Isolated volar dislocation of the distal radioulnar joint: Current concepts review and case report.

Isolated volar distal radioulnar joint (DRUJ) dislocation is a rare condition with only a few cases reported in the literature. Its diagnosis is often overlooked in the acute phase, and there is no consensus in its management. We present the case of a 20-year-old male patient with an isolated volar radioulnar dislocation, together with a review of the literature. The aim is to present and summarize the acute management of this condition and propose a therapeutic algorithm.

Latarjet in women for anterior shoulder instability: a case series analysis.

PURPOSE: The Latarjet procedure is traditionally used to treat chronic anterior shoulder instability associated with glenoid bone loss. However, few series have analyzed outcomes in a female-only population. The objective of this study was to evaluate the clinical and radiological outcomes of a Latarjet bone block in this specific population. METHODS: This single-center retrospective study included 15 women (mean age 35 ± 11.3; 19-60) reviewed with a minimum follow-up of 2 years. The procedure was performed using the open bone block screw technique (n = 7) or by arthroscopy with cortical button (n = 8). Clinical evaluation was based on active range of motion measurements, Rowe and Walch-Duplay scores, and subjective shoulder value (SSV). Radiographic analysis explored bone block healing at the last follow-up. RESULTS: At a mean follow-up of 48 months (32-86), no recurrence was reported. The mean Rowe score was 91 points (70-100), Walch-Duplay 90 points (60-100), and SSV 87% (70-100). The active mobilities reached 169° (± 9°) in elevation, 57° (± 15°) in external rotation at side, and 89° (± 6°) in abduction. The return-to-sport rate was 91%. Five patients experienced persistent anterior pain, with screws requiring hardware removal in 2 (p = 0.02). Radiological assessment detected one case of nonunion (7%). CONCLUSION: Women treated with the Latarjet procedure experienced satisfactory midterm clinical outcomes. The arthroscopic technique using cortical button fixation seems to avoid residual anterior pain requiring hardware removal.

Reverse shoulder arthroplasty renders better clinical scores at a minimum follow-up of two years for patients with no rotator cuff deficiency operated by the deltopectoral approach.

PURPOSE: The purpose of this multi-centre study was to report outcomes of a large cohort of reverse shoulder arthroplasty (RSA) at a minimum follow-up of two years and to determine patient and surgical factors that influence postoperative outcomes. The hypothesis was that surgical indication, surgical approach, and implant design would affect clinical outcomes significantly. METHODS: The authors reviewed records of 743 RSAs in patients with primary osteoarthritis (OA) with or without rotator cuff (RC) tears, secondary OA due to RC tears, and irreparable massive rotator cuff tears (mRCT). The deltopectoral (DP) approach was used in 540 and the anterosuperior (AS) approach in 203. Pre- and postoperative Constant scores (CS) were recorded. Multivariable linear analyses were performed to determine if CS was associated with indications for surgery, surgical approach, or implant design. RESULTS: Of the 743 shoulders, 193 (25.7%) were lost to follow-up, 16 (2.1%) died, and 33 (4.4%) were revised, leaving 501 for analysis. At a mean follow-up of 3.2 ± 0.9 years, net improvement in CS was 29.2 ± 17.0. Multivariable analyses revealed that postoperative CS decreased with age and was worse in shoulders that had preoperative rotator cuff deficiency and in shoulders operated by the AS approach. Multivariable analyses also revealed worse net improvement in shoulders operated for secondary OA due to RC tears or for irreparable mRCT, as well as shoulders operated by the AS approach. CONCLUSION: This large multi-centre study confirms that, at two or more years following RSA, Constant scores are not associated with implant design, but rather with rotator cuff deficiency and surgical approach. Multivariable analysis revealed that postoperative CS was worse for shoulders with preoperative rotator cuff deficiency and for shoulders operated by the AS approach. Multivariable analysis also revealed that net improvement in CS was worse in shoulders treated for secondary OA due to RC tears and for shoulders with irreparable mRCT, as well as for shoulders operated by the AS approach.

Arthroscopic double-button Latarjet: two-thirds of bone block healed at 90 days.

PURPOSE: The aim of this study was to evaluate the union rate and risk factors for delayed union in the early postoperative period after an arthroscopic Latarjet with double-button fixation. METHOD: In a retrospective study, postoperative CT scans at 3 months were analysed following an arthroscopic Latarjet with double-button fixation used to treat anterior shoulder instability. Healing of the bone block, its position in the sagittal and coronal planes, and the contact area graft/scapula were analysed. RESULTS: Ninety-eight CT scans (98 patients) were included. The rate of healing at 3 months was 63/98 (64%) and four grafts clearly migrated. The position was perfectly flush to the glenoid rim in 67% and under the equator in 96%. The mean contact graft/scapula area was 135 mm 2 (4-420). In multivariate analysis, the risk of non-union at 3 months was associated with tobacco consumption (p = 0.001, aOR = 12.17 95% CI [2.62-56.49]), absence of preoperative glenoid bone defect (p = 0.003, aOR = 8.06 95% CI [2.06-31.56]), and a contact area graft/scapula less than 120 mm 2 (p = 0.010, aOR = 5.25 95% CI [1.50-18.40]). Among 31 non-united grafts, 93% definitively healed on CT scan at 1 year, leaving an overall rate of 93% of united grafts at last follow-up. CONCLUSIONS: The rate of union at 3 months after an arthroscopic Latarjet with double-button fixation was 64%, reaching 93% at 1 year. This procedure should be carefully indicated in case of tobacco use or instability without glenoid bone defect, especially when the shoulder is exposed to high-energy trauma in the early phase after surgery.

Vancomycin Soaking to Reduce Intraoperative Contamination by Cutibacterium acnes During the Latarjet Procedure.

BACKGROUND: Postoperative infection after the Latarjet procedure, ranging from 1% to 6%, can compromise the functional outcome of young athletes. Cutibacterium acnes is a main pathogen as a consequence of an intraoperative contamination. PURPOSE: To evaluate intraoperative contamination with C. acnes and the effectiveness of the local application of vancomycin during the Latarjet procedure. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: This was a single-center study including 75 patients (mean age, 26 years; range, 15-55 years) operated on for anterior shoulder instability with the primary open Latarjet procedure; they underwent the same protocol of skin preparation and preoperative prophylactic antibiotics. Three groups of 25 patients were created and divided sequentially, without the results of each group being known before the end of the study: group A (5 mg/mL of vancomycin), group B (20 mg/mL of vancomycin), and group C (control group with no vancomycin). Swab samples of the coracoid were taken before sectioning the coracoid process (time 1) and after its preparation (time 2). The coracoid was then wrapped in gauze impregnated with different concentrations of vancomycin, except for group C. A final sample (time 3) was taken before screwing the bone block onto the glenoid. All samples were cultured for 21 days, and patients underwent clinical and radiological follow-up for 6 months. RESULTS: The C. acnes contamination rates at times 1, 2, and 3 were 25%, 44%, and 45%, respectively, without significant difference. There was no significant difference between groups A and B with respect to the number of positive cultures at each time point. Of 9 positive cultures at time 1, all were still positive at time 3 in group A, whereas 3 of 5 were negative in group B (P = .027). The rate of C. acnes at time 3 in the control group was higher than that in the 2 other groups (68% vs 44% for group A and 20% for group B; P = .003). Body mass index was the only prognostic factor for a C. acnes-positive culture (26.05 ± 3.39 vs 23.34 ± 2.33; P = .018). No clinical infection was reported at the 6-month postoperative follow-up. CONCLUSION: The rate of C. acnes contamination ranged from 25% to 68% during the open Latarjet procedure in young athletes. Vancomycin reduced the bacterial contamination when it was used at high concentrations in a gauze wrap on the coracoid. The type of C. acnes detected and its clinical implications remain to be studied.

Arthroscopic Latarjet With Cortical Buttons Versus Open Latarjet With Screws: A Short-Term Comparative Study.

BACKGROUND: The arthroscopic bone block procedure according to Latarjet remains a controversial subject, and few comparative studies have demonstrated the benefit of arthroscopy over open surgery. PURPOSE/HYPOTHESIS: The objective of this study was to compare both procedures by analyzing the short-term clinical results. The hypothesis was that the arthroscopic procedure is superior to the standard open procedure. STUDY DESIGN: Cohort study; Level of evidence, 3. METHOD: This was a retrospective comparative study. Patients treated for chronic anterior instability by arthroscopic Latarjet with double cortical buttons (group A) or open Latarjet with screws (group O) with a minimum follow-up of 12 months were included. Intraoperative (duration, complications) and postoperative (complications, pain, mobility, functional scores, resumption of sport, Patient and Observer Scar Assessment Scale scar aesthetics, satisfaction) data were compared. RESULTS: In total, 50 patients were included (n = 24 in group A, n = 26 in group O). Operating time was longer in group A (103 vs 61 min; P = .001). The average number of days on analgesics was higher in group A (8.9 vs 5.3 days; P = .04). The complication rate was similar for the 2 groups (12.5% vs 27%; P = .46). At 3 months, the loss of external rotation was greater in group A (-33° vs -18°; P = .01), and resumption of sports was less frequent (11% vs 48%; P = .01). At 12 months, the average scores were excellent, with no significants differences between the 2 groups: Walch-Duplay average, 90 points; Rowe, 94 points; Subjective Shoulder Value (SSV), 92.5%; sport SSV, 85%; and Patient and Observer Scar Assessment Scale score, 17.2 points. CONCLUSION: Over the short term, this comparative study did not prove the superiority of the cortical-button arthroscopic Latarjet procedure over the open Latarjet procedure. A delay in the resumption of sports, longer time to recover range of motion, and no benefit regarding postoperative pain or the aesthetic aspect of the scar were observed in this study with the arthroscopic procedure.

Long-term results of arthroscopic Bankart repair with Hill-Sachs remplissage.

Background: Arthroscopic Bankart repair with Hill-Sachs remplissage (BHSR) is suggested for the treatment of anterior shoulder instability in the presence of an engaging humeral lesion. The objective of this study is to report the long-term clinical and radiological results of this procedure. Methods: This is a single-center retrospective study including 51 patients who underwent surgery by BHSR for anterior shoulder instability with engaging Hill-Sachs lesion and who were reviewed after a minimum follow-up of 5 years. The mean age was 26 years (16-49; ±8.4) and 70% of the patients practiced sports. The average for Instability Severity Index score was 3.3 points (3-7; ±1.7). At the last follow-up, active range of motion, Subjective Shoulder Value, Walch-Duplay and Rowe scores, and the incidence of osteoarthritis according to the Samilson classification were assessed. Results: At a mean follow-up of 87 months (60.0-124; ±17), 83% of the patients had resumed their sports activities. The mean Rowe, Walch-Duplay, and Subjective Shoulder Value scores were respectively 88 points (51-100; ±12), 82 points (50-100; ±16.4), and 89% (50-100; ±8). There was a recurrence of dislocation or subluxation for 8 patients (15.6%). In univariate analysis, patients who were unstable at follow-up had a deeper Hill-Sachs lesion (25% vs. 18% of the humeral head radius, P = .04) and were younger (19 vs. 27 years, P = .04). Radiographically, 17% of the patients showed signs of osteoarthritis (14% grade 1). Conclusion: Considering that at a follow-up of more than 5 years, the failure rate was more than 15% of the BHSR, this procedure should be recommended with caution in case of deep Hill-Sachs lesions in young patients. The incidence of osteoarthritis after this procedure was acceptable, with few severe forms.

Short-Term Bone Fusion With Arthroscopic Double-Button Latarjet Versus Open-Screw Latarjet.

BACKGROUND: Recently, arthroscopic double-button Latarjet (AL) has provided an alternative to conventional open Latarjet (OL) in the treatment of anterior shoulder instability with glenoid bone loss. Therefore, theoretically, the faster fusion is obtained, the sooner return to sports under safe conditions can occur. The emerging flexible fixation of the bone block has clearly offered a new approach to achieve bone fusion. However, the period required to achieve this goal remains controversial. PURPOSE/HYPOTHESIS: The purpose was to compare computed tomography (CT) scan results of AL and OL in the early postoperative period. It was hypothesized that the bone block fusion with AL would require a longer time than that with OL. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: In a retrospective 1-year study, the authors compared 17 primary double-button AL to 22 primary 2-screw OL procedures indicated for anterior shoulder instability in patients with an Index Severity Instability Score >3 points. These patients were reviewed with a CT scan at 1 day, 3 months, and 6 months postoperatively. The characteristics for the 2 groups were comparable. CT scans aimed to analyze graft position, bone contact area with the scapula, and fusion at 3 and 6 months. Clinical assessment was based on the Walch-Duplay and Rowe scores. RESULTS: The mean preoperative Index Severity Instability Score was 5.3 ± 1.9 points, with a mean anterior glenoid bone loss of 9.1% ± 4.6%. At 3 months, the rates of fusion were 41% and 100% for the AL and OL groups, respectively (P < .001). This rate increased to 70% in the AL group at 6 months (P = .006). In the axial and sagittal planes, there was no difference in graft position between the AL group and the OL group. The bone block was longer and there was a more extensive bone contact area in the OL group (AL, 131 mm2 vs OL, 223 mm2; P < .001). At 6 months of follow-up, no significant difference in clinical scores was noted between the groups: Walch-Duplay score, 93.0 ± 10.9 points versus 91.8 ± 12.5 points (P = .867); and Rowe score, 99.0 ± 2.2 points versus 95.0 ± 8.4 points (P = .307) for the AL and OL groups, respectively. CONCLUSION: AL required more time to achieve bone block fusion than OL. This finding should be taken into account when considering this procedure for patients in a hurry to return to sports involving the shoulder.

Does anterior acromioplasty reduce critical shoulder angle?

INTRODUCTION: Critical shoulder angle (CSA) is the angle between glenoid inclination and the lateral edge of the acromion. CSA>35° has been shown to be a risk factor for primary and iterative rotator cuff tendon tear. The present study aimed to assess change in CSA after anterior acromioplasty. The study hypothesis was that CSA is significantly reduced. METHOD: A single-center retrospective descriptive observational study included patients undergoing open or arthroscopic anterior acromioplasty, with strict AP pre- and post-operative radiographs. Patients with radiographs not meeting Moor's criteria were excluded. RESULTS: One hundred and forty-eight patients were included: arthroscopy, 112; open surgery, 36. Mean age was 57.8 years (range, 29-80 years). Mean preoperative CSA was 36.1±4.25° (range, 25-48.4°) and postoperative CSA 33.5±3.9° (23.8-45.2°), for a significant reduction of -2.6±2.5° (p=0.001). Surgical technique did not affect change in CSA: open surgery, -2.3±1.9° (-6.3° to -1°); arthroscopy, -2.7±2.7° (-10.5° to -5°) (p=0.06). In pathologic CSA (>35°), the mean reduction was -3.2±2.6° (-10.5°to -5°). CSA normalized below the 35° threshold in 48% of patients. DISCUSSION: Despite reduction in CSA, the 35° threshold for iterative tear is not always reached after anterior acromioplasty. Complementary strictly lateral resection is theoretically required. However, change in CSA is difficult to predict intraoperatively. CONCLUSION: Anterior acromioplasty significantly reduced CSA, independently of technique and preoperative value. LEVEL OF EVIDENCE: IV, retrospective descriptive study.