Position of shoulder arthroplasty and clinical outcome in proximal humerus fractures.

Four-part proximal humeral fractures are frequently treated with shoulder replacement. Outcome of this procedure has not been standardized, and there are controversy data on range of motion (ROM) and active function of the shoulder. The aim of this study is to compare shoulder prosthesis position (SPP) in terms of version of humeral head and height of stem with clinical subjective and objective outcome. Fifty patients were treated with shoulder hemiarthroplasty for four-part proximal humeral fracture or fracture-dislocation of the humeral head. Radiological examination and CT-scan were performed preoperatively and at follow-up. Clinical outcome evaluation included active and passive ROM, and subjective perspective collected through SF-36, OSQ, ASES, and DASH. No significant correlation between stem height and clinical outcome were found. The prosthesis version correlates with all subjective questionnaires. The ROM was not correlated with stem height and prosthesis version. SPP involves clinical outcome, with great relevance of implant version.

Italian version of ASES questionnaire for shoulder assessment: cross-cultural adaptation and validation.

The patient-oriented measures, represented by self-administered questionnaire, have become an important aspect of clinical outcome assessment. To be used with different language groups and in different countries, questionnaires must be translated and adapted to new cultural characteristics and then validated by a widely accepted process to evaluate reliability and validity, fundamental characteristic for each measure. The aim of the study is to perform the cross-cultural adaptation and to assess the Italian version instrument reliability and validity. The study design is a cross-cultural adaptation and cross-sectional study of a sample of patients affected by shoulder disorder with a subsample followed prospectively for retest reliability. The American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form was culturally adapted for Italian-speaking people, following the simplified Guillemin criteria. Reliability and validity were assessed in a cross-sectional study of 50 consecutive patients affected by shoulder disorder. A sub-sample of 20 patients was followed prospectively for retest reliability. The results were compared with other validated patient-oriented measures. The ASES scales showed a high correlation with other patient-oriented measures, as hypothesized, and it also showed good values with regard to reproducibility, consistency and validity, to the original versions published in English. These findings suggest that the evaluation capacities of the Italian version of ASES are equivalent to those of English language version.

Treatment of acute grade III acromioclavicular dislocation: a lack of evidence.

BACKGROUND: Although nonoperative treatment is considered the standard of care for the treatment of grade I and II acromioclavicular joint injuries, the treatment of grade III injuries is controversial. There are as many methods of nonoperative treatment as there are for operative stabilization. That is why we conducted a literature research to find out the best evidence regarding the treatment of acute grade III acromioclavicular dislocation. METHOD: The research was limited to RCTs, systematic review and meta-analysis in the most representative databases. Even if research identifies more than 600 articles, only five were included in the study because there were RCTs, and systematic reviews, but no meta-analysis articles were found. Moreover, no meta-analysis was performed because of differences of data published in the three RCTs (different type of surgical treatments and different outcome measures). RESULTS: From the literature evaluation, clinical results seem to be comparable between the operative and the conservative treatments, but complications are more evident in the surgery group. Since there is not a preponderance of positive papers showing the benefits of a surgical technique over conservative therapy, the nonoperative treatment is still considered a valid procedure in the grade III acromioclavicular separation. CONCLUSION: More prospective randomized studies using validated outcome measures are needed to identify the suitable operation techniques for the acute injuries.