Beach tennis injuries: a cross-sectional survey of 206 elite and recreational players.

Objectives: Although a million people regularly play beach tennis (BT) through the world there is no published information on BT injuries. The aim of this study was to describe the epidemiology of BT injuries, and to identify differences between injured and non-injured players.Methods: This was a retrospective cross-sectional epidemiology study of 206 BT players from Réunion Island describing the injuries occurring in BT. A questionnaire was developed to capture the type and chronicity of the injuries they had suffered over the prior three years. Comparisons were made between elite, regional and recreational players.Results: There were 178 injuries in 92 players (44.7%), which was an incidence of 1.81 injuries per 1000 hours of play. There were 77 acute injuries (23.8% of players, incidence of 0.78 injuries/1000 hrs.) and 101 chronic injuries (30.6% of players, incidence of 1.03 injuries/1000 hrs.). The shoulder was the most frequently injured area. The main upper limb injuries were chronic tendinopathy while most acute injuries occurred in the lower limbs. The incidence of lateral epicondylitis at the elbow was 0.36 per 1000 hours of play, or a prevalence of 4.2%. The incidence of injuries in elite players was less than that in non-ranked players (1.71 vs 2.04 injuries/1000 hours play). Recreational players more often had chronic injuries (p < 0.001).Conclusion: Information about musculoskeletal injuries is invaluable for healthcare professionals involved in the care of athletes. Such knowledge can be used to guide the medical surveillance of athletes and to help develop injury prevention strategies.

Shoulder loading reliability in seated able-bodied subjects.

Shoulder performance and sensorimotor control assessments help to identify shoulder instabilities and document the rehabilitation progress. Testing seated subjects in a position of hand prehension requires less controlled adjustments to maintain body balance in a clinically relevant situation. The objective of this work was to determine the test-retest repeatability of a novel shoulder stability test in seated subjects with the ipsi-lateral hand in prehension during four arm loading conditions. Able-bodied subjects were seated on a rigid chair fixed to a force plate. A horizontally and posteriorly directed force was applied to the hand for four 4 loading conditions ranging from 0 to 3 kg. Ten postural balance parameters were calculated from the center of pressure displacements and its corresponding free moments. Intra-class correlation coefficients were calculated for three consecutive trials and for four loading conditions. Generally, the intra-class correlations values increased gradually with the load and varied from 0.727 to 0.948. Tz values increased non-linearly with the applied load. The test-retest reliability of a new shoulder stability test in seated able-bodied subjects was high with sufficient loading (3 kg) and 3 trials.

Clinical features of 27 shark attack cases on La Réunion Island.

BACKGROUND: Between January 2000 and September 2016, there have been 27 documented shark attacks on La Réunion Island. The insular nature of La Réunion has allowed us to perform an extensive survey of these attacks. The objective was to describe the clinical features of these shark attacks, as only case reports have been published up to now. METHODS: This was a retrospective observational study of the 27 cases of nonprovoked shark attacks that have occurred between January 2000 and September 2016. Post-humate predation, provoked attacks, and isolated attack on devices were excluded. All bone and vascular injuries were documented in the 21 remaining cases. Prehospital tourniquet use was specifically recorded. RESULTS: Among the 21 victims, eight died (38%) despite rapid use of resuscitation techniques in five cases when it was feasible; these techniques were not needed in the survivors. Thirteen patients were immediately treated in the operating room. Amputation or disarticulation occurred 13 times in 10 victims, five of whom died. Twelve injuries to major vascular structures were found in 11 victims, six of which died. A prehospital tourniquet was applied in four of the five surviving victims who had injuries to major vascular structures (including one victim with major humeral and femoral artery damage) and in one victim who died (the very proximal wound was not controlled). CONCLUSION: Our study found that quickly applying a tourniquet to the injured limb(s) contributes to the victim's survival. Disarticulation is a particular feature of shark attacks. The number and severity of shark attacks at La Réunion Island are worse than in the rest of the world. LEVEL OF EVIDENCE: Epidemiological, level V.

Stemless shoulder prosthesis for treatment of proximal humeral malunion does not require tuberosity osteotomy.

PURPOSE: When the proximal humeral anatomy is altered because of malunion, shoulder arthroplasty is a challenge for the orthopaedic surgeon, and tuberosity osteotomy should be avoided whenever possible. The purpose of this study was to investigate the clinical and radiological outcomes of anatomic stemless shoulder arthroplasty in cases of malunion. We hypothesized that a stemless prosthesis can be implanted without performing tuberosity osteotomy. METHODS: We conducted a continuous, single surgeon, retrospective case series study with a minimum follow-up of two years (mean of 44 months, range 24-80). The Constant-Murley score, active range of motion and X-rays were evaluated in 27 patients (mean age of 60 years, range 37-83) with proximal humeral malunion who were treated with a stemless anatomic shoulder prosthesis. RESULTS: In all patients, the prosthesis was implanted without the need for tuberosity osteotomy. The Constant score improved from 27 to 62 (p ≤ 0.001), active anterior elevation from 81° to 129° (p ≤ 0.001), and external rotation from 5° to 40° (p ≤ 0.001). There was no evidence of radiological loosening. CONCLUSIONS: Use of a stemless anatomic shoulder prosthesis avoids the need for tuberosity osteotomy and certain surgical difficulties, even in cases of severe tuberosity malunion, and leads to good functional outcomes in the short term.

Anterior glenohumeral joint stabilization in tetraplegic patients by medializing the anterior head of deltoid muscle.

To improve control of the upper limb in high-level tetraplegic patients, the proximal shoulder must be the first consideration. Medialization of the anterior part of the deltoid muscle provides stabilization and is then an antagonist to the posterior deltoid when a pectoralis major palsy exists. It can also be performed in isolation in high-level tetraplegia even when there is little hope of distal extremity reconstruction to stabilize the shoulder. It also precedes the ability to restore elbow extension and perform further reconstructive hand surgery. We describe the surgical technique and report a clinical case.

Results of a stemless reverse shoulder prosthesis at more than 58 months mean without loosening.

HYPOTHESIS: A stemless reverse shoulder prosthesis with humeral cup was developed to allow stemless press-fit fixation, to preserve bone stock. Our hypothesis was that a stemless reverse shoulder arthroplasty could produce the same functional results without compromising humeral fixation. METHODS: This is a continuous, prospective, single-surgeon series including prostheses implanted from 2004 to 2009. Patients received pre- and postoperative clinical evaluation with measurement of joint mobility, the Oxford Shoulder score, and the Constant-Murley score by independent evaluators. Standard radiographs and computed tomographic arthrography were performed. RESULTS: Fifty-six implants were reviewed at a mean of 58 months (38-95). The Constant-Murley score improved from 29 to 62 points and the Oxford Shoulder score from 46 to 17 points. Active elevation in forward flexion improved from 79° to 140°. One intraoperative complication was recorded: a metaphyseal-diaphyseal humeral bone crack without consequence. One revision surgery due to early instability was performed using a conventional implant. No humeral loosening was observed. Five cases of scapular notching were reported. CONCLUSION: This is the first study reporting results with mid-term follow-up for a stemless reverse shoulder arthroplasty. The clinical results are comparable to conventional prostheses with stem. The absence of a humeral stem preserves bone stock for possible later revisions.

Computer-assisted total knee arthroplasty: impact of the surgeon's experience on the component placement.

INTRODUCTION: Accuracy of implant positioning in total knee arthroplasty (TKA) has a major impact on postoperative outcomes. We investigate the accuracy of positioning of multiples values simultaneously in TKA navigated, even among novice users. METHOD: The "novice" group included the first 91 knees operated on by 10 operators new to navigation and the "experienced" group 174 knees by an experienced navigator. Deviations from the preoperative planning were graded as optimal (≤3°), acceptable (4°-5°) or non-acceptable (≥5°). Moreover, the percentage of the three values fulfilling simultaneously the objective was calculated. RESULTS: No significant difference in the number of non-acceptable results was found. The common objective for these three values was achieved within 5° in 96 % in the novice group and 98 % in the experienced one. CONCLUSION: The satisfactory HKA alignment was not the result of reversed errors between the tibia and the femur, since it correlated the successful simultaneous results of alpha and beta angles.