Long-term clinical and radiological outcomes following arthroscopic microfracture of the glenohumeral joint for chondral defects.

Background: The primary aim of this study was to evaluate mid- and long-term outcomes following microfracture in patients with glenohumeral chondral lesions. Methods: This prospective cohort study assessed patients with shoulder pain who were treated with arthroscopic microfracture for full-thickness chondral lesions of the glenohumeral joint. Outcomes included the Simple Shoulder Test at baseline, mid-term (approximately 1 year) and long-term (approximately 10 years), and the Oxford Shoulder Score, shoulder pain (0-10 numerical scale) and radiological assessment using a modified Samilson & Prieto score at long-term follow-up. Data were analyzed with paired t-tests and Wilcoxon's signed rank tests, which were considered significant if P < .05. Results: Twenty-five patients with a mean age of 52.7 ± 12.1 were enrolled. The mean Simple Shoulder Test score improved from baseline to 1 year (6.7 ± 2.5 to 11.0 ± 1.4, P < .001), which was maintained at long-term follow-up (10.3 ± 2.1, P < .001). Additionally, at long-term follow-up, Oxford Shoulder Score and Verbal Pain Score scores were 43 ± 4.8 and 1.1 ± 1.5, respectively while median modified Samilson & Prieto scores increased from 1 preoperatively to 2 at 10 years (P < .001). Conclusion: Patients undergoing microfracture for full-thickness chondral lesions of the glenohumeral joint reported substantial improvements in shoulder pain and function at 1 and 10 years, despite progressive radiological degeneration.

Implementation of a clinical pathway for osteoporosis management within an Orthopaedic Fracture Clinic.

BACKGROUND: A fracture liaison service (FLS) is a multidisciplinary system approach to reducing subsequent fracture risk in patients with a recent fragility fracture. This study investigated the utility of an alternate model delivered by orthopaedic surgeons in increasing the investigation and treatment of osteoporosis within an orthopaedic fracture clinic in a tertiary hospital. METHOD: We established a pathway of treatment (FLS) for women ≥50 years old with a minimal trauma fracture (MTF) in the orthopaedic fracture clinic using existing clinic resources to identify patients. All female patients ≥50 years old with upper limb MTFs during the study period were included and compared with historical controls prior to the intervention. The intervention and control groups were compared to assess the capacity of the new model of care to identify suitable patients and deliver best practice care. RESULTS: After the intervention the cumulative rate of osteoporosis screening increased from 52/173 to 201/318 (P < 0.001). Among the patients who were screened for osteoporosis the treatment rate increased from 25/52 to 126/201 (P < 0.001). The intervention resulted in a significant reduction in patients who were not screened after MTF from 87/173 to 40/318 (P < 0.001). CONCLUSION: We have developed a low-cost pathway developed by the orthogeriatric team integrated into an orthopaedic fracture clinic that leads to increased screening and treatment of osteoporosis. This model was implemented in a tertiary hospital with an integrated inpatient orthogeriatric service and highly engaged orthopaedic surgeons and may not be applicable in other settings.

The efficacy of nonsteroidal anti-inflammatories in the prevention of heterotopic ossification following elbow trauma surgery.

BACKGROUND: Heterotopic ossification (HO) is common following surgery for elbow trauma and can have a significant impact on elbow function. The use of nonsteroidal anti-inflammatories (NSAIDs) for HO prophylaxis following total hip arthroplasty is well described, with the gold standard of indomethacin 25 mg tid for 6 weeks. However, there is sparse evidence relating to the elbow joint, particularly after elbow trauma surgery. We aim to investigate the efficacy of NSAIDs in the primary prevention of HO amongst all adult patients undergoing surgery for elbow trauma and identify risk factors for HO formation. METHODS: A search of the Fiona Stanley Hospital electronic theater database for procedures undertaken for elbow trauma from January 2015 to June 2020 was performed. Electronic medical records and radiographs were reviewed to determine the incidence of HO, prescription of NSAIDs, biographical data, and complications. RESULTS: One hundred and fifty-three patients were identified of which 78 patients received NSAIDs postoperatively, compared to 72 who did not. The prescribing history of the remaining 3 patients was unknown. In the NSAID group, the typical patient was prescribed 3-7 days of NSAIDs. Ten patients received a prophylactic course (4-6 weeks). The incidence of HO was similar in both groups (24% in those taking NSAIDs vs. 21% in those not taking NSAIDs). Of those specifically prescribed a prophylactic course, 50% developed HO and 50% did not. Statistical analysis demonstrated that patients with increased body mass index and high energy injuries were more likely to develop HO. Overall complications were low within the cohort. Only 1 patient, who was prescribed NSAIDs, suffered a fracture nonunion (1.3%). CONCLUSION: NSAIDs did not affect the incidence of HO about the elbow following surgery for trauma amongst our cohort. There was no appreciable difference in the rates of HO amongst those prescribed NSAIDs and those who were not. Increased body mass index and high energy trauma were predictive for higher incidence of HO. Risks of NSAID therapy were low, with only 1 (1.3%) patient suffering a nonunion.

Comparison of outcomes between hip fracture patients with concurrent upper limb injuries and patients with an isolated hip fracture.

BACKGROUND: Concurrent upper limb injuries can occur with hip fractures, and its incidence and effect on outcomes are unclear. The objective of this study was to review the number and types of upper limb injuries sustained by patients with hip fractures, and investigate how acute hospital stay, rehabilitation and patient outcomes are affected. METHODS: A retrospective study was performed on 820 patients with traumatic fracture of the hip over the age of 50. We reviewed the patients with concurrent upper limb injuries and compared patient outcomes - including mortality, acute length of stay in the orthopaedic ward, rehabilitation outcomes and rehabilitation length of stay. RESULTS: Thirty-four patients (4.1%) with a hip fracture had a concurrent upper limb injury. Patients with and without concurrent upper limb injuries had similar acute length of stays on the orthopaedic ward (mean 5.2 versus 5.5 days, P = 0.4), and no significant difference in mortality rates at time of discharge (0% versus 3.8%, P = 0.4) and at 30 days (2.9% versus 9.1%, P = 0.2). However, they also required significantly longer rehabilitation (mean 34.6 versus 19.9 days, P = 0.009) even after other demographic factors including upper limb injury, older age and dementia were taken into consideration (multivariate linear model: concurrent upper limb injury, P = 0.0003; older age, P = 0.05; dementia, P = 0.09). CONCLUSION: A concurrent upper limb injury is infrequent in the hip fracture population. Overall, these patients were previously higher functioning than the average hip fracture patient and required longer stays in inpatient rehabilitation than patients with isolated hip fractures.

Magnetic resonance imaging based coracoid morphology and its associations with subscapularis tears: a new index.

BACKGROUND: We aimed to assess the validity of magnetic resonance imaging (MRI) in assessing the subcorocoid space and determine the validity of novel sagittal plane subcorocoid space measurements. METHODS: We assessed 33 arthroscopically proven subscapularis tears with MRIs compared to 33 (instability) controls with normal subscapularis tendons. Three examiners analyzed MRIs for seven static indices of corocoid morphology, in axial and sagittal planes. We explored reviewer variation using intraclass correlation coefficients (ICC) and differences between the two groups was explored using t-tests. RESULTS: Groups were similar in characteristics but different in age (cases = 53, controls = 23). ICC showed good (2/7) or excellent (5/7) reliability. Small differences(<1.6 mm) were identified between subscapularis tears and controls in coraco-humeral distance, in axial (p = 0.092) and sagittal planes (p = 0.045). There were statistically significant differences between groups when analyzing the angular projection of the coracoid from the glenoid, in both sagittal (p < 0.0001) and axial planes (p = 0.045). CONCLUSIONS: Acute inferior angulation of the corocoid in the sagittal plane may be associated with subscapularis tears. Static indices are measured within the scapula and not affected by arm position. MRI reliably provided a platform to assess the coracoid. Based on this, we currently consider corocoplasty in patients with subscapularis tears and a sagittal coroco-glenoid angle <60o to reduce potential impingement.

The modified ilioinguinal and anterior intrapelvic approaches for acetabular fracture fixation: indications, quality of reduction, and early outcome.

OBJECTIVES: Traditionally, the anterior surgical approach of choice for acetabular reconstruction was ilioinguinal. There has been an increasing usage of the midline "Stoppa" or "anterior intrapelvic approach." The aim is to report the techniques, early results (minimum 1 year), and complications of anterior approaches for acetabular reconstruction. DESIGN: Retrospective case-note review. SETTING: Pelvic and acetabular tertiary center. PATIENTS: A consecutive series of acetabular fractures treated at 1 tertiary specialist unit were retrospectively reviewed. The fracture patterns, incisions used, intraoperative and postoperative complications, reduction achieved (measured on postoperative radiographs and computed tomography scans), and early postoperative results (minimum 1-year follow-up), were recorded. MAIN OUTCOME MEASUREMENTS: Postoperative reduction (measured by postoperative plain radiographs and computed tomography). RESULTS: Of 160 consecutive patients who underwent acetabular reconstruction, 56 (mean age, 44 years) underwent reconstruction using only anterior approaches (mean of 7 days after injury). Iatrogenic complications, postoperative infection, arthritis, and avascular necrosis rates are comparable with the literature. Overall, anatomic reduction was seen in 71% of cases and concentric reconstruction of the dome in over 90%. Thirty-six of the 56 patients (64%) were symptom-free at the latest follow-up and 34 (61%) had returned to work. CONCLUSIONS: The results reported suggest the use of dual approaches using the lateral 2 windows, and/or a midline anterior intrapelvic approach in anterior acetabular reconstructions has a relatively low complication rate and can lead to anatomic reconstructions in 71%. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.