1. Arthrography demonstrates two types of injury to the capsule in acute anterior dislocations of the shoulder. 2. The first is a capsular rupture which does not appear to lead to recurrent dislocation of the shoulder unless there is concomitant humeral head damage. In this group healing is complete in ten days and it should be safe to start exercises early. 3. The second is associated with labral detachment from the glenoid and most heal with immobilisation for three weeks. Failure to heal leads to recurrent dislocation. It is not known whether immobilisation had any influence on healing of the lesion in these patients and this remains the subject of further investigation. 4. In recurrent anterior dislocation of the shoulder there is constant enlargement of the subscapular bursa, the outline of which becomes continuous with the inferior pouch. Axial arthrographs show either an absence of the glenoid labral outline or an enlarged entrance to the subscapular bursa. 5. Ruptures of the supraspinatus portion of the tendinous cuff were seen in five patients out of a total of twenty-seven acute dislocations, suggesting that this associated injury is more common than was previously believed. POSTERIOR DISLOCATIONS. 6. When the dislocation is voluntary there is marked elasticity of the capsule but the joint is only unstable in one direction when examined under anaesthesia. Both shoulders appear equally affected when examined radiologically under general anaesthesia even though the patient only has the ability to dislocate one. 7. All patients with voluntary dislocation had a curious voluntary muscle control and were able to contract the anterior and posterior parts of
The purpose of this study was to determine whether there were long-term differences in outcomes of reverse shoulder arthroplasty (RSA) undertaken for acute proximal humeral fracture versus rotator cuff deficiency with a minimum follow-up of five years. This was a prospective cohort study comparing 67 patients with acute complex proximal humeral fracture and 64 patients with irreparable rotator cuff deficiency who underwent primary RSA. In the fracture group, there were 52 (77.6%) females and 15 (22.4%) males, with a mean age of 73.5 years (51 to 85), while in the arthropathy group, there were 43 (67.1%) females and 21 (32.9%) males, with a mean age of 70.6 years (50 to 84). Patients were assessed by the Constant score, University of California Los Angeles shoulder score (UCLA), short version of the Disability of the Arm Shoulder and Hand score (QuickDASH), and visual analogue scales (VAS) for pain and satisfaction. Radiological evaluation was also performed.Aims
Methods
The aim of this study was to determine the current incidence and epidemiology of humeral diaphyseal fractures. The secondary aim was to explore variation in patient and injury characteristics by fracture location within the humeral diaphysis. Over ten years (2008 to 2017), all adult patients (aged ≥ 16 years) sustaining an acute fracture of the humeral diaphysis managed at the study centre were retrospectively identified from a trauma database. Patient age, sex, medical/social background, injury mechanism, fracture classification, and associated injuries were recorded and analyzed.Aims
Methods
Acromial fractures following reverse shoulder arthroplasty (RSA) have a wide range of incidences in reported case series. This study evaluates their incidence following RSA by systematically reviewing the current literature. A systematic review using the search terms “reverse shoulder”, “reverse total shoulder”, or “inverted shoulder” was performed using PubMed, Web of Science, and Cochrane databases between 1 January 2010 and 31 March 2018. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. Studies were included if they reported on RSA outcomes and the incidence rate of acromial and/or scapular spine fractures. The rate of these fractures was evaluated for primary RSA, revision RSA, RSA indications, and RSA implant design.Aims
Materials and Methods
The purpose of this study was to determine the functional outcome and implant survivorship of mobile-bearing total ankle arthroplasty (TAA) performed by a single surgeon. We reviewed 205 consecutive patients (210 ankles) who had undergone mobile-bearing TAA (205 patients) for osteoarthritis of the ankle between January 2005 and December 2015. Their mean follow-up was 6.4 years (2.0 to 13.4). Functional outcome was assessed using the Ankle Osteoarthritis Scale, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, 36-Item Short-Form Health Survey (SF-36) score, visual analogue scale, and range of movement. Implant survivorship and complications were also evaluated.Aims
Patients and Methods
The primary aim of this study was to address the hypothesis that fracture morphology might be more important than posterior malleolar fragment size in rotational type posterior malleolar ankle fractures (PMAFs). The secondary aim was to identify clinically important predictors of outcome for each respective PMAF-type, to challenge the current dogma that surgical decision-making should be based on fragment size. This observational prospective cohort study included 70 patients with operatively treated rotational type PMAFs, respectively: 23 Haraguchi Type I (large posterolateral-oblique), 22 Type II (two-part posterolateral and posteromedial), and 25 (avulsion-) Type III. There was no standardized protocol on how to address the PMAFs and CT-imaging was used to classify fracture morphology and quality of postoperative syndesmotic reduction. Quantitative 3D-CT (Q3DCT) was used to assess the quality of fracture reduction, respectively: the proportion of articular involvement; residual intra-articular: gap, step-off, and 3D-displacement; and residual gap and step-off at the fibular notch. These predictors were correlated with the Foot and Ankle Outcome Score (FAOS) at two-years follow-up.Aims
Methods
The medial malleolus, once believed to be the primary stabilizer of the ankle, has been the topic of conflicting clinical and biomechanical data for many decades. Despite the relevant surgical anatomy being understood for almost 40 years, the optimal treatment of medial malleolar fractures remains unclear, whether the injury occurs in isolation or as part of an unstable bi- or trimalleolar fracture configuration. Traditional teaching recommends open reduction and fixation of medial malleolar fractures that are part of an unstable injury. However, there is recent evidence to suggest that nonoperative management of well-reduced fractures may result in equivalent outcomes, but without the morbidity associated with surgery. This review gives an update on the relevant anatomy and classification systems for medial malleolar fractures and an overview of the current literature regarding their management, including surgical approaches and the choice of implants. Cite this article: Abstract
To date, no study has considered the impact of acromial morphology on shoulder range of movement (ROM). The purpose of our study was to evaluate the effects of lateralization of the centre of rotation (COR) and neck-shaft angle (NSA) on shoulder ROM after reverse shoulder arthroplasty (RSA) in patients with different scapular morphologies. 3D computer models were constructed from CT scans of 12 patients with a critical shoulder angle (CSA) of 25°, 30°, 35°, and 40°. For each model, shoulder ROM was evaluated at a NSA of 135° and 145°, and lateralization of 0 mm, 5 mm, and 10 mm for seven standardized movements: glenohumeral abduction, adduction, forward flexion, extension, internal rotation with the arm at 90° of abduction, as well as external rotation with the arm at 10° and 90° of abduction.Objectives
Methods
The present study aimed to investigate the long-term functional
results of scapulothoracic fusion using multifilament cables in
patients with facioscapulohumeral dystrophy (FSHD) to identify if
the early improvement from this intervention is maintained. We retrospectively investigated the long-term outcomes of 13
patients with FSHD (18 shoulders) in whom scapulothoracic fusion
using multifilament cables was performed between 2004 and 2007.
These patients have previously been reported at a mean of 35.5 months
(24 to 87). There were eight men and five women with a mean age
of 26 years. Their mean length of follow-up of our current study
was 128 months (94 to 185). To evaluate long-term functional results,
the range of shoulder flexion and abduction, Quick Disabilities
of the Arm, Shoulder and Hand (QuickDASH) scores were analyzed with
a comparison of preoperatively, interim and at the final outcomes. The
fusion was examined radiographically in all.Aims
Patients and Methods
The purpose of this study was to report the long-term results of extendable endoprostheses of the humerus in children after the resection of a bone sarcoma. A total of 35 consecutive patients treated with extendable endoprosthetic replacement of the humerus in children were included. There were 17 boys and 18 girls in the series with a median age at the time of initial surgery of nine years (interquartile range (IQR) 7 to 11).Aims
Methods
The aim of this study was to report the outcomes of different treatment options for glenoid loosening following reverse shoulder arthroplasty (RSA) at a minimum follow-up of two years. We retrospectively studied the records of 79 patients (19 men, 60 women; 84 shoulders) aged 70.4 years (21 to 87) treated for aseptic loosening of the glenosphere following RSA. Clinical evaluation included pre- and post-treatment active anterior elevation (AAE), external rotation, and Constant score.Aims
Patients and Methods
The reasons for failure of a hemirthroplasty (HA) when used to
treat a proximal humeral fracture include displaced or necrotic
tuberosities, insufficient metaphyseal bone-stock, and rotator cuff
tears. Reverse total shoulder arthroplasty (rTSA) is often the only
remaining form of treatment in these patients. The aim of this study
was to evaluate the clinical outcome after conversions from a failed
HA to rTSA. A total of 35 patients, in whom a HA, as treatment for a fracture
of the proximal humerus, had failed, underwent conversion to a rTSA.
A total of 28 were available for follow-up at a mean of 61 months
(37 to 91), having been initially reviewed at a mean of 20 months
(12 to 36) postoperatively. Having a convertible design, the humeral
stem could be preserved in nine patients. The stem was removed in
the other 19 patients and a conventional rTSA was implanted. At
final follow-up, patients were assessed using the American Shoulder
and Elbow Surgeons (ASES) score, the Constant Score, and plain radiographs.Aims
Material and Methods
Stable fractures of the ankle can be safely treated
non-operatively. It is also gradually being recognised that the integrity
of the ‘medial column’ is essential for the stability of the fracture.
It is generally thought that bi- and tri-malleolar fractures are
unstable, as are pronation external rotation injuries resulting
in an isolated high fibular fracture (Weber type-C), where the deltoid
ligament is damaged or the medial malleolus fractured. However,
how best to identify unstable, isolated, trans-syndesmotic Weber
type-B supination external rotation (SER) fractures of the lateral
malleolus remains controversial. We provide a rationale as to how to classify SER distal fibular
fractures using weight-bearing radiographs, and how this can help
guide the management of these common injuries. Cite this article:
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
In order to determine whether and for whom serial radiological evaluation is necessary in one-part proximal humerus fractures, we set out to describe the clinical history and predictors of secondary displacement in patients sustaining these injuries. Between January 2014 and April 2016, all patients with an isolated, nonoperatively treated one-part proximal humerus fracture were prospectively followed up. Clinical and radiological evaluation took place at less than two, six, 12, and 52 weeks. Fracture configuration, bone quality, and comminution were determined on the initial radiographs. Fracture healing, secondary displacement, and treatment changes were recorded during follow-up.Aims
Patients and Methods
