deep infection nor delayed union/non-union. Benefits include a decreased requirement for repeat debridements and soft tissue procedures, minimized surgical morbidity, hospital stay, and cost of treatment. Primary closure may be a safe practice in the care of most open fractures.

The standard of care has been to leave traumatic wounds open after initial emergent surgical debridement. Due to orthopedic advancements and current resource limitations, treatment at our institution has evolved to immediate closure of all open wounds after adequate irrigation and debridement.

Of the two hundred and ninety-seven open fractures, two hundred and fifty-five (86 %) were closed immediately after irrigation and debridement. Grades 3a, 3b and 3c open fractures accounted for 24.2% of cases. The superficial infection rate of primary closure was 10.9 %. All cases resolved with oral antibiotics. The combined deep infection and osteomyelitis rate was 4.7%. Neither region of injury, Gustilo grade, velocity of trauma, nor time to primary closure had a significant influence on the incidence of infection.

The study reviewed all open fractures presenting to a Level One Trauma center over a five-year study period. Patients were followed until fracture union or complication resolution. Multiple variables were examined including patient demographics, injury mechanism, fracture location, Gustilo classification, time to antibiotic administration, surgical debridement and wound closure, and method of wound closure. Outcome measurement included infection or union problems.