The current standard of the shoulder trauma series in Ireland - A national audit.

OBJECTIVES/AIMS: The primary aim of this study was to assess the current standard of shoulder radiographs in Ireland. The secondary aim of this study was to determine whether orthopaedic surgeons in Ireland are of the opinion that a national protocol is required, and what this protocol should consist of. METHODS: A national audit of shoulder trauma series x-rays performed in emergency departments was conducted. The number and type of views performed was recorded. The anteroposterior (AP) and axillary or Velpeau views were assessed to determine if they met pre-defined audit criteria. Consultant orthopaedic surgeons working in public trauma hospitals were invited to participate in an online survey by email. RESULTS: The number of shoulder trauma series included in this audit was 789. The majority of patients had two views performed (75.92%, n â€‹= â€‹599) and 21.17% (n â€‹= â€‹167) had an axillary or Velpeau view. The AP view met the audit criteria in 23.09% (n â€‹= â€‹181) of cases. The survey response rate was 70.8% (n â€‹= â€‹17). 88.2% (n â€‹= â€‹15) of surgeons agreed that three views should be performed for a shoulder trauma series and 94.12% (n â€‹= â€‹16) agreed that an axillary or Velpeau view should be included. The majority of surgeons surveyed (94%, n â€‹= â€‹16) are in favour of establishing a national protocol. CONCLUSION: The current standard shoulder trauma series in Irish hospitals consists of two views, most frequently a thoracic AP and a scapular Y view. We propose the introduction of a national protocol consisting of three views: Grashey AP, Scapular Y, and an axillary or Velpeau view.

Kin recognition and perceived facial similarity.

Facial similarity between individuals informs kinship judgments in third-party kin recognition. Indeed, one study found that similarity and kinship judgments encapsulate the same information (Maloney & Dal Martello, 2006). Yet, another study found that this is not the case when comparing adult face pairs of different sex (DeBruine et al., 2009). We replicated these studies to further clarify the role of facial similarity in kin recognition. We recruited 318 raters, who were shown 50 sibling pairs and 50 age- and sex-matched unrelated pairs ranging from 3 to 17 years old. Each rater was randomly assigned to make either kinship judgments ("related" or "unrelated") or similarity judgments (scale from 0 [not very similar] to 10 [very similar]). The threshold model found that performance in both tasks was equally accurate, with participants detecting child siblings in the kinship task above chance and giving significantly higher similarity ratings to siblings in the similarity task. In both tasks, opposite-sex siblings were perceived to be siblings less often than same-sex siblings, and judgments of unrelated face pairs were not affected by the sex of faces. Conversely, the effect of age difference within pairs of faces differed for the two tasks: a greater age difference decreased all kinship judgments, but only decreased similarity judgments of siblings, not unrelated pairs. In line with DeBruine et al. (2009), these findings suggest that similarity and kinship judgments are highly correlated but not strictly synonymous. The OSF Pre-registration Challenge for this project can be found at osf.io/ps9hy and the data at osf.io/sef9k.

Facial masculinity is only weakly correlated with handgrip strength in young adult women.

OBJECTIVES: Ancestrally, strength is likely to have played a critical role in determining the ability to obtain and retain resources and the allocation of social status among humans. Responses to facial cues of strength are therefore thought to play an important role in human social interaction. Although many researchers have proposed that sexually dimorphic facial morphology is reliably correlated with physical strength, evidence for this hypothesis is somewhat mixed. Moreover, to date, only one study has investigated the putative relationship between facial masculinity and physical strength in women. Consequently, we tested for correlations between handgrip strength and objective measures of face-shape masculinity. METHODS: 531 women took part in the study. We measured each participant's handgrip strength (dominant hand). Sexual dimorphism of face shape was objectively measured from each face photograph using two methods: discriminant analysis and vector analysis. These methods use shape components derived from principal component analyses of facial landmarks to measure the probability of the face being classified as male (discriminant analysis method) or to locate the face on a female-male continuum (vector analysis method). RESULTS: Our analyses revealed that handgrip strength is, at best, only weakly correlated with facial masculinity in women. There was a weak significant association between handgrip strength and one measure of women's facial masculinity. The relationship between handgrip strength and our other measure of women's facial masculinity was not significant. DISCUSSION: Together, these results do not support the hypothesis that face-shape masculinity is an important cue of physical strength, at least in women.

Contribution of shape and surface reflectance information to kinship detection in 3D face images.

Previous research has established that humans are able to detect kinship among strangers from facial images alone. The current study investigated what facial information is used for making those kinship judgments, specifically the contribution of face shape and surface reflectance information (e.g., skin texture, tone, eye and eyebrow color). Using 3D facial images, 195 participants were asked to judge the relatedness of 100 child pairs, half of which were related and half of which were unrelated. Participants were randomly assigned to judge one of three stimulus versions: face images with both surface reflectance and shape information present (reflectance and shape version), face images with shape information removed but surface reflectance present (reflectance version), or face images with surface reflectance information removed but shape present (shape version). Using binomial logistic mixed models, we found that participants were able to detect relatedness at levels above chance for all three stimulus versions. Overall, both individual shape and surface reflectance information contribute to kinship detection, and both cues are optimally combined when presented together. Preprint, preregistration, code, and data are available on the Open Science Framework (osf.io/7ftxd).

No Compelling Evidence that Preferences for Facial Masculinity Track Changes in Women's Hormonal Status.

Although widely cited as strong evidence that sexual selection has shaped human facial-attractiveness judgments, findings suggesting that women's preferences for masculine characteristics in men's faces are related to women's hormonal status are equivocal and controversial. Consequently, we conducted the largest-ever longitudinal study of the hormonal correlates of women's preferences for facial masculinity ( N = 584). Analyses showed no compelling evidence that preferences for facial masculinity were related to changes in women's salivary steroid hormone levels. Furthermore, both within-subjects and between-subjects comparisons showed no evidence that oral contraceptive use decreased masculinity preferences. However, women generally preferred masculinized over feminized versions of men's faces, particularly when assessing men's attractiveness for short-term, rather than long-term, relationships. Our results do not support the hypothesized link between women's preferences for facial masculinity and their hormonal status.

SECEC Research Grant 2008 II: Use of platelet- and leucocyte-rich fibrin (L-PRF) does not affect late rotator cuff tendon healing: a prospective randomized controlled study.

BACKGROUND: Because the retear rate after rotator cuff repairs remains high, methods to improve healing are very much needed. Platelet-rich concentrates have been shown to enhance tenocyte proliferation and promote extracellular matrix synthesis in vitro; however, their clinical benefit remains unclear. We hypothesized that arthroscopic rotator cuff repair with leucocyte- and platelet-rich fibrin (L-PRF) results in better clinical and radiographic outcome at 12 months of follow-up than without L-PRF. METHODS: Thirty-five patients were randomized to receive arthroscopic rotator cuff repair with L-PRF locally applied to the repair site (L-PRF+ group, n = 17) or without L-PRF (L-PRF- group, n = 18). Preoperative and postoperative clinical evaluation included the Subjective Shoulder Value, visual analog score for pain, Simple Shoulder Test, and Constant-Murley score. The anatomic watertight healing, tendon thickness, and tendon quality was evaluated using magnetic resonance arthrography at 12 months of follow-up. RESULTS: No complications were reported in either group. The mean Subjective Shoulder Value, Simple Shoulder Test, and Constant-Murley scores increased from preoperatively to postoperatively, showing no significant differences between the groups. Complete anatomic watertight healing was found in 11 of 17 in the L-PRF+ group and in 11 of 18 in the L-PRP- group (P = .73). The mean postoperative defect size (214 ± 130 mm(2) in the L-PRF+ group vs 161 ± 149 mm(2) in the L-PRF- group; P = .391) and the mean postoperative tendon quality according to Sugaya (L-PRF+ group: 3.0 ± 1.4, L-PRF- group: 3.0 ± 0.9) were similar in both groups at 12 months of follow-up. CONCLUSION: Arthroscopic rotator cuff repair with application of L-PRF yields no beneficial effect in clinical outcome, anatomic healing rate, mean postoperative defect size, and tendon quality at 12 months of follow-up.

A cross-culture, cross-gender comparison of perspective taking mechanisms.

Being able to judge another person's visuo-spatial perspective is an essential social skill, hence we investigated the generalizability of the involved mechanisms across cultures and genders. Developmental, cross-species, and our own previous research suggest that two different forms of perspective taking can be distinguished, which are subserved by two distinct mechanisms. The simpler form relies on inferring another's line-of-sight, whereas the more complex form depends on embodied transformation into the other's orientation in form of a simulated body rotation. Our current results suggest that, in principle, the same basic mechanisms are employed by males and females in both, East-Asian (EA; Chinese) and Western culture. However, we also confirmed the hypothesis that Westerners show an egocentric bias, whereas EAs reveal an other-oriented bias. Furthermore, Westerners were slower overall than EAs and showed stronger gender differences in speed and depth of embodied processing. Our findings substantiate differences and communalities in social cognition mechanisms across genders and two cultures and suggest that cultural evolution or transmission should take gender as a modulating variable into account.

Traumatic flexor digitorum superficialis and A2-A3 pulley rupture: case report.

We present a case of simultaneous traumatic rupture of the flexor digitorum superficialis tendon and the A2 and A3 flexor tendon pulleys. Excision of the flexor digitorum superficialis tendon and reconstruction of the pulleys led to restoration of function.

Motorised mobility scooters; upper limb fractures in elderly novice users.

We describe three upper limb injuries admitted in one year to our institution resulting from falls from motorised mobility scooters (MMS) where all three users were novices, using their MMS for less than 6 weeks. They sustained injuries in close proximity to their homes, necessitating admission to hospital. None had received any formal training before commencing use of their respective devices. Use of MMS devices increases independence in mobility, enhances quality of life, improves self-esteem, facilitating social participation in everyday life. Use of these devices is not without risks, and no clear safety guidelines or competency testing exists for users. We believe these injuries in novice users highlights this deficiency, and should alert prescribers of these devices to advocate some form of driver training for new users.

Glenohumeral joint osteoarthritis is not associated with clavicle fractures in a large arthroplasty cohort.

Introduction: A recent study based on a large osteological collection reported an association between clavicle fractures and osteoarthritis of the glenohumeral joint. No clinical study has yet addressed this potential association. Other radiographic parameters such as the critical shoulder angle have been associated with the risk of glenohumeral joint osteoarthritis. The primary outcome of this study was to determine if there is an association between glenohumeral joint arthritis and clavicle fractures. The secondary outcome was to determine the association between critical shoulder angle and glenohumeral joint arthritis in our patient cohort. Methods: We retrospectively analysed 572 consecutive shoulder arthroplasty surgeries. Osteoarthritis was the indication for 343 shoulder arthroplasties. 229 shoulder arthroplasties were performed due to another diagnosis such as trauma or fracture, cuff arthropathy, or revision surgery. Three fellowship trained consultant shoulder surgeons assessed the pre- and post-operative radiographs of all patients. Results: A clavicle fracture was suspected in 5/343 (1.5 %) shoulder arthroplasties performed due to osteoarthritis and 5/229 (2.1 %) shoulder arthroplasties performed for another diagnosis. Interobserver variability was assessed using a Fisher Exact test and showed no significant relationship between osteoarthritis and a fracture of the clavicle (p = 0.531). Critical shoulder angle results correlated with the previously published literature regarding critical shoulder angle and osteoarthritis and rotator cuff arthropathy. Conclusion: Clavicle fractures were not associated with glenohumeral osteoarthritis in our patient cohort of shoulder arthroplasty patients. Critical shoulder angle results were consistent with published literature. Further research in the form of prospective long term studies are needed to establish if any association exists between clavicle fractures and osteoarthritis of the glenohumeral joint. Level of evidence: Level III. Retrospective analysis.

Alleged recurrent traumatic shoulder dislocation in a young male patient - Diagnostic and management considerations.

A young male presented to a nearby hospital with a left shoulder dislocation after an alleged kickboxing injury. The patient reported worrying clinical findings including excruciating pain and absent sensation distally. Reduction was successful but his shoulder re-dislocated shortly after. His reported symptoms worsened and he was transferred to our institution. Imaging findings were not immediately concerning and he went to theatre the next day for an examination under anaesthetic. His shoulder was re-located easily and an immobiliser applied. Less than an hour later, the patient managed to re-dislocate his shoulder in recovery. He was subjected to another general anaesthetic and successful reduction. He absconded the following day after being declined multiple and increasing doses of opioid analgesia. He re-presented three weeks later with similar clinical findings but a different mechanism of injury. Further exploration of his collateral history revealed that he had been using a false identity. He had presented to all hospitals in our city within the previous 6 months. Once confronted, he did not return to these hospitals. He was also capable of self-relocating his shoulder. This case bore a striking resemblance to a case described by Warren in 2000 of a young lady with an apparently dislocated shoulder presenting to multiple city hospitals looking for analgesia and general anaesthetics. We wished to highlight the diagnostic and ethical challenges associated with these patients. They are vulnerable and so a high index of clinical suspicion is needed on the part of the surgeon to avoid unnecessary interventions. Effective communication between orthopaedic departments is a key recommendation from this case to mitigate risk of harm to these patients.

Modified trauma assessment clinic: A rapid, scalable model.

INTRODUCTION: Trauma Assessment Clinic (TAC) has become a very useful tool in managing busy trauma clinics and reducing attendances. There is good evidence of safety and efficacy. Extension of pre-existing TAC during the COVID pandemic has proven successful. Rapid start-up models for establishing TACs are not well described in the literature. This study aimed to prove that a modified TAC has similar efficacy and can be initiated in rapid start-up manner with minimal cost. METHODS: A new electronic pathway of referral with a template was created between the Emergency Department (ED) and the Orthopaedic department. RESULTS: Following introduction of our modified TAC 32% of patients referred to the TAC did not require in-person review thereby avoiding any additional hospital visit. Average time to first in-person review appointment was 15 days. Combining these, the projected reduction in all fracture clinic attendance was 48%. CONCLUSION: This paper describes the process of how a major teaching and tertiary referral orthopaedic unit developed an accelerated establishment process for a Trauma Assessment Clinic as an alternative to the traditional "Glasgow model". This can be instituted quickly, safely, and is scalable for use in a large hospital. The template provided can be used as a guide or "blueprint" should other orthopaedic departments require a rapid start-up of a Trauma Assessment Clinic.

No increased inbreeding avoidance during the ovulatory phase of the menstrual cycle.

Mate preferences and mating-related behaviours are hypothesised to change over the menstrual cycle to increase reproductive fitness. Recent large-scale studies suggest that previously reported hormone-linked behavioural changes are not robust. The proposal that women's preference for associating with male kin is down-regulated during the ovulatory (high-fertility) phase of the menstrual cycle to reduce inbreeding has not been tested in large samples. Consequently, we investigated the relationship between longitudinal changes in women's steroid hormone levels and their perceptions of faces experimentally manipulated to possess kinship cues (Study 1). Women viewed faces displaying kinship cues as more attractive and trustworthy, but this effect was not related to hormonal proxies of conception risk. Study 2 employed a daily diary approach and found no evidence that women spent less time with kin generally or with male kin specifically during the fertile phase of the menstrual cycle. Thus, neither study found evidence that inbreeding avoidance is up-regulated during the ovulatory phase of the menstrual cycle.

Bony increased-offset reversed shoulder arthroplasty: minimizing scapular impingement while maximizing glenoid fixation.

BACKGROUND: Scapular notching, prosthetic instability, limited shoulder rotation and loss of shoulder contour are associated with conventional medialized design reverse shoulder arthroplasty. Prosthetic (ie, metallic) lateralization increases torque at the baseplate-glenoid interface potentially leading to failure. QUESTIONS/PURPOSES: We asked whether bony lateralization of reverse shoulder arthroplasty would avoid the problems caused by humeral medialization without increasing torque or shear force applied to the glenoid component. PATIENTS AND METHODS: We prospectively followed 42 patients with rotator cuff deficiency treated with bony increased-offset reverse shoulder arthroplasty. A cylinder of autologous cancellous bone graft, harvested from the humeral head, was placed between the reamed glenoid surface and baseplate. Graft and baseplate fixation was achieved using a lengthened central peg (25 mm) and four screws. Patients underwent clinical, radiographic, and CT assessment at a minimum of 2 years after surgery. RESULTS: The humeral graft incorporated completely in 98% of cases (41 of 42) and partially in one. At a mean of 28 months postoperatively, no graft resorption, glenoid loosening, or postoperative instability was observed. Inferior scapular notching occurred in 19% (eight of 42). The absolute Constant-Murley score improved from 31 to 67. Thirty-six patients (86%) were able to internally rotate sufficiently to reach their back over the sacrum. CONCLUSIONS: Grafting of the glenoid surface during reverse shoulder arthroplasty effectively creates a long-necked scapula, providing the benefits of lateralization. Bony increased-offset reverse shoulder arthroplasty is associated with low rates of inferior scapular notching, improved shoulder rotation, no prosthetic instability and improved shoulder contour. In contrast to metallic lateralization, bony lateralization has the advantage of maintaining the prosthetic center of rotation at the prosthesis-bone interface, thus minimizing torque on the glenoid component. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Do 3D Face Images Capture Cues of Strength, Weight, and Height Better than 2D Face Images do?

OBJECTIVES: A large literature exists investigating the extent to which physical characteristics (e.g., strength, weight, and height) can be accurately assessed from face images. While most of these studies have employed two-dimensional (2D) face images as stimuli, some recent studies have used three-dimensional (3D) face images because they may contain cues not visible in 2D face images. As equipment required for 3D face images is considerably more expensive than that required for 2D face images, we here investigated how perceptual ratings of physical characteristics from 2D and 3D face images compare. METHODS: We tested whether 3D face images capture cues of strength, weight, and height better than 2D face images do by directly comparing the accuracy of strength, weight, and height ratings of 182 2D and 3D face images taken simultaneously. Strength, height and weight were rated by 66, 59 and 52 raters respectively, who viewed both 2D and 3D images. RESULTS: In line with previous studies, we found that weight and height can be judged somewhat accurately from faces; contrary to previous research, we found that people were relatively inaccurate at assessing strength. We found no evidence that physical characteristics could be judged more accurately from 3D than 2D images. CONCLUSION: Our results suggest physical characteristics are perceived with similar accuracy from 2D and 3D face images. They also suggest that the substantial costs associated with collecting 3D face scans may not be justified for research on the accuracy of facial judgments of physical characteristics.

Are affective factors related to individual differences in facial expression recognition?

Evidence that affective factors (e.g. anxiety, depression, affect) are significantly related to individual differences in emotion recognition is mixed. Palermo et al. (Palermo et al. 2018 J. Exp. Psychol. Hum. Percept. Perform. 44, 503-517) reported that individuals who scored lower in anxiety performed significantly better on two measures of facial-expression recognition (emotion-matching and emotion-labelling tasks), but not a third measure (the multimodal emotion recognition test). By contrast, facial-expression recognition was not significantly correlated with measures of depression, positive or negative affect, empathy, or autistic-like traits. Because the range of affective factors considered in this study and its use of multiple expression-recognition tasks mean that it is a relatively comprehensive investigation of the role of affective factors in facial expression recognition, we carried out a direct replication. In common with Palermo et al. (Palermo et al. 2018 J. Exp. Psychol. Hum. Percept. Perform. 44, 503-517), scores on the DASS anxiety subscale negatively predicted performance on the emotion recognition tasks across multiple analyses, although these correlations were only consistently significant for performance on the emotion-labelling task. However, and by contrast with Palermo et al. (Palermo et al. 2018 J. Exp. Psychol. Hum. Percept. Perform. 44, 503-517), other affective factors (e.g. those related to empathy) often also significantly predicted emotion-recognition performance. Collectively, these results support the proposal that affective factors predict individual differences in emotion recognition, but that these correlations are not necessarily specific to measures of general anxiety, such as the DASS anxiety subscale.

Bony Increased Offset-Reversed Shoulder Arthroplasty (BIO-RSA).

INTRODUCTION: Bony increased offset-reversed shoulder arthroplasty (BIO-RSA) is an effective and safe means of achieving lateralization of the prosthetic center of rotation in reverse shoulder arthroplasty. STEP 1 PREOPERATIVE PLANNING: Confirm the indication for surgery and obtain radiographs and 3-dimensional (3D) imaging (computed tomography [CT] or magnetic resonance imaging [MRI] scans) to confirm the suitability for a BIO-RSA. STEP 2 PATIENT POSITIONING AND SURGICAL APPROACH VIDEO 1: With the patient in the beach-chair position, approach the shoulder via a standard deltopectoral approach. STEP 3 HARVESTING OF HUMERAL GRAFT AND INITIAL HUMERAL PREPARATION: Dislocate the humeral head anteriorly and use the instrumentation to harvest a 29-mm fully cancellous graft of desired thickness from the humeral head. STEP 4 GLENOID EXPOSURE PREPARATION AND PROSTHETIC IMPLANTATION: Carefully and meticulously expose and prepare the glenoid for prosthetic implantation. STEP 5 HUMERAL PREPARATION AND PROSTHETIC IMPLANTATION: Prepare and implant the humeral prosthesis as per the standard surgical technique described for implantation of the Aequalis Reversed prosthesis10. STEP 6 POSTOPERATIVE MANAGEMENT: Postoperative management is the same as that for a nonlateralized reverse prosthesis, with no alteration in rehabilitation required. RESULTS: In our original series of 42 patients with a minimum follow-up of 2 years (mean, 28 months), the glenoid bone graft incorporated completely in 41 patients and partially in 1 patient (Fig. 5)6.

Arthroscopic Hill-Sachs Remplissage with Bankart Repair: Strategy and Technique.

INTRODUCTION: Arthroscopic Hill-Sachs remplissage describes the fixation of the posterior aspect of the capsule and the infraspinatus tendon into a posterosuperior humeral head impaction fracture in cases of recurrent anteroinferior glenohumeral instability. STEP 1 ANTERIOR CAPSULOLABRAL MOBILIZATION AND GLENOID PREPARATION: Perform diagnostic arthroscopy through a standard posterior portal to rule out additional pathology and document the "engaging" nature of the Hill-Sachs defect. STEP 2 PREPARATION OF THE HILL-SACHS DEFECT: With the camera remaining in the posterior portal, the assistant provides visualization of the Hill-Sachs defect by translating the humeral head anteriorly over the glenoid rim with direct pressure on the proximal part of the humerus. STEP 3 REMPLISSAGE WITH THE POSTERIOR ASPECT OF THE CAPSULE AND INFRASPINATUS TENDON: Transfer the camera to the anterior portal and leave a switching stick in the posterior portal; under direct visualization, withdraw the posterolateral cannula from the posterior aspect of the capsule and the infraspinatus tendon until it rests in the subdeltoid space (∼1 cm). STEP 4 ANTERIOR BANKART REPAIR: Transition the camera back to the standard posterior portal over a switching stick in order to perform the Bankart repair. STEP 5 POSTOPERATIVE REHABILITATION PROTOCOL: Patients wear a brace and perform pendulum exercises for four weeks, and then initiate range-of-motion exercises; they avoid strengthening for eight weeks and sports for three to six months. RESULTS: In our recently published series of forty-seven patients (forty-two male and five female; average age, twenty-nine years), the use of Bankart repair combined with Hill-Sachs remplissage performed according to the above algorithm resulted in 98% of the patients being satisfied or very satisfied with their surgical result and a recurrent instability rate of only 2% at a mean of twenty-four months postoperatively.IndicationsContraindicationsPitfalls & Challenges.

Two-stage reconstruction with the modified Paneva-Holevich technique.

Flexor tendon reconstruction poses both a technical challenge to the hand surgeon and a rehabilitative challenge to the patient and therapist. The modified Paneva-Holevich technique, using a pedicled intra-synovial graft, is a safe and reliable means of staged flexor tendon reconstruction, offering a number of theoretical advantages over classic free-tendon grafting techniques. Clinical outcomes are at the least comparable, if not superior, to those achieved following free-tendon techniques with most authors reporting a low requirement for third stage tenolysis.

Fractures of the hamate and pisiform bones.

Osseous injuries to the ulnar aspect of the carpus are increasing in frequency because of greater participation in sporting activities. Hamate body fractures are subdivided into coronal, sagittal oblique, proximal pole, and medial tuberosity fractures. Successful treatment of coronal fractures requires identification and treatment of associated disruption or instability of the ulnar 2 carpometacarpal joints. Displaced hamate hook fractures are optimally treated with early excision to avoid sequelae such as flexor tendon and nerve injury, and to allow early return to activity. Undisplaced pisiform fractures are managed nonoperatively, whereas displaced fractures and nonunions are treated by simple excision.