Reproducibility of the Mayo and Schatzker classification systems in proximal ulna fractures.

INTRODUCTION: A fracture classification system should provide a reliable and reproducible means of communication between different parties. It should be logical and understandable, with few categories to memorize. The aim of this study was to determine the intra- and interobserver reliability of the Schatzker and Mayo classification systems for the assessment of proximal ulna fractures. MATERIALS AND METHODS: Intra- and interobserver reliability studies were conducted on 39 X-rays of injured elbows drawn randomly from 74 cases previously used in a series on predictors of ulnohumeral osteoarthritis in proximal ulna fractures. Ten observers independently reviewed these X-rays on 2 separate occasions 3 months apart. The fracture type was assessed according to the Schatzker and Mayo classification systems during each reading session. Cohen's and Fleiss' kappa were used to measure the intra- and interobserver reliability. RESULTS: The Schatzker classification had a fair interobserver reliability for the first (Schatzker R1, Fleiss' κ: 0.394) and second (Schatzker R2, Fleiss' κ: 0.351) readings. The mean intraobserver reliability value between the 10 reviewers for the Schatzker classification was rated as substantial (0.61). The Mayo classification had a fair interobserver reliability for the first (Mayo R1, Fleiss' κ: 0.278) and second (Mayo R2, Fleiss' κ: 0.292) readings. The mean intraobserver reliability value between the 10 reviewers for the Mayo classification was rated as fair (0.52). DISCUSSION: The classification systems for proximal ulna fractures showed poor reproducibility between the different observers since they had low interobserver agreement values. Nevertheless, their use remained reliable since the measured intraobserver agreement value was deemed substantial. LEVEL OF EVIDENCE: IV; retrospective.

Stemless reverse shoulder arthroplasty: clinical and radiologic outcomes with minimum 2 years' follow-up.

BACKGROUND: Recently, a stemless reverse shoulder arthroplasty (RSA) design was developed to preserve bone stock. Clinical and radiologic studies of this design in larger cohorts with >100 patients are not frequent. The purpose of this study was to present the clinical and radiologic results of a newly developed stemless RSA implant. The hypothesis was that this design would provide similar clinical and radiologic results to other stemless implants, as well as stemmed implants. METHODS: Between September 2015 and December 2019, all patients who underwent primary RSA with a stemless Easytech prosthesis were considered eligible for inclusion in this prospective multicenter study. The minimum follow-up period was 2 years. Clinical outcomes consisted of the Constant score, adjusted Constant score, QuickDASH (short version of Disabilities of the Arm, Shoulder and Hand questionnaire) score, Subjective Shoulder Value, and American Shoulder and Elbow Surgeons shoulder score. Radiographic parameters included radiolucency, loosening, scapular notching, and specific geometric parameters. RESULTS: Stemless RSA was performed in 115 patients (61 women and 54 men) at 6 different clinical centers. The average age at the time of surgery was 68.7 years. The average Constant score was 32.5 preoperatively and showed significant improvement to 61.8 at latest follow-up (P < .001). The Subjective Shoulder Value also demonstrated significant improvement postoperatively (from 27.0 to 77.5, P < .001). Scapular notching was observed in 28 patients (24.3%); humeral loosening, 5 (4.3%); and glenoid loosening, 4 (3.5%). The total complication rate was 17.4%. Eight patients (4 women and 4 men) underwent implant revision. CONCLUSION: The clinical outcomes of the examined stemless RSA seem to be comparable to those of other humeral designs; however, the complication and revision rates are higher than those of historical controls. Surgeons should proceed with caution when using this implant until longer-term follow-up data are available.

Intra- and Inter-rater Reliability of Postoperative Radiographic Analysis of Reverse Shoulder Arthroplasty in 49 Shoulders After Proximal Humerus Fracture.

Introduction: The lateralization shoulder angle (LSA), the distalization shoulder angle (DSA) and the new "pentagon" concept are tools used in scheduled shoulder surgery to evaluate the positioning of reverse shoulder arthroplasty (RSA) implants. There is no information on the intra- and inter-rater reliability of these tools in the context of RSA for a proximal humerus fracture. The first hypothesis was the high reliability of the intra- and inter-rater analysis of the LSA and DSA angles. The second hypothesis was the reproductibility of the pentagon based on LSA and DSA analysis. Methods: Forty-nine patients were evaluated retrospectively with a minimum of 2 years radiological follow-up after RSA surgery. Tuberosity healing was evaluated using an AP radiograph of the shoulder and their location analyzed within the said "pentagon" defined by the LSA/DSA angles and the maximum lengthening recommended. Results: The intra-rater analysis found strong to an almost perfect agreement for the LSA and DSA. The agreement was moderate to strong for the pentagon. The inter-rater analysis found a fair agreement for the LSA and moderate agreement for the DSA and pentagon. Conclusion: The LSA/DSA is used in patients undergoing RSA for glenohumeral OA. In this context, the tuberosities were intact and certain complications inherent to RSA for humeral fracture were not present. The population studied here (RSA after fracture) creates an interpretation bias due to the difficulty in analyzing tuberosity position. Level of Evidence: 4, retrospective study.

Assessment of intraoperative bleeding in reverse shoulder arthroplasty - with or without a stem.

INTRODUCTION: The functional results of stemless reverse shoulder prostheses are similar to those with stems. However, the operative time and the bleeding appear less significant because of the absence of humeral reaming. To date, the data amongst the literature regarding this subject is limited. Thus, we report a retrospective evaluation on these 2 types of prostheses by assessing their respective intraoperative blood loss. HYPOTHESIS: Reverse shoulder arthroplasty without a stem leads to less blood loss, compared to arthroplasty with a stem. MATERIALS AND METHODS: Twenty-three patients underwent an operation for a stemless prosthesis, while 37 patients had a prosthesis with a stem. The hemoglobin was measured preoperatively, as well as postoperatively. Drainage of the operative site was maintained for two to three days. In the stem group, the preoperative hemoglobin was 14g/dL (11.7-16.6), while it was 13.1g/dL (11-15.8) in the stemless group. RESULTS: The intraoperative bleeding reached 223cm3 (80-530), with an operative duration of 81minutes (40-110) in the stemless group, compared to 260cm3 (50-1000) and 92minutes (33-110) in the stem group. On the first day postoperatively, 333cm3 (20-570) of blood had been collected by drainage for the stemless group, compared to 279cm3 (40-550) in the stem group. The amount decreased the second day, with 139cm3 (20-510) and 129cm3 (0-750) respectively. There was no difference between the two groups regarding the postoperative hemoglobin level (11g/dL). DISCUSSION: There is no significant difference concerning the blood loss between reverse shoulder replacements with and without stems. LEVEL OF EVIDENCE: III Retrospective case control study.