Outcomes following Humeral Head Autograft Glenoid Reconstruction in Primary Reverse Total Shoulder Arthroplasty.

BACKGROUND: Patients with severe glenoid bone loss are at increased risk for poor implant fixation, scapular notching, dislocation, joint kinematic disturbances, and prosthetic failure following reverse total shoulder arthroplasty (rTSA). Glenoid bone grafting has proven useful when performing rTSA in patients with inadequate glenoid bone stock, although the current literature is limited. The purpose of this study is to evaluate clinical outcomes in patients with significant glenoid deformity undergoing primary rTSA with one-stage glenoid reconstruction using a humeral head autograft. METHODS: A database of prospectively enrolled patients was reviewed to identify patients who underwent primary rTSA with humeral head autograft (n=40) between 2008 and 2020 by six high-volume shoulder arthroplasty surgeons with minimum two-year follow-up. Variables studied included demographics, medical comorbidities, range of motion (ROM), Constant score, American Shoulder and Elbow Surgeons (ASES) score, pain score, patient satisfaction, glenoid deformity, revisions and complications. Preoperative glenoid deformity was characterized using glenoid version and beta-angles, measured on computed tomography (CT). Improvement at final follow-up was compared to a matched control group of 120 standard primary rTSA patients. Following the post hoc Bonferroni correction, an adjusted alpha value of 0.004 was used to define statistical significance. RESULTS: Forty patients were included with a mean follow-up of 5.3 (range, 2.0-13.2) years. Patients exhibited a mean preoperative glenoid retroversion and beta-angle of 29° and 80°, respectively. At final follow-up, patients who received a graft exhibited lower mean scores for active external rotation (25° vs. 39°; p = 0.001) in comparison to those who did not receive a graft. No differences were observed in active abduction (p = 0.029), active forward elevation (p = 0.009), active internal rotation (p = 0.147), passive external rotation (p = 0.082), Global Shoulder Function score (p = 0.157), Constant score (p = 0.036), ASES score (p = 0.009), or pain score (p = 0.186) between groups. Seven patients (17.5%) exhibited complications of which the most common being aseptic glenoid loosening (15%). CONCLUSION: This study demonstrates that patients undergoing primary rTSA with autogenous humeral head autograft for severe glenoid deficiency experience postoperative improvements in ROM and functional outcome scores that exceeded the minimal clinically important difference and substantial clinical benefit but inferior to matched controls. This suggests that glenoid reconstruction using a resected humeral head autograft is an effective strategy when conducting primary rTSA in patients with significant glenoid deformity.

Ulnar Collateral Ligament Repair With Internal Brace Using Linked Knotless Suture Anchors.

This article presents an adaptation of the internal brace ulnar collateral ligament (UCL) repair technique using knotless suture anchors, which shows promise for improved postsurgical functionality and a shortened recovery period in patients with UCL injuries. Traditional methods of UCL reconstruction often require a lengthy 12- to 18-month recovery period, presenting a significant challenge for athletes keen to return to their sport. The modified technique uses smaller sutures and drill holes, thereby eliminating the need for larger anchors and simplifying the surgical process. Furthermore, we provide a comprehensive exploration of the rehabilitation protocol involved after surgery, which includes various phases of physical therapy and use of the "thrower's ten" program to improve shoulder and elbow stability, strength, and mobility. This technique paves the way for a promising alternative to traditional UCL reconstruction or repair methods, with the potential to significantly enhance clinical outcomes, improve recovery times, and positively impact athletes' lives.

Outcome and complication comparison for intramedullary nail versus open reduction internal fixation in humeral diaphyseal fractures for 2800 matched patient pairs utilizing the Nationwide Readmissions Database.

INTRODUCTION: Open reduction internal fixation (ORIF) and intramedullary nail fixation (IMN) are the predominant repair methods for operative treatment of humeral diaphyseal fractures; however, the optimal method is not fully elucidated. The purpose of this study was to analyze whether IMN or ORIF humeral diaphyseal surgeries result in a significantly higher prevalence of adverse outcomes and whether these outcomes were age dependent. We hypothesize there is no difference in reoperation rates and complications between IMN and ORIF for humeral diaphyseal fractures. METHODS: Data collected from 2015 to 2017 from the Nationwide Readmissions Database were evaluated to compare the prevalence of six adverse outcomes: radial nerve palsy, infections, nonunion, malunion, delayed healing, and revisions. Patients treated for a primary humeral diaphyseal fracture with either IMN or ORIF were matched and compared (n = 2,804 pairs). Patients with metastatic cancer were excluded. RESULTS: Following an ORIF procedure, there was a greater odds of undergoing revision surgery (p = 0.03) or developing at least one of the complications of interest (p = 0.03). In the age-stratified analysis, no significant differences were identified in the prevalence of adverse outcomes between the IMN and ORIF cohorts in the 0-19, 20-39, and 40-59 age groups. Patients who were 60 + had 1.89 times the odds of experiencing at least one complication and 2.04 times the odds of undergoing a revision after an ORIF procedure versus an IMN procedure (p = 0.03 for both). DISCUSSION: IMN and ORIF for humeral diaphyseal fractures are comparable in regard to complications revision rates in patients under the age of 60. Meanwhile, patients 60 + years show a statistically significant increase in the odds of undergoing revision surgery or experiencing complications following an ORIF. Since IMN appears to be more beneficial to older patients, being 60 + years old should be considered when determining fracture repair techniques for patients presenting with primary humeral diaphyseal fractures.

Comparison of Efficiency and Effectiveness Between a Slap Hammer and Rigid C-Frame Device for Extraction of an Intramedullary Nail.

BACKGROUND: Removal of orthopaedic intramedullary implants can be difficult and time-consuming. Instrumentation for implant removal is frequently deficient for effective removal. The purpose of this study was to compare the efficiency of a C-type jig with a standard slap hammer attachment. We hypothesize that a C-type jig will be a more energy-efficient method for implant removal. METHODS: An intramedullary (IM) nail removal was simulated in a series of 10 tests using 40 PCF Sawbones bone blocks with drilled holes and custom-made IM nails. Each attachment was secured to a Shukla Medical threaded connector from their IM nail revision product. A camera recorded each hammer swing, and a caliper recorded the distance the nail traveled out of the bone block. The data were then analyzed to determine extraction rate and efficiency. RESULTS: The c-frame hammer exerted a greater force, had a greater extraction efficiency, and required 37.4% less energy expenditure than the slap hammer to extract the nail the same distance. The c-frame hammer also removed the nail 38.1% faster with the same energy expenditure and possessed greater usable kinetic energy, whereas the slap hammer had more "lost" energy. CONCLUSIONS: The c-frame hammer attachment was found to have a considerably higher extraction rate and efficiency than the slap hammer. It will be a more useful method of implant extraction, especially for cases involving larger bones or larger implants. However, the slap hammer may be more suitable for smaller tools or bones for which larger impact loading would be detrimental.

Identification of Independent Predictors of Increased 90-Day Complication and Revision Rates Following Total Elbow Arthroplasty.

Introduction: Total elbow arthroplasty (TEA) is an increasingly popular surgical option for many debilitating conditions of the elbow. There currently exists a paucity of literature regarding patient and hospital factors that lead to inferior outcomes following TEA. The purpose of this study is to identify independent predictors of increased complication and revision rates following TEA. Methods: The National Readmissions Database (NRD) was queried from 2011 to 2018 to identify all cases of TEA (n = 8932). Relevant patient demographic factors, comorbidities, and hospital characteristics were identified and run in a univariate binomial logistic regression model. All significant variables were included in a multivariate binomial logistic regression model for data analysis. Results: Independent predictors of increased complication rates included age, female sex, Medicare and Medicaid payer status, medium bed-sized center, and 18 of 34 medical comorbidities (all P < .05). Independent predictors of increased revision rates included medium bed-sized centers, non-teaching hospital status, chronic pulmonary disease, depression, and pulmonary circulatory disorders (all P < .05). Conclusion: This study identified several patient and hospital characteristics that are independently associated with both increased complication and revision rates following TEA. This information can aid orthopedic surgeons during shared decision making when considering TEA in patients. Level of Evidence: Level III, retrospective cohort study.

Timing and frequency of screening in schools: A latent variable analysis of behavioral stability over time.

The growth of school-based initiatives incorporating multitiered systems of support (MTSS) for social, emotional, and behavioral domains has fueled interest in behavioral assessment. These assessments are foundational to determining risk for behavioral difficulties, yet research to date has been limited with regard to when and how often to administer them. The present study evaluated these questions within the framework of behavioral stability and examined the extent to which behavior is stable when measured by two school-based behavioral assessments: the Direct Behavior Rating-Single-Item Scales (DBR-SIS), and the Behavioral and Emotional Screening System (BESS). Participants included 451 students rated three times per year across 4 years, with the primary teacher from each year providing the within-year ratings. Latent variable models were employed to measure the constructs underlying the observed assessment scores. Models demonstrated that the DBR-SIS best captured changes within the year, whereas the BESS scores remained stable across time points within a year. Across years, scores from both assessments captured changes. The unique contributions of each assessment in the data-based decision-making process are discussed, and recommendations are given for their combined use within and across school years. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Examining the stability of social, emotional, and behavioral risk status: Implications for screening frequency.

Responsive service delivery frameworks rely on the use of screening approaches to identify students in need of support and to guide subsequent assessment and intervention efforts. However, limited empirical investigations have been directed to informing how often screening should occur for social, emotional, and behavioral difficulties in school settings. The purpose of the current study was to evaluate the stability of risk status on 3 different screening instruments across 3 administrations across the course of a school year. A total of 1,594 students had complete screening data across 3 time points, corresponding to a total of 187 teachers from 22 different public schools located within the northeastern and midwestern United States. Across measures, we examined patterns of risk across time points and investigated the utility of (a) different screening schedules (fall, winter, and spring) and (b) borderline screening when conducting multiple screenings per year. Results indicated that a large proportion of students exhibited stable risk patterns across time points and suggested that borderline screening may be a viable alternative for schools with limited resources. Implications for practice and future research are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Methods matter: A multi-trait multi-method analysis of student behavior.

Reliable and valid data form the foundation for evidence-based practices, yet surprisingly few studies on school-based behavioral assessments have been conducted which implemented one of the most fundamental approaches to construct validation, the multitrait-multimethod matrix (MTMM). To this end, the current study examined the reliability and validity of data derived from three commonly utilized school-based behavioral assessment methods: Direct Behavior Rating - Single Item Scales, systematic direct observations, and behavior rating scales on three common constructs of interest: academically engaged, disruptive, and respectful behavior. Further, this study included data from different sources including student self-report, teacher report, and external observers. A total of 831 students in grades 3-8 and 129 teachers served as participants. Data were analyzed using bivariate correlations of the MTMM, as well as single and multi-level structural equation modeling. Results suggested the presence of strong methods effects for all the assessment methods utilized, as well as significant relations between constructs of interest. Implications for practice and future research are discussed.

Test order in teacher-rated behavior assessments: Is counterbalancing necessary?

Counterbalancing treatment order in experimental research design is well established as an option to reduce threats to internal validity, but in educational and psychological research, the effect of varying the order of multiple tests to a single rater has not been examined and is rarely adhered to in practice. The current study examines the effect of test order on measures of student behavior by teachers as raters utilizing data from a behavior measure validation study. Using multilevel modeling to control for students nested within teachers, the effect of rating an earlier measure on the intercept or slope of a later behavior assessment was statistically significant in 22% of predictor main effects for the spring test period. Test order effects had potential for high stakes consequences with differences large enough to change risk classification. Results suggest that researchers and practitioners in classroom settings using multiple measures evaluate the potential impact of test order. Where possible, they should counterbalance when the risk of an order effect exists and report justification for the decision to not counterbalance. (PsycINFO Database Record

Evaluating the technical adequacy of DBR-SIS in tri-annual behavioral screening: A multisite investigation.

The implementation of multi-tiered systems in schools necessitates the use of screening assessments which produce valid and reliable data to identify students in need of tiered supports. Data derived from these screening assessments may be evaluated according to their classification accuracy, or the degree to which cut scores correctly identify individuals as "at-risk" or "not-at-risk." The current study examined the performance of mean scores derived from over 1700 students in Grades 1, 2, 4, 5, 7, and 8 using Direct Behavior Rating-Single Item Scales. Students were rated across three time points (Fall, Winter, Spring) by their teachers in three areas: (a) academically engaged behavior, (b) disruptive behavior, and (c) respectful behavior. Classification accuracy indices and comparisons among behaviors were derived using Receiver Operating Characteristic (ROC) curve analyses, partial area under the curve (pAUC) tests, and bootstrapping methods to evaluate the degree to which mean behavior ratings accurately identified students who demonstrated elevated behavioral symptomology on the Behavioral and Emotional Screening System. Results indicated that optimal cut-scores for mean behavior ratings and a composite rating demonstrated high levels of specificity, sensitivity, and negative predictive value, with sensitivity point estimates for optimal cut-scores exceeding .70 for individual behaviors and .75 for composite scores across grade groups and time points.

A comparison of measures to screen for social, emotional, and behavioral risk.

The purpose of this study was to examine the relation between teacher-implemented screening measures used to identify social, emotional, and behavioral risk. To this end, 5 screening options were evaluated: (a) Direct Behavior Rating - Single Item Scales (DBR-SIS), (b) Social Skills Improvement System - Performance Screening Guide (SSiS), (c) Behavioral and Emotional Screening System - Teacher Form (BESS), (d) Office discipline referrals (ODRs), and (e) School nomination methods. The sample included 1974 students who were assessed tri-annually by their teachers (52% female, 93% non-Hispanic, 81% white). Findings indicated that teacher ratings using standardized rating measures (DBR-SIS, BESS, and SSiS) resulted in a larger proportion of students identified at-risk than ODRs or school nomination methods. Further, risk identification varied by screening option, such that a large percentage of students were inconsistently identified depending on the measure used. Results further indicated weak to strong correlations between screening options. The relation between broad behavioral indicators and mental health screening was also explored by examining classification accuracy indices. Teacher ratings using DBR-SIS and SSiS correctly identified between 81% and 91% of the sample as at-risk using the BESS as a criterion. As less conservative measures of risk, DBR-SIS and SSiS identified more students as at-risk relative to other options. Results highlight the importance of considering the aims of the assessment when selecting broad screening measures to identify students in need of additional support.

Direct behavior rating as a school-based behavior universal screener: replication across sites.

The purpose of this study was to evaluate the utility of Direct Behavior Rating Single Item Scale (DBR-SIS) targets of disruptive, engaged, and respectful behavior within school-based universal screening. Participants included 31 first-, 25 fourth-, and 23 seventh-grade teachers and their 1108 students, sampled from 13 schools across three geographic locations (northeast, southeast, and midwest). Each teacher rated approximately 15 of their students across three measures, including DBR-SIS, the Behavioral and Emotional Screening System (Kamphaus & Reynolds, 2007), and the Student Risk Screening Scale (Drummond, 1994). Moderate to high bivariate correlations and area under the curve statistics supported concurrent validity and diagnostic accuracy of DBR-SIS. Receiver operating characteristic curve analyses indicated that although respectful behavior cut scores recommended for screening remained constant across grade levels, cut scores varied for disruptive behavior and academic engaged behavior. Specific cut scores for first grade included 2 or less for disruptive behavior, 7 or greater for academically engaged behavior, and 9 or greater for respectful behavior. In fourth and seventh grades, cut scores changed to 1 or less for disruptive behavior and 8 or greater for academically engaged behavior, and remained the same for respectful behavior. Findings indicated that disruptive behavior was particularly appropriate for use in screening at first grade, whereas academically engaged behavior was most appropriate at both fourth and seventh grades. Each set of cut scores was associated with acceptable sensitivity (.79-.87), specificity (.71-.82), and negative predictive power (.94-.96), but low positive predictive power (.43-.44). DBR-SIS multiple gating procedures, through which students were only considered at risk overall if they exceeded cut scores on 2 or more DBR-SIS targets, were also determined acceptable in first and seventh grades, as the use of both disruptive behavior and academically engaged behavior in defining risk yielded acceptable conditional probability indices. Overall, the current findings are consistent with previous research, yielding further support for the DBR-SIS as a universal screener. Limitations, implications for practice, and directions for future research are discussed.

Direct behavior rating scales as screeners: a preliminary investigation of diagnostic accuracy in elementary school.

This study presents an evaluation of the diagnostic accuracy and concurrent validity of Direct Behavior Rating Single Item Scales for use in school-based behavior screening of second-grade students. Results indicated that each behavior target was a moderately to highly accurate predictor of behavioral risk. Optimal universal screening cut scores were also identified for each scale, with results supporting reduced false positive rates through the simultaneous use of multiple scales.