A validation of the Nottingham Clavicle Score: a clavicle, acromioclavicular joint and sternoclavicular joint-specific patient-reported outcome measure.

BACKGROUND: Patients with acromioclavicular joint (ACJ) and sternoclavicular joint (SCJ) injuries and with clavicle fractures are typically younger and more active than those with other shoulder pathologies. We developed the Nottingham Clavicle Score (NCS) specifically for this group of patients to improve sensitivity for assessing the outcomes of treatment of these conditions compared with the more commonly used Constant Score (CS) and Oxford Shoulder Score (OSS). MATERIALS AND METHODS: This was a cohort study in which the preoperative and 6-month postoperative NCS evaluations of outcome in 90 patients were compared with the CS, OSS, Imatani Score (IS), and the EQ-5D scores. Reliability was assessed using the Cronbach α. Reproducibility of the NCS was assessed using the test/retest method. Effect sizes were calculated for each score to assess sensitivity to change. Validity was examined by correlations between the NCS and the CS, OSS, IS, and EQ-5D scores obtained preoperatively and postoperatively. RESULTS: Significant correlations were demonstrated preoperatively with the OSS (P = .025) and all subcategories of the EQ-5D (P < .05) and postoperatively with the OSS (P < .001), CS (P = .008), IS (P < .001), and all subcategories of EQ-5D (P < .02). The NCS had the largest effect size (1.92) of the compared scores. Internal consistency was excellent (Cronbach α = 0.87). CONCLUSION: The NCS has been proven to be a valid, reliable and sensitive outcome measure that accurately measures the level of function and disability in the ACJ, SCJ and clavicle after traumatic injury and in degenerative disease.

The United Kingdom and Ireland Trauma & Orthopaedic eLogbook--an evidence base for enhancing training.

The United Kingdom and Ireland Trauma and Orthopaedic (T&O) eLogbook was originally conceived over ten years ago in order to provide individual surgeon support and allow national analysis of surgical training experience. Since 2003 every trainee in T&O has been required to submit data recording their operative experience throughout the six years of higher specialist training. We describe how orthopaedic surgeons are using the evidence from the eLogbook to improve training, set operative standards and support consultant (post-specialist registration) revalidation.

Two Aviation Accident Investigation Questionnaires for Passenger and Crew Survival Factors and Injuries.

BACKGROUND: Review of injuries resulting from aircraft accidents and analysis of their mechanisms have proved helpful in generating and implementing survival-related improvements. Ideally, such information should be correlated with seat belt type and use, as well as any brace position adopted. This information should be recorded and made publicly available to future researchers. METHODS: Members of IBRACE have developed two questionnaires to assist accident / cabin-safety investigators to record this information in an integrated consistent manner. RESULTS: One questionnaire relates to the survivors and one to the deceased. DISCUSSION: IBRACE members hope that these questionnaires will assist the investigation of future aircraft accidents.Davies JM, Wallace WA, Colton CL, Yoo KI, Maurino M. Two aviation accident investigation questionnaires for passenger and crew survival factors and injuries. Aerosp Med Hum Perform. 2018; 89(5):483-486.

A comparison of methods for shoulder strength assessment and analysis of Constant score change in patients aged over fifty years in the United Kingdom.

Normal values for shoulder assessment are imperative for the diagnosis of pathology and measurement of treatment outcome. Normal values for the United Kingdom are currently not known. This study comprised 108 control patients aged over 50 years who were under the care of one general practitioner, and the Constant score was measured. The Constant score was assessed via 3 techniques for strength measurement: maximum strength with myometer, mean strength with myometer, and maximum strength with fixed spring balance. Myometer maximum strength values were very similar to fixed spring balance maximum strength values, with a mean difference of 0.5. Myometer mean strength was lower than myometer maximum strength by 3 points. Age and sex both significantly affected Constant score (P < .001 for both). The Constant score fell by 0.3 points per year over 50 years of age. Men had a score that was 7.5 points greater than that in women. The Constant score decreases predictably with age in the United Kingdom. Methods of strength assessment are not the same. A uniform method of shoulder strength assessment is required to allow for meaningful comparisons between series.

Cauliflower Ear and Skin Infections among Wrestlers in Tehran.

The purpose of the study was to describe the magnitude of the selected sports medicine problems (i.e. cauliflower ear and skin infections) among wrestlers in Tehran. A number of 411 wrestlers were randomly selected from wrestling clubs in Tehran employing cluster sample setting method. The participants were interviewed using a specially designed and validated questionnaire. Nearly half of the participants (44%) had "cauliflower ears". Only 23% of these participants had received any kind of treatment for their acute ear haematomas that are known to result in "cauliflower ears". The prevalence of reported hearing loss among participants with cauliflower ears (11.5%, 95%CI: 6.9 to 16.2) was significantly more than this prevalence among those participants without cauliflower ears (1.8%, 95%CI: 0.1 to 3.5) (p < 0.05). More than half of the participants (52%) had skin infection diagnosed by a physician during the previous year. This study has identified evidence of an increase in hearing loss as a possible side effect of either cauliflower ear or ear injury in wrestling in Iran. There has been an outbreak of ringworm and there is a significant potential for an outbreak of impetigo among wrestlers in Tehran. Key pointsSkin infections are prevalent among wrestlers in Tehran.Commonly wrestlers in Tehran continue to carry out wrestling training while affected by skin infections.Cauliflower ear "is common among wrestlers in Tehran.More research is needed to investigate hearing loss as a possible side effect of either cauliflower ear or ear injury in wrestling in Iran.

Pitch-side management of acute shoulder dislocations: a conceptual review.

The shoulder, specifically the glenohumeral joint, by virtue of its anatomical characteristics and biomechanics confers a large range of movement, which ultimately results in a joint that is inherently prone to becoming unstable. The incidence of acute traumatic shoulder dislocation varies within the sporting environment, commonly occurring following direct trauma. Anterior dislocations account for nearly 90% of all dislocations. While most are referred and managed in the emergency department, pitch-side relocation by experienced clinicians does occur prior to referral. The aim of this study was to delineate a guideline specifically for the pitch-side management of this common injury. A literature search of PubMed and Medline using the keywords 'prehospital', 'pitch-side', 'shoulder dislocation' and 'reduction' or 'relocation technique' was performed, and the available literature was reviewed and collated. Articles focusing on reduction techniques were then reviewed, with particular consideration on their applicability to a pitch-side setting. While studies exist that compare and contrast examination and reduction techniques, most are based in a hospital setting. To date, there is no standardised management protocol published for the initial management of an anterior dislocated shoulder in a pitch-side setting. This article addresses this discrepancy and proposes a structured, algorithmic approach to the pitch-side management of a shoulder dislocation. The article addresses factors to consider in a pitch-side setting, suitable techniques and postreduction care. While a systematic approach has been delineated in this article, we recommend those pitch-side medical practitioners who provide this form of support should have attended appropriate training and ensure adequate malpractice cover.

Use of scoring systems for assessing and reporting the outcome results from shoulder surgery and arthroplasty.

To investigate shoulder scoring systems used in Europe and North America and how outcomes might be classified after shoulder joint replacement. All research papers published in four major journals in 2012 and 2013 were reviewed for the shoulder scoring systems used in their published papers. A method of identifying how outcomes after shoulder arthroplasty might be used to categorize patients into fair, good, very good and excellent outcomes was explored using the outcome evaluations from patients treated in our own unit. A total of 174 research articles that were published in the four journals used some form of shoulder scoring system. The outcome from shoulder arthroplasty in our unit has been evaluated using the constant score (CS) and the oxford shoulder score and these scores have been used to evaluate individual patient outcomes. CSs of < 30 = unsatisfactory; 30-39 = fair; 40-59 = good; 60-69 = very good; and 70 and over = excellent. The most popular shoulder scoring systems in North America were Simple Shoulder Test and American shoulder and elbow surgeons standard shoulder assessment form score and in Europe CS, Oxford Shoulder Score and DASH score.

Patient-reported outcomes following a physiotherapy rehabilitation programme for atraumatic posterior shoulder subluxation.

BACKGROUND: There is a paucity of research that describes the patient-reported benefits of physiotherapy rehabilitation for atraumatic posterior instability despite non-operative treatment being considered the initial treatment of choice. This retrospective case series review describes the patient-reported outcomes following a physiotherapy rehabilitation programme for atraumatic posterior shoulder instability. METHODS: Nineteen consecutive patients with a clinical diagnosis of atraumatic posterior shoulder subluxation completed our physiotherapy programme. All patients completed Oxford Instability Shoulder scores (OISS) and Western Ontario Shoulder Instability Index (WOSI) scores before and after physiotherapy intervention. RESULTS: Patients reported a statistically significant clinical improvement in the main outcome measures following physiotherapy intervention. The OISS showed a mean improvement of 18.6 points, whereas the WOSI score showed a mean improvement of 37.2%. Following physiotherapy rehabilitation, all patients reported that their shoulder did not prevent them from performing their work/studies or their chosen hobbies/sports. CONCLUSIONS: Our results support the view that specialized physiotherapy rehabilitation is a valuable treatment option for atraumatic posterior shoulder instability and reveal significant clinically important improvements in patient-reported outcomes.

Modified Weaver-Dunn procedure versus the use of a synthetic ligament for acromioclavicular joint reconstruction.

PURPOSE. To compare the subjective outcome of acromioclavicular joint (ACJ) reconstruction using the modified Weaver-Dunn procedure versus the Surgilig synthetic ligament. METHODS. 55 patients aged 19 to 72 (mean, 42) years underwent ACJ reconstruction of Rockwood grade 3 (n=38), grade 4 (n=8), and grade 5 (n=9) using the modified Weaver-Dunn procedure (n=31) or the Surgilig synthetic ligament (n=24), based on the surgeon's preference. The mean period from injury to surgical treatment was 39 months. Subjective outcomes were assessed before and after surgery using the Oxford Shoulder score and Nottingham Clavicle score. The time required to return to work and sports was also recorded. RESULTS. After a mean follow-up period of 40 months, the mean Oxford Shoulder scores improved from 28 to 42 in the Weaver-Dunn group (p=0.009), and from 26 to 45 in the Surgilig group (p=0.007), whereas the respective mean Nottingham Clavicle scores improved from 53 to 81 (p=0.047) and from 51 to 93 (p=0.023). The Surgilig group achieved significantly better postoperative Oxford Shoulder score (p=0.008) and Nottingham Clavicle score (p=0.007), and could also return to work (14 vs. 6 weeks, p<0.001) and sports (25 vs. 12 weeks, p<0.001) sooner than the Weaver-Dunn group. Three patients in the Weaver- Dunn group and one patient in the Surgilig group had persistent pain and/or functional deficit with evidence of ACJ dislocation. CONCLUSION. Chronic ACJ reconstruction using the Surgilig synthetic ligament achieved better Oxford Shoulder score and Nottingham Clavicle score and earlier return to work and sports, compared with the modified Weaver-Dunn procedure.

Scapular Winging.

This review explores the causes of scapula winging, with overview of the relevant anatomy, proposed aetiology and treatment. Particular focus is given to lesions of the long thoracic nerve, which is reported to be the most common aetiological factor.

Risk factors and predictors of mortality for proximal humeral fractures.

BACKGROUND: Risk factors for mortality after proximal humeral fracture, including socioeconomic status, are poorly defined. This retrospective review of prospectively collected data defines the epidemiology and predictors of mortality in association with proximal humeral fractures. METHODS: Patients who sustained proximal humeral fractures were identified from fragility fracture and trauma databases between May 2001 and September 2012. RESULTS: In total, 1880 patients with a mean age of 69 years and a male to female ratio of 2 : 3 were identified. Socioeconomic distribution is skewed towards the lowest and highest quintiles. Low-energy mechanisms caused 88% of fractures. Men sustain fractures when they are aged 10 years younger and via higher-energy mechanisms. In total, 536 patients (29%) died within the study period with a 1-year mortality of 9.8%, rising to 28.2% at 5 years. Female gender, increasing age, pathological fracture and increased number of co-morbidities were independent variables for increased mortality. CONCLUSIONS: The present study, which was conducted over an 11-year period, is the first to combine the epidemiology and risk factors for mortality with socioeconomic rank. One-year mortality risk is twice that of the background matched population. Patient counselling with respect to increased mortality should be considered, especially in higher-risk elderly females with multiple co-morbidities.

Percentage of body fat and weight gain in participants in the tehran high school wrestling championship.

PURPOSE: Weight loss in wrestling has been found to be an interesting issue for researchers. In this regard, complications of weight loss in wrestlers before the competitions and their weight gain in course of competitions have been debated in previous studies. The objective of this study was to investigate the extent of weight gain and to estimate the percentage of body fat in participants in the Tehran high school male wrestling championship. METHODS: This study was a cross sectional survey. Subjects were participants of the Tehran high school male wrestling championship (n = 365). Weight gain in course of competitions and body fat levels (based on skin fold measurements) of subjects were measured. RESULTS: Between the first weigh-in of the wrestlers which was done one day before the competitions and the second weigh-in which was conducted immediately before the first round of their first competition (20 hours), 69% of subjects gained on average 1.3±0.9 kg (range: 0.1 to 6.10 kg) or 2.2±1.7% of the wrestler's weight (range: 0.1 to 9.3). Among the subjects, the mean of fat body percentage was found to be 15.2%. CONCLUSIONS: Rapid weight loss for matches was prevalent among subjects. It was also found that Iranian wrestlers have a relatively higher body fat percentage in comparison to American wrestlers. Therefore, it can be concluded that weight loss behavior of these wrestlers should be changed from using dehydration methods to using gradual methods of weight loss such as fat reduction methods.

Long-term follow-up for mortality and cancer in a randomized placebo-controlled trial of vitamin D(3) and/or calcium (RECORD trial).

CONTEXT: Vitamin D or calcium supplementation may have effects on vascular disease and cancer. OBJECTIVE: Our objective was to investigate whether vitamin D or calcium supplementation affects mortality, vascular disease, and cancer in older people. DESIGN AND SETTING: The study included long-term follow-up of participants in a two by two factorial, randomized controlled trial from 21 orthopedic centers in the United Kingdom. PARTICIPANTS: Participants were 5292 people (85% women) aged at least 70 yr with previous low-trauma fracture. INTERVENTIONS: Participants were randomly allocated to daily vitamin D(3) (800 IU), calcium (1000 mg), both, or placebo for 24-62 months, with a follow-up of 3 yr after intervention. MAIN OUTCOME MEASURES: All-cause mortality, vascular disease mortality, cancer mortality, and cancer incidence were evaluated. RESULTS: In intention-to-treat analyses, mortality [hazard ratio (HR) = 0.93; 95% confidence interval (CI) = 0.85-1.02], vascular disease mortality (HR = 0.91; 95% CI = 0.79-1.05), cancer mortality (HR = 0.85; 95% CI = 0.68-1.06), and cancer incidence (HR = 1.07; 95% CI = 0.92-1.25) did not differ significantly between participants allocated vitamin D and those not. All-cause mortality (HR = 1.03; 95% CI = 0.94-1.13), vascular disease mortality (HR = 1.07; 95% CI = 0.92-1.24), cancer mortality (HR = 1.13; 95% CI = 0.91-1.40), and cancer incidence (HR = 1.06; 95% CI = 0.91-1.23) also did not differ significantly between participants allocated calcium and those not. In a post hoc statistical analysis adjusting for compliance, thus with fewer participants, trends for reduced mortality with vitamin D and increased mortality with calcium were accentuated, although all results remain nonsignificant. CONCLUSIONS: Daily vitamin D or calcium supplementation did not affect mortality, vascular disease, cancer mortality, or cancer incidence.

Indirect catastrophic injuries in olympic styles of wrestling in iran.

BACKGROUND: Data on indirect catastrophic injuries in wrestling are scarce. OBJECTIVES: To develop a profile of indirect catastrophic injuries in international styles of wrestling and to describe possible risk factors. STUDY DESIGN: Retrospective case series; Level of evidence, 3. METHODS: Indirect catastrophic injuries that occurred in wrestling clubs in Iran from July 1998 to June 2005 were identified by contacting several sources. The cases were retrospectively reviewed. RESULTS: The injuries included 9 indirect catastrophic injuries. The injury rate was 0.62 injuries per 100 000 wrestlers per year. The majority of indirect injuries were cardiovascular events in veteran groups of wrestlers. CONCLUSIONS: Indirect catastrophic wrestling injuries are rare and present most commonly in older athletes. Coronary artery disease was the main cause.