Outcomes after rotator cuff repair in the elderly as assessed by the American Shoulder and Elbow Surgeons shoulder score

Rotator cuff tears are common among the elderly, and studies on the outcomes after rotator cuff repair in the elderly are limited. We carried out this meta-analysis with systematic literature search, aiming to clarify the outcomes after rotator cuff repair in the elderly as assessed by the American Shoulder and Elbow Surgeons (ASES) shoulder score. We conducted a literature search through October 2019 in PubMed and EMBASE databases and performed meta-analysis to calculate the summary mean difference comparing the post- and pre-operation ASES scores under both fixed-effect and random-effect models. Among 4978 studies identified through literature search, four studies (two in the United States, one in France, and one in Republic of Korea) were eligible for the meta-analysis, including 282 patients who were aged over 70 years. These studies had low heterogeneity as measured by Cochran's Q test (p=0.88) and I2 statistic (0%). The ASES scores on average increased by 39.7 (95% confidence interval 28.3-51.1, p<0.001) after rotator cuff repair, in both fixed-effect and random-effect models. No substantial publication bias was indicated. Our findings suggest improved outcomes after rotator cuff repair in the elderly population as measured by the ASES score, and such improvements have been consistent in previous studies.

Relevance of a skilled vascular surgeon and optimized facility practices in the long-term patency of arteriovenous fistulas: a prospective study / Relevância de um cirurgião vascular qualificado e práticas hospitalares otimizadas na patência a longo prazo das fístulas arteriovenosas: um estudo prospectivo

Abstract Introduction: Arteriovenous fistulas (AVF) are the best hemodialysis vascular accesses, but their failure rate remains high. Few studies have addressed the role of the vascular surgeon's skills and the facility's practices. We aimed to study these factors, with the hypothesis that the surgeon's skills and facility practices would have an important role in primary failure and patency rates at 12 months, respectively. Methods: This was a single-center, prospective cohort study carried out from March 2005 to March 2017. Only incident patients were included. A single surgeon made all AVFs, either in the forearm (lower) or the elbow (upper). Vascular access definitions were in accordance with the North American Vascular Access Consortium. Results: We studied 113 AVFs (65% lower) from 106 patients (39% diabetics, 58% started with catheter). Time to first connection was 21.5 days (IR: 14 - 31). Only 14 AVFs (12.4%) underwent primary failure and 18 failed during the first year. Functional primary patency rate was 80.9% (SE 4.1) whereas primary unassisted patency rate, which included PF, was 70.6% (4.4). Logistic regression showed that diabetes (OR = 3.3, 95%CI 1.38 - 7.88, p = .007) and forearm location (OR = 3.03, 95CI% 1.05 - 8.76, p = 0.04) were predictors of AVF failure. Patency of lower and upper AVFs was similar in non-diabetics, while patency in diabetics with lower AVFs was under 50%. (p = 0.003). Conclusions: Results suggest that a long-lasting, suitable AVF is feasible in almost all patients. The surgeon's skills and facility practices can have an important role in the long term outcome of AVF.

Resumo Introdução: Fístulas arteriovenosas (FAV) são os melhores acessos vasculares para hemodiálise, mas sua taxa de falhas permanece alta. Poucos estudos abordaram o papel das habilidades do cirurgião vascular e das práticas hospitalares. Nosso objetivo foi avaliar esses fatores, com a hipótese de que as habilidades do cirurgião e as práticas hospitalares teriam um papel importante nas taxas de falhas primárias e perviedade em 12 meses, respectivamente. Métodos: Este foi um estudo de coorte prospectivo de um único centro, realizado de março de 2005 a março de 2017. Apenas os pacientes incidentes foram incluídos. Um único cirurgião fez todas as FAVs, seja no antebraço (inferior) ou no cotovelo (superior). As definições de acesso vascular estavam de acordo com o Consórcio Norte-Americano de Acesso Vascular. Resultados: Estudamos 113 FAVs (65% inferiores) de 106 pacientes (39% diabéticos, 58% começaram com cateter). O tempo até a primeira conexão foi de 21,5 dias (RI: 14 - 31). Apenas 14 FAV (12,4%) tiveram falha primária e 18 falharam durante o primeiro ano. A taxa de patência funcional primária foi de 80,9% (SE 4,1), enquanto a taxa de permeabilidade primária não assistida, que incluiu FP, foi de 70,6% (4,4). A regressão logística mostrou que o diabetes (OR = 3,3, 95% IC 1,38 - 7,88, p = 0,007) e localização no antebraço (OR = 3,03, 95% IC 1,05 - 8,76, p = 0,04) foram preditores de falha da FAV. A patência das FAVs inferior e superior foi semelhante em não-diabéticos, enquanto a perviedade em diabéticos com FAV inferior foi menor que 50%. (p = 0,003). Conclusões: Nossos resultados sugerem que uma FAV duradoura e adequada é viável em quase todos os pacientes. As habilidades do cirurgião e das práticas hospitalares podem ter um papel importante no resultado a longo prazo da FAV.

Artroplastía total de codo en un paciente adulto mayor como opción terapéutica para el manejo de seudoartrosis en fractura de húmero distal / Total elbow arthroplasty in an older adult patient, as a therapeutic option for the management of pseudoarthrosis in distal humerus fracture

Resumen: Introducción: Las fracturas de húmero distal en el adulto mayor constituyen un desafío terapéutico para ortopedistas, debido a las condiciones fisiológicas y los cambios óseos propios de esta edad. Reporte de caso: Se presenta el caso de una mujer de 80 años con osteopenia, quien sufrió una caída de su propia altura con fractura de húmero distal derecho, inicialmente se le dio manejo conservador, pero debido al desarrollo de seudoartrosis, se decidió hacer una artroplastía total de codo, con buenos resultados funcionales en el seguimiento postoperatorio a cuatro años. Discusión: En las fracturas de húmero distal, el manejo no quirúrgico es una opción en pacientes con baja demanda funcional o que tengan un mal estado general, y si no es el caso o fracasa el manejo conservador, deben ser llevados a artroplastía total de codo, ya que ésta proporciona una rápida recuperación del paciente en comparación con la reducción abierta y el manejo con material de osteosíntesis.

Abstract: Introduction: Distal humeral fractures in the elderly patient are a therapeutic challenge for orthopaedists, because of age's characteristic physiological conditions and bone changes. Case report: We present the case of an 80-year-old woman with osteopenia, who had distal humeral fracture due to a fall from her own height; she was initially treated conservatively, but by the reason of a non-union, we decided to perform a total elbow arthroplasty, achieving a positive functional result in the four years of postoperative follow-up. Discussion: Nonsurgical management is an option for treat humeral fractures in patients with low functional demands or in poor general condition. If the patient does not present the conditions above, or if nonsurgical management fails, a total elbow arthroplasty must be performed, because this method provides a rapid recovering if compared to an open reduction and osteosynthesis material management.

Acute distal biceps ruptures: single incision repair by use of suture anchors / Lesão do bíceps distal aguda: reparo por via única e fixação por âncora de sutura

ABSTRACT OBJECTIVE: Clinical and functional assessment of the surgical treatment for acute injury of the distal insertion of the biceps brachial performed with a surgical technique using a single incision in proximal forearm and fixation with suture anchors in the radial tuberosity. METHODS: This study reviewed the medical records of patients who underwent surgical treatment of distal biceps injury during the period between January 2008 and July 2014. In a mean follow-up of 12 months, 22 patients with complete and acute injury, diagnosed through physical examination and imaging studies, were functionally assessed in the postoperative period regarding the range of motion (degrees of flexion-extension and pronation-supination), the presence of pain (VAS), the Andrews Carson-score, and the Mayo Elbow Performance Score (MEPS). RESULTS: During the postoperative follow-up assessment, no patient reported pain by VAS scale; all were satisfied with the esthetic appearance of the surgery. The range of articular movement remained unchanged at 95.4% of patients, with the loss of 8° of supination in one patient. No changes in muscle strength were observed. The results of the Andrews-Carson score were good in 4.6% and excellent in 95.4% of cases; the MEPS presented 100% of excellent results. The rate of complications was 27.2%, similar to the literature. CONCLUSION: Surgical repair of acute injury of the distal biceps trough a single incision in the proximal forearm and fixation with two suture anchors in the radial tuberosity is an effective and safe therapeutic option, allowing early motion and good functional results.

RESUMO OBJETIVO: Avaliação clínica e funcional do tratamento cirúrgico da lesão aguda da inserção distal do bíceps braquial pela técnica cirúrgica por via de acesso única no antebraço proximal e fixação com âncoras de sutura na tuberosidade radial. MÉTODO: Estudo feito por meio da revisão dos prontuários de pacientes submetidos a tratamento cirúrgico de lesão da inserção distal do bíceps braquial entre janeiro de 2008 e julho de 2014. Em um seguimento médio de 12 meses, 22 pacientes com lesão completa e aguda, diagnosticados por exame físico e exames de imagem, foram avaliados funcionalmente no pós-operatório por meio da mensuração da amplitude de movimentos (graus de flexoextensão e pronossupinação), pela presença de dor (EVA) e pelas escores de Andrews-Carson e Mayo Elbow Performance Score (MEPS). RESULTADOS: Durante a avaliação dos pacientes no seguimento pós-operatório, nenhum paciente referia dor pela escala EVA e todos estavam satisfeitos com a aparência estética da cirurgia. A amplitude de movimento articular encontrava-se inalterada em 95,4% dos pacientes, com a perda de 8o de supinação em um paciente. Os resultados segundo o escore de Andrews-Carson foram bons em 4,6% e excelentes em 95,4% dos casos; no MEPS, observaram-se 100% de resultados excelentes. A taxa de complicações foi de 27,2%, valor semelhante aos dados da literatura. CONCLUSÃO: O tratamento cirúrgico das lesões agudas do bíceps distal por via única com fixação com o uso de duas âncoras de sutura mostrou-se uma opção terapêutica segura e eficaz, permitiu movimentação precoce e bons resultados clínicos e funcionais.

Accidental implantation of a bur tip in the elbow of a dentist. A possible pathway for inoculation with deadly infectious agent

The most common source of occupational injury to dentists is percutaneous puncture of the hands from "sharps". We report a percutaneous injury involving a dentist where the tip of a dental bur became implanted in his elbow. The dentist had been vaccinated against Hepatitis B and both the patient and dentist were Hiv and Hepatitis B seronegative immediately after the incident. Surgical exploration of the dentist's elbow the following day was unsuccessful in locating the bur tip. The dentist remains healthy and is not incapacitated as a result of the injury, despite retention of the bur tip. This accident has implications for modifying the design of present and future dental units. We are not aware of a previous report of this type of injury.

Ruptura bilateral simultânea do tendäo tricipital em paciente renal crônico em hemodiálise / Simutaneous bilateral rupture of the triceps tendon in a patient in hemodialysis for chronic renal failure

Os autores relatam o caso de uma paciente com insuficiência renal crônica em hemodiálise que apresentou ruptura bilateral simultânea do tendao tricipital, sendo submetida a tratamento cirúrgico, com recuperaçao dos movimentos ativos após três meses.

Acroqueratosis paraneoplásica de Bazex: caso clínico: revisión bibliográfica / Acrokeratosis paraneoplastica of Bazex: clinic case: bibliographic review

Se comunica el caso de un paciente masculino, de 61 años,fumador crónico con su consiguiente enfermedad pulmonar obstructiva crónica (EPOC),que presentó lesiones escamosas en nariz,codos,orejas,alteraciones ungueales,hiperqueratosis plantar y adenomegalia cervical izquierda de tipo metastásico. Se diagnostica Acroqueratosis de Bazex y se inicia la búsqueda de tumor primitivo,sin éxito.Se hace revisión bibliográfica de este síndrome paraneoplásico