Inter-rater agreement among shoulder surgeons on treatment options for proximal humeral fractures among shoulder surgeons.

BACKGROUND: The treatment approach for proximal humeral fractures is determined by various factors, including patient age, sex, dominant arm, fracture pattern, presence of osteoporosis, preexisting arthritis, rotator cuff status, and medical comorbidities. However, there is a lack of consensus in the literature regarding the optimal treatment for displaced proximal humeral fractures. This study aimed to assess and quantify the decision-making process for either conservative or surgical treatment and the choice of surgical method among shoulder surgeons when treating proximal humeral fractures. METHODS: Forty sets of true anteroposterior view, scapular Y projection view, and three-dimensional computed tomography of proximal humeral fractures were provided to 12 shoulder surgeons along with clinical information. Surveys regarding Neer classification, decisions between conservative and surgical treatments, and chosen methods were conducted twice with an interval of 2 months. The factors affecting the treatment plans were also assessed. RESULTS: The inter-rater agreement was fair for Neer classification (kappa=0.395), moderate for the decision between conservative and surgical treatments (kappa=0.528), and substantial for the chosen method of surgical treatment (kappa=0.740). The percentage of agreement was 71.1% for Neer classification, 84.6% for the decision between conservative and surgical treatment, and 96.4% for the chosen method of surgical treatment. The fracture pattern was the most crucial factor in deciding between conservative and surgical treatments, followed by age and physical activity. CONCLUSIONS: The decision between conservative and surgical treatment for proximal humeral fractures showed good agreement, while the chosen method between osteosynthesis and arthroplasty showed substantial agreement among shoulder surgeons.

Short-term Comparison of Supervised Rehabilitation and Home-based Rehabilitation for Earlier Recovery of Shoulder Motion, Pain, and Function after Rotator Cuff Repair.

BACKGROUND: This study was undertaken to compare the outcome of supervised and home exercises with respect to range of motion (ROM), pain, and Single Assessment Numeric Evaluation (SANE). We further correlated the ROM recovery and pain reduction as well. METHODS: The study included 49 patients who underwent arthroscopic rotator cuff repair. Rehabilitation was initiated after 4 weeks of immobilization. A total of 29 patients performed supervised exercise 3 times a week. Standardized education and brochures for review were provided to the remaining 20 patients who insisted on home rehabilitation. Statistical analysis was performed for comparing pain Numerical Rating Scale (NRS), SANE, and ROM. In addition, we also evaluated the correlation between pain and ROM. RESULTS: Comparison of the two groups revealed no significant differences in forward flexion, internal rotation, abduction, and pain NRS. However, SANE at the 9th week (63.8 vs. 55.0, p=0.038) and improvement of external rotation from the 5th to the 9th week (17.6 vs. 9.3, p=0.018) were significantly higher in the supervised exercise group as compared to the home exercise group. Correlation of pain NRS with forward flexion, external rotation, internal rotation and abduction were statistically not significant (correlation coefficient=0.032 [p=0.828], -0.255 [p=0.077], 0.068 [p=0.642], and -0.188 [p=0.196], respectively). CONCLUSIONS: The supervised rehabilitation after arthroscopic rotator cuff repair showed better improvement in external rotation and higher SANE score after 4 weeks of rehabilitation exercise. However, no statistically significant correlation was observed between the recovery of ROM and short-term pain relief.

Changes in Hindfoot Alignment After High or Low Tibial Osteotomy.

BACKGROUND: We aimed to determine the change in hindfoot alignment after high (HTO) or low tibial osteotomy (LTO), which is commonly performed to prevent the progression of arthritis of the knee or ankle. METHODS: We retrospectively reviewed the radiographic findings of patients who underwent HTO or LTO for arthritis with varus deformity of the knee or ankle joint. The hindfoot alignment view angle (HAVA), hindfoot alignment ratio (HAR), and hindfoot moment arm (HMA) were measured using the hindfoot alignment radiographs. All radiographic parameters were measured at 3, 6, and 12 months postoperatively to assess serial changes. RESULTS: In the HTO group, the HAVA and HMA were significantly increased at 12 months postoperatively compared to preoperatively ( P = .03 and .001, respectively). Similarly, the HAR increased from 0.23 preoperatively to 0.44 at 12 months postoperatively, which was a statistically significant change ( P = .001). In the LTO group, the 12-month postoperative HAVA, HAR, and HMA were significantly decreased ( P = .001 for each), which represented a hindfoot alignment change to the valgus position. CONCLUSIONS: After HTO, preoperative hindfoot valgus deviation was significantly decreased at 12 months and approached normal values, while the preoperative mild hindfoot varus alignment was changed to valgus deviation after LTO. LEVEL OF EVIDENCE: Level III, comparative series.

Clinical comparison of two different plating methods in minimally invasive plate osteosynthesis for clavicular midshaft fractures: A randomized controlled trial.

AIM: The aim of this study was to compare the clinical and radiographic outcomes between two different plating methods (superior vs. anteroinferior) in minimally invasive plate osteosynthesis (MIPO) for acute displaced clavicular shaft fractures. MATERIALS AND METHODS: A prospective, randomized controlled trial was performed in a single centre. Nineteen patients were treated with superior plating and 18 with anteroinferior plating using the MIPO technique. A 3.5-mm locking reconstruction plate was bent preoperatively and applied to either the anteroinferior or superior aspect of the clavicle through two separate incisions. The operating time, time to union, the proportional length difference, complications, and functional outcome of the shoulder joint were evaluated using the Constant score and the University of California Los Angeles (UCLA) score. RESULTS: There was no statistically significant difference in the Constant score and UCLA score. The mean time to union was 16.8 weeks for superior plating and 17.1 weeks for anteroinferior plating (p=0.866). The average operation time was 77.2min in superior plating and 79.4min in anteroinferior plating (p=0.491). One patient in the superior plating group showed plate failure. Despite no significant difference, one patient had nonunion in the superior plating group (p>0.999). CONCLUSIONS: From a clinical perspective, although MIPO with anteroinferior plating provides better outcomes especially in complications without statistically significant difference, both plating methods provided satisfactory clinical and radiographic outcomes. LEVEL OF EVIDENCE: Level I, a single-centre, prospective, randomized controlled trial.