Scapular dyskinesis after treatment of proximal humerus fracture, a 3-dimensional motion analysis and clinical outcomes.

BACKGROUND: The alteration of scapular kinematics can predispose patients to shoulder pathologies and dysfunction. Previous literature has associated various types of shoulder injuries with scapular dyskinesis, but there are limited studies regarding the effect that proximal humeral fractures (PHFs) have on scapular dyskinesis. This study aims to determine the change in scapulohumeral rhythm following treatment of a proximal humerus fracture as well as differences in shoulder motion and functional outcomes among patients who presented with or without scapular dyskinesis. We hypothesized that differences in scapular kinematics would be present following treatment of a proximal humerus fracture, and patients who presented with scapular dyskinesis would subsequently have inferior functional outcome scores. METHODS: Patients treated for a proximal humerus fracture from May 2018 to March 2021 were recruited for this study. The scapulohumeral rhythm and global shoulder motion were determined using a 3-dimensional motion analysis (3DMA) and the scapular dyskinesis test. Functional outcomes were then compared among patients with or without scapular dyskinesis, including the SICK (scapular malposition, inferomedial border prominence, coracoid pain and malposition, and dyskinesis of scapular movement) Scapula Rating Scale, the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), the visual analog scale (VAS) for pain, and the EuroQol-5 Dimension 5-Level questionnaire (EQ-5D-5L). RESULTS: Twenty patients were included in this study with a mean age of 62.9 ± 11.8 years and follow-up time of 1.8 ± 0.2 years. Surgical fixation was performed in 9 of the patients (45%). Scapular dyskinesis was present in 50% of patients (n = 10). There was a significant increase in scapular protraction on the affected side of patients with scapular dyskinesis during abduction of the shoulder (P = .037). Additionally, patients with scapular dyskinesis demonstrated worse SICK scapula scores (2.4 ± 0.5 vs. 1.0 ± 0.4, P = .024) compared to those without scapular dyskinesis. The other functional outcome scores (ASES, VAS pain scores, and EQ-5D-5L) showed no significant differences among the 2 groups (P = .848, .713, and .268, respectively). CONCLUSIONS: Scapular dyskinesis affects a significant number of patients following treatment of their PHFs. Patients presenting with scapular dyskinesis exhibit inferior SICK scapula scores and have more scapular protraction during shoulder abduction compared to patients without scapular dyskinesis.

The factors influencing the component sizes in Oxford Phase 3 unicompartmental knee arthroplasty.

OBJECTIVES: This study aims to investigate the Thai population characteristics that may correlate the component sizes used in the Oxford Phase 3 unicompartmental knee arthroplasty (OUKA) and to examine common matching patterns and variables affecting matching and patient-specific factors while determining the femoral component (Fc) size for Thai patients. PATIENTS AND METHODS: Between June 2003 and June 2019, a total of 773 knees of 773 patients (145 males, 628 females; median age: 64.0 years; range: 44 to 86 years) who underwent OUKA using Oxford Microplasty® Instrumentation were retrospectively analyzed. The femoral and tibial components (Tc) were matched based on the patient's age, sex, height, weight, and other characteristics. The Fc sizes were compared in terms of patient characteristics. Also, the area under the receiver operating characteristic (AuROC) was calculated. RESULTS: A total of 6.5% of the Fcs were extra small (XS), 65.7% were small (S), 20.6% were medium (M), 7.2% were large (L), and 0% were extra-large (XL). For Tc sizes, the distribution was as follows: 20.2% AA; 31.6% A; 24.3% B; 16.3% C; 6.0% D; 1.7% E; and 0% F. Females had the most common Fc and Tc sizes of S and A, while males had the most common sizes of M and C. The S-A (32.3%) and M-C (27.5%) were the most often used matching patterns among females and males, respectively. Sex, body weight (BW), height, and body mass index (BMI) were independent predictors of Fc sizes. The AuROC for BW, height, and BMI was statistically significant. CONCLUSION: The S and A for females and M and C for men were the most common sizes of Fc and Tc in Thai patients. Among females, the most prevalent pairing was S-A and, among men, it was M-C. The strongest determinants of Fc sizes were found to be male sex and height.