The current standard of the shoulder trauma series in Ireland - A national audit.

OBJECTIVES/AIMS: The primary aim of this study was to assess the current standard of shoulder radiographs in Ireland. The secondary aim of this study was to determine whether orthopaedic surgeons in Ireland are of the opinion that a national protocol is required, and what this protocol should consist of. METHODS: A national audit of shoulder trauma series x-rays performed in emergency departments was conducted. The number and type of views performed was recorded. The anteroposterior (AP) and axillary or Velpeau views were assessed to determine if they met pre-defined audit criteria. Consultant orthopaedic surgeons working in public trauma hospitals were invited to participate in an online survey by email. RESULTS: The number of shoulder trauma series included in this audit was 789. The majority of patients had two views performed (75.92%, n â€‹= â€‹599) and 21.17% (n â€‹= â€‹167) had an axillary or Velpeau view. The AP view met the audit criteria in 23.09% (n â€‹= â€‹181) of cases. The survey response rate was 70.8% (n â€‹= â€‹17). 88.2% (n â€‹= â€‹15) of surgeons agreed that three views should be performed for a shoulder trauma series and 94.12% (n â€‹= â€‹16) agreed that an axillary or Velpeau view should be included. The majority of surgeons surveyed (94%, n â€‹= â€‹16) are in favour of establishing a national protocol. CONCLUSION: The current standard shoulder trauma series in Irish hospitals consists of two views, most frequently a thoracic AP and a scapular Y view. We propose the introduction of a national protocol consisting of three views: Grashey AP, Scapular Y, and an axillary or Velpeau view.

Arthroscopic Rotator Cuff Repair Results in Improved Clinical Outcomes and Low Revision Rates at 10-Year Follow-Up: A Systematic Review.

PURPOSE: To study the literature to evaluate the functional outcomes, radiologic outcomes, and revision rates following arthroscopic rotator cuff repair (ARCR) at a minimum of 10-years follow-up. METHODS: Two independent reviewers performed a literature search of PubMed, Embase, and Scopus using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Only studies reporting on outcomes of ARCR with a minimum 10-year follow-up were considered for inclusion. Patient demographics, satisfaction, and clinical, radiologic, and surgical outcomes were evaluated. RESULTS: Our search found 9 studies including 455 shoulders in 448 patients (51.6% male patients), with age at time of surgery ranging from 45 to 90 years met our inclusion criteria. Overall follow-up ranged from 10 to 18 years. At final follow-up, the ranges of American Shoulder & Elbow Surgeons, age- and sex-adjusted Constant-Morley, and University of California Los Angeles scores were reported in 5, 6, and 3 studies, respectively, as 79.4 to 93.2, 73.2 to 94, and 26.5 to 33, respectively. Of the included studies, satisfaction rates varied in 6 studies from 85.7% to 100% in the long-term. Additionally, the overall radiologic retear rate ranged from 9.5% to 63.2%. The overall surgical revision rates ranged in 6 studies from 3.8% to 15.4%, with from 0% to 6.7% requiring revision ARCR and from 1.0% to 3.6% requiring revision subacromial decompression in 6 and 2 studies, respectively, at minimum 10-years' follow-up. CONCLUSIONS: In this study, we found that ARCR results in high rates of patient satisfaction, satisfactory clinical outcomes with respect to patient-reported functional outcomes and range of motion, and low revision rates at minimum 10-years' follow-up. However, an overall 30% retear rate was observed in asymptomatic patients. LEVEL OF EVIDENCE: Level IV, systematic review of Level II-IV studies.

Clinical outcomes at medium-term follow-up of sub-acromial balloon spacer insertion in the operative management of massive rotator cuff tears.

INTRODUCTION: The management of massive rotator cuff tears (RCTs) remains a debated topic amongst orthopaedic surgeons, with a wide spectrum of treatment options available. In recent years, the use of sub-acromial balloon spacers has emerged as an option in the management of massive RCTs. The purpose of this study is to evaluate the clinical outcomes of patients with massive RCTs who underwent arthroscopic sub-acromial balloon spacer insertion at medium-term follow-up. METHODS: All consecutive patients in our institution who had undergone sub-acromial balloon spacer insertion under the senior author from 2015 to 2020 were identified and followed up via telephone survey. Patient demographics, patient-reported outcomes, complications and subsequent surgeries were all analysed using the SPSS. RESULTS: Overall, 45 patients (31 males) including 36 retired (80.0%) patients, with a mean age of 70.3 ± 7.0 (40-83) years, and mean follow-up of 37.1 ± 16.4 (12-62) months were included. At final follow-up, the mean ASES score was 73.4 ± 21.8 (25-100), the mean SSV was 76.4 ± 16.0 (45-100), baseline VAS score was 0.3 ± 1.1 (0.0-6.0) and functional VAS score was 2.6 ± 2.3 (0.0-8.0), with a total of 89.9% of patients (n = 40) being satisfied at final follow-up. This series reported no intra-operative complications (0.0%), with 4 patients (8.9%) required subsequent procedures to the ispilateral shoulder post-sub-acromial balloon insertion. CONCLUSION: In selected patient cohorts, the use of sub-acromial balloon spacer insertion represents a minimally invasive, viable surgical option in the management of massive rotator cuff tears, with satisfactory patient-reported outcomes, high rates of satisfaction and a low complication rate reported at medium-term follow-up. LEVEL OF EVIDENCE: III; Retrospective Cohort Study.

Refracture of the Pediatric Forearm with Intramedullary Nails in situ.

INTRODUCTION: There are few described cases in literature describing the management of refracture of both bone forearm fractures with elastic stable intramedullary nails (ESIN) in situ. We describe our experience and discuss it in the context of existing reports. CASE REPORT: A 6-year-old girl presented to our unit with a refracture of her forearm with ESIN in situ following a trauma, 5 months post her index injury and ESIN procedure. She was managed with closed reduction under general anesthesia with a good outcome. DISCUSSION: Treatment of this unusual injury is challenging given the paucity of evidence to inform management. Many existing case series fail to report this complication. We echo those studies that have employed similar strategies and note potential complications associated with this management including altered biomechanics of the ESIN. CONCLUSION: Closed reduction of a refracture of pediatric forearm with ESIN in situ is an acceptable approach to this unusual injury. Caution must be taken intraoperatively and postoperatively to account for any biomechanical deficiencies in the ESIN resulting from the forces applied to cause the refracture and forces applied to the in situ nails to achieve correction intraoperatively.

Osteochondroma of acromioclavicular joint.

Osteochondroma is the most common type of benign bone tumour. It is a benign chondrogenic lesion derived from aberrant cartilage from the perichondral ring, and it commonly presents in the proximal humerus, proximal femur and knee. Osteochondroma is usually solitary but can be multiple with patients with hereditary multiple exostoses. Malignant changes happen in approximately 1% of cases. Osteochondroma usually causes local pain or swelling. We discuss a unique case of an osteochondroma that highlights the fact that osteochondroma can occur in the most unlikely places, and they should be properly visualised via radiography to evaluate any extensions and compromised surrounding structures before surgical intervention.

A single centre experience of pre-contoured clavicle plates by an anterior approach.

AIM: In recent years there has been increasing evidence that comminuted and shortened clavicle fractures should be treated surgically. The aim of this study was to assess the outcome of patients who had their clavicle fracture fixed using a pre-contoured, clavicle specific plate from an anterior approach. METHOD: A retrospective analysis was carried out of all patients treated with pre-contoured clavicle plates from an anterior approach between May 2014 and June 2016.Medical records were analysed, and a phone survey was carried out to assess patient function and note any complications. RESULTS: Thirty-five eligible patients were identified. Post-operative complications included: 3 patients experienced altered sensation of the anterior chest wall, 2 suture granulomas, 1 incidence of prominent metalwork. In addition, 2 patients suffered peri-implant fractures due to secondary trauma after union. Patients who had Open Reduction and Internal Fixation (ORIF) for acute fractures had a mean qDASH of 8.93 and those who had a ORIF and bone grafting for non-union had an mean qDASH of 34.38. CONCLUSION: Although there are 6 complications listed for 33 procedures, these would be considered minor. Patients appear to do better if treated for an acute fracture. Anterior approach for clavicle ORIF using an anatomically shaped pre-contoured plate appears to be a safe and effective procedure.

The Effect of Hand Dominance on Functional Outcome Following Single Row Rotator Cuff Repair.

INTRODUCTION: Rotator cuff tears are a common cause of shoulder disability and pain. Excellent outcomes can be obtained with surgical treatment although this outcome is affected by several factors. We sought to investigate the effect of hand dominance on subjective functional outcome post rotator cuff repair. METHODS: All patients who had rotator cuff repair over a calendar year were identified and followed up at 3 years post operatively. Patients were consented for inclusion in the study and demographic data, hand dominance and functional outcome data was collected. L'insalata shoulder questionnaire was used for outcome data collection. SPSS version 22 was used for statistical analysis where appropriate. RESULTS: 144 patients were included in this study. Mean age was 63 +/- 10.1 years in the dominant side group and 62 +/- 8.6 years in the non-dominant group. 92 patients had dominant side surgery and 52 had non-dominant side surgery. There was a statistically significant correlation between dominant hand and operated side (P=0.005). The mean overall outcome score was marginally higher in the dominant surgery group with a mean of 89.8 +/- 14.2 compared with a mean of 87.4 +/- 17.5 in the non-dominant group. Multi-variate linear regression analysis revealed this difference to be non-significant (p = 0.4). CONCLUSION: No difference was found in the functional outcome of rotator cuff repair between dominant and non-dominant side surgery. This information will help in counselling patients who are concerned about the potential impact of rotator cuff repair on the function of their dominant hand.

Replicating proximal humeral articular geometry with a third-generation implant: a radiographic study in cadaveric shoulders.

Prosthetic shoulder arthroplasty must replicate humeral geometry or risk compromising success. The purpose of our study was to evaluate humeral head replacement with respect to replicating proximal humeral anatomy. Using scanning technology and AutoCAD, this study was conducted in 2 parts. First, geometric parameters were measured on 35 cadaveric humeri and were used to design a new shoulder arthroplasty system. Second, humeral head replacement was performed on 18 of these humeri by use of the new shoulder arthroplasty system, and selected preoperative and postoperative measurements were compared. Preoperative to postoperative differences were minimal and exhibited improvement compared with earlier designs. In this study, humeral head replacement with a third-generation system reproduced the original anatomy of 18 cadaveric humeri more accurately than previously reported. This finding is important because accurate anatomic reconstruction in shoulders is essential for minimizing subacromial contact and optimizing range of motion.

Compliance and satisfaction with foot compression devices: an orthopaedic perspective.

INTRODUCTION: Although mechanical methods of thromboembolic prophylaxis have proven efficacy, relatively little is known about levels of patient compliance in the usage of these devices. Based on anecdotal evidence, we hypothesised that levels of compliance are sometimes insufficient to provide adequate thromboprophylaxis in the clinical setting. We prospectively analysed the use of foot pumps in 30 orthopaedic patients undergoing lower limb arthroplasty in order to assess levels of both patient compliance and satisfaction. MATERIALS AND METHODS: The study was carried out over a 5-month period. Levels of compliance were measured by using a system of random "spot checks". Each patient completed a questionnaire before discharge. Parameters investigated included comfort levels while using the device and identification of factors about the device which the patients disliked. RESULTS: Three hundred and ninety-one measurements were made. The utilisation of the device was found to be effective in 40.2% of measurements. We detected an overall progressive decline in the level of compliance as post-operative time increased [P < 0.001, Chi-square (chi(2)) test]. The average level of patient "comfort" was 7.1 on a visual analogue scale of 0-10. Sleep disturbance was reported by 57% of patients, while 43% complained of "heat intolerance". We have also shown that compliance is significantly reduced in those who complained of "sleep disturbance" while using the foot pumps (t-test, P < 0.05). CONCLUSIONS: These findings suggest that satisfactory levels of compliance can be difficult to achieve in the clinical setting despite the proven efficacy in clinical trials of this device. Greater emphasis on patient education may help improve compliance. Unless compliance can be strictly enforced, it appears advisable to only use foot pumps in combination with other forms of pharmacological prophylaxis.