Comparative Short-Term Outcomes of Femoral Neck System (FNS) and Cannulated Screw Fixation in Patients with Femoral Neck Fractures: A Multicenter Study.

Background: Femoral neck fractures need to be treated in their early stages with accurate reduction and stable fixation to reduce complications. The authors compared the early radiologic outcomes of femoral neck fractures treated with the recently introduced Femoral Neck System (FNS, Depuy-Synthes) with conventional cannulated screws (CS) in a multicenter design. Furthermore, the factors associated with early failure after FNS were analyzed. Methods: The FNS group included 40 patients treated between June 2019 and January 2020, and the CS group included 65 patients treated between January 2015 and May 2019. The operation was performed in 3 university hospitals. Patient demographics, fracture classification, postoperative reduction quality, sliding distance of FNS or CS, union and time to union, and complication rates were examined. Logistic regression analysis was performed on candidate factors for early failure of the FNS group. Results: The FNS group had a 90% union rate and a mean time to union of 4.4 months, while the CS group had similar results with an 83.1% union rate and a mean time to union of 5.1 months. In the subgroup analysis of Pauwels type III fractures, the union rates were 75.0% and 58.8% in the FNS and CS groups, respectively, and the time to union was significantly shorter in the FNS group with 4.8 months compared to 6.8 months in the CS group. Early failure rate within 6 months of FNS fixation was observed to be 10%, which included 3 reduction failures and 1 excessive sliding with a broken implant. Risk factors for early failure after FNS were identified as displaced fractures (Garden classification type III or IV), poor reduction quality, longer tip-apex distance, greater sliding distance, and 1-hole implants, of which sliding distance was the only significant risk factor in multivariate analysis. Conclusions: In femoral neck fractures, FNS and CS did not show significant differences for short-term radiologic results. FNS resulted in shorter operative time than cannulated screw fixation and favorable outcomes in Pauwels type III femoral neck fractures. The FNS could be considered a reliable and safe alternative to CS when treating femoral neck fractures.

Comparative analysis of superior capsule reconstruction between long head of biceps tendon autograft and human dermis allograft.

BACKGROUND: Although many superior capsule reconstruction (SCR) techniques are currently practiced in clinical settings, guidelines for choosing the appropriate graft material are lacking. Therefore, at most times, the surgeon's personal preference becomes the deciding factor. This study compared 2 fairly recent SCR techniques-SCR with biceps tendon (BT) autograft and SCR with human dermis (HD) allograft-by evaluating clinical and radiologic outcomes to aid the surgeon's decision in choosing the appropriate graft. METHODS: Thirty-one patients underwent SCR using BT autograft (SCR BT), and 22 underwent SCR using HD allograft (SCR HD). SCR BT was selected for patients with a partial BT tear <20%, no severe inflammation signs, and favorable anchor conditions. SCR HD was performed in patients with a BT tear >20%, a superior labrum anterior-posterior (SLAP) lesion, severe inflammation, or subluxation. Range of motion (ROM), strength and shoulder function scoring, plain radiography, and magnetic resonance imaging were evaluated before and after surgery at regular intervals. RESULTS: In the SCR BT group, forward flexion ROM increased from 122° ± 43° to 149° ± 18° at 2 years postoperatively, whereas in the SCR HD group, forward flexion ROM improved from 129° ± 28° to 149° ± 18°. In the SCR BT group, internal rotation (IR) ROM increased from 5 ± 3 to 6 ± 2 at 2 years postoperatively, whereas in the SCR HD group, IR ROM improved from 5 ± 3 to 6 ± 1. Although ROM, strength, visual analog scale score, American Shoulder and Elbow Surgeons score, and Constant score all improved 2 years after surgery, no statistically significant differences were found. Six months after surgery, graft thickness was 3.58 ± 0.384 mm in the SCR BT group and 2.49 ± 0.326 mm in the SCR HD group (P < .001). At 2 years postoperatively, graft thickness was 3.54 ± 0.399 mm in the SCR BT group and 2.49 ± 0.306 mm in the SCR HD group (P < .001). The SCR HD group showed a negative correlation of -0.475 between graft thickness and IR ROM (P = .026). In the SCR BT group, a negative correlation of -0.466 was found between graft thickness and IR ROM (P = .008). A positive correlation of 0.363 was found between IR ROM and the acromiohumeral distance when the results were compared before and 2 years after surgery (P = .045). CONCLUSION: Both SCR using BT autograft and SCR using HD allograft tissue showed favorable results, and no significant difference was noted between the 2 techniques. Given that the 2 techniques show equally favorable results, the surgeon's personal preference in choosing the SCR technique appears to be acceptable. Understanding the costs and patient's characteristics may aid the surgeon in deciding on the graft material.

Clinical and radiological outcomes of ultrasound-guided barbotage using a spinal needle and subacromial steroid injection for calcific tendinitis of the shoulder.

BACKGROUND: Ultrasound (US)-guided techniques reported for the treatment of calcific tendinitis have mostly demonstrated good results. This study investigates the effect of US-guided barbotage using a spinal needle in patients with calcific tendinitis of the shoulder. METHODS: Thirty-six patients with calcific tendinitis of the shoulder treated by US-guided barbotage with a spinal needle and subacromial steroid injection were included in the study. We evaluated clinical outcomes based on American Shoulder and Elbow Surgeons (ASES) score, Constant score, and visual analog scale (VAS) for pain score. Radiological outcomes were assessed by X-ray imaging at each visit. RESULTS: Our results showed that US-guided barbotage and subacromial steroid injection produced good clinical and radiological outcomes in patients with calcific tendinitis of the shoulder. Of the 36 patients, only one required surgical treatment, while the others showed improvement without any complications. Compared to values before the procedure, calcific deposit size and VAS, ASES, and Constant scores showed significant improvement 6 weeks after the procedure. No significant correlation was found between the initial calcific deposit size and clinical outcomes at each time point. CONCLUSIONS: In patients with calcific tendinitis of the shoulder, US-guided barbotage using a spinal needle and subacromial steroid injection can yield satisfactory clinical and radiological results.

Comparison between anterior and posterior plating systems in extra-articular distal-third diaphyseal humeral fractures.

PURPOSE: The ideal surgical treatment of extra-articular distal-third diaphyseal humeral fractures is controversial in terms of the surgical approach and plate position. The aim of this study was to compare the clinical and radiological outcomes between anterior and posterior plating methods for extra-articular distal-third diaphyseal humeral fractures. METHODS: Twenty-four patients were treated with anterior plating with modified placement of the proximal humeral internal locking system (PHILOS) plate, and 22 patients were treated with posterior plating of the extra-articular distal humerus plate (EADHP). Patient demographics, the fracture configuration, the number of screws in the distal fragment, the operation time, and the time to union were analyzed. The range of elbow motion, Mayo elbow performance score (MEPS), plate-related symptoms, and complications were evaluated at the final follow-up. RESULTS: There were no statistically significant differences in the demographic data between the two groups. The mean operation time for anterior plating (108.2 ± 24.5 min) was significantly shorter than that for posterior plating (144.2 ± 29.5 minutes, p < 0.001). The average number of screws used in the distal humeral fragment was significantly higher with anterior plating (5.7 ± 0.7) than with posterior plating (4.8 ± 0.5, p < 0.001). No patients in the anterior plating group had plate-related symptoms, while 17 patients in the posterior plating group (77%) had discomfort or cosmetic problems related to the plate (p < 0.001). Plate removal was performed upon patient request in nine patients of the posterior plating (52.9%) and four (17%) in anterior plating (p = 0.040). Nonunion occurred in one patient who underwent anterior plating, and one patient who underwent posterior plating had post-operative radial nerve palsy. There were no significant differences in the MEPS or elbow range of motion between the two surgical methods. CONCLUSION: Both anterior and posterior plating provide satisfactory clinical and radiologic outcomes for extra-articular distal-third diaphyseal humeral fractures. Despite the satisfactory outcomes, however, posterior plating is highly associated with plate-related complaints, which might be one of the considerations when the surgical method is selected for extra-articular distal-third diaphyseal humeral fractures.