Clinics in Shoulder and Elbow最新文献

{"title":"Does acromioplasty enhance arthroscopic rotator cuff repair? A systematic review and meta-analysis of randomized trials.","authors":"Muhammad Baig, Kunal Mohan, P Groarke, H Mullet","doi":"10.5397/cise.2025.00458","DOIUrl":"https://doi.org/10.5397/cise.2025.00458","url":null,"abstract":"<p><strong>Background: </strong>Acromioplasty is frequently performed during arthroscopic rotator cuff repair (ARCR) to address subacromial impingement, though its clinical value remains debated. This meta-analysis examines whether acromioplasty improves functional outcomes, pain relief, or re-tear rates in patients undergoing ARCR for full-thickness rotator cuff tears.</p><p><strong>Methods: </strong>A systematic search of PubMed, Embase, Cochrane Library, and Scopus was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify randomized controlled trials from 2011 to 2023. Six randomised controlled trials comparing ARCR with and without acromioplasty were included. Primary outcomes included functional scores of American Shoulder and Elbow Surgeons (ASES), Western Ontario Rotator Cuff Index, University of California, Los Angeles scores), pain levels (visual analog scale [VAS]), and re-tear rates. Data were pooled using a random-effects model. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE).</p><p><strong>Results: </strong>Across 574 patients, both groups demonstrated improvement in functional outcomes. The acromioplasty group showed a modest advantage (e.g., ASES score: mean difference, 2.93), but these gains did not exceed the minimal clinically important difference. There were no significant differences in pain relief (as measured by VAS) or re-tear rates between groups. The risk of bias was moderate in some trials due to a lack of blinding. GRADE assessment rated evidence as high for ASES scores and moderate for other outcomes.</p><p><strong>Conclusions: </strong>Acromioplasty offers statistically modest improvements in shoulder function but does not meaningfully enhance pain relief or reduce re-tear rates. Given these findings, the routine use of acromioplasty in ARCR is not supported; however, select patients may benefit based on individual anatomical or clinical factors. Level of evidence: I.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of tear size on outcomes after acellular dermal matrix-augmented rotator cuff repair.","authors":"Ji-Hun Park, Jung-Han Kim, Hyung-Jun Koo","doi":"10.5397/cise.2025.00745","DOIUrl":"https://doi.org/10.5397/cise.2025.00745","url":null,"abstract":"<p><strong>Background: </strong>Acellular dermal matrix (ADM) patch augmentation in rotator cuff repair reinforces the repaired tendon and provides additional structural support. This study aimed to compare outcomes based on rotator cuff tear size.</p><p><strong>Methods: </strong>We retrospectively reviewed patients who underwent ADM-augmented rotator cuff repair at two hospitals between April 2021 and April 2023. After excluding subjects with <2 years of follow-up or no magnetic resonance imaging (MRI) at 6 months, patients were grouped based on tear size: ≤30 mm (group 1) and >30 mm (group 2). Outcomes were American Shoulder and Elbow Surgeons score, Constant-Murley score, University of California, Los Angeles score, pain visual analog scale score, and range of motion (ROM). Retear was defined based on Sugaya type 4-5 on 6-month MRI.</p><p><strong>Results: </strong>Both groups showed significant improvement in postoperative clinical outcomes compared with preoperative outcomes, with no significant intergroup differences. ROM gains were limited overall, with significant increases only in group 1 for forward flexion and scaption. Stiffness occurred in 4.8% of group 1 and 17.9% of group 2 patients. Retear was found in 1 of 21 patients (4.8%) in group 1 and 7 of 28 (25.0%) in group 2.</p><p><strong>Conclusions: </strong>Arthroscopic rotator cuff repair with ADM patch augmentation showed reduced retear rates and improved clinical outcomes across tear sizes. Postoperative ROM improvements were limited, and stiffness tended to occur more frequently in larger tears. Thus, the success of ADM patch augmentation depends on patient selection and appropriate graft application. Level of evidence: III.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Midshaft clavicular fractures in adolescents: a comprehensive review of diagnosis and management.","authors":"Heather L MacEwen, Michael Morell, Scott Feeley, Nicholas Lopreiato, Chris Renninger, Daniel Song","doi":"10.5397/cise.2025.00500","DOIUrl":"https://doi.org/10.5397/cise.2025.00500","url":null,"abstract":"<p><strong>Background: </strong>Midshaft clavicular fractures account for approximately 80% of all clavicle fractures in pediatric and adolescent populations and represent up to 15% of all fractures in adolescents. These injuries commonly result from falls, sports-related trauma, or motor vehicle accidents, with adolescent males experiencing fractures at rates up to three times higher than females.</p><p><strong>Methods: </strong>This review examines the diagnosis, classification, and management of these fractures, highlighting the nuances between pediatric and adult treatment approaches. Historically, nonoperative management has been favored, leveraging the adolescent clavicle's remodeling capacity.</p><p><strong>Results: </strong>Recent trends reflect increasing operative interventions, driven by adult studies demonstrating faster recovery and improved functional outcomes in displaced fractures. While nonoperative treatment, using slings or figure-of-8 braces, remains effective for most cases, operative fixation, including open reduction and internal fixation or elastic stable intramedullary nailing, is indicated for open fractures, neurovascular injury, or significant displacement. Studies demonstrate high union rates with both methods, but operative treatment offers quicker return to activity, albeit with higher risks of hardware-related complications. The Function after Adolescent Clavicle Trauma and Surgery study notably supports nonoperative management, showing similar long-term functional outcomes compared to operative treatment.</p><p><strong>Conclusions: </strong>Future research should focus on refining patient-reported outcome measures specific to adolescents and identifying subsets of patients who may benefit from surgery. Shared decision-making remains crucial for optimal patient-centered care.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Human Dermal Allograft Patch Cushioning Augmentation in Large Rotator Cuff Repair.","authors":"Eugene Baek, Hyun Gon Kim, Jong Hyun Lee, Seung Jin Yoo, Je Hyeong Jo, Su Cheol Kim, Jae Chul Yoo","doi":"10.5397/cise.2025.00311","DOIUrl":"https://doi.org/10.5397/cise.2025.00311","url":null,"abstract":"<p><p>In large posterosuperior rotator cuff tears, retear is more likely due to factors such as poor tendon quality, tendon loss, incomplete footprint coverage, and incomplete repair. To reduce the retear rate and promote healing, various strategies have been explored, including augmentation using a human acellular dermal matrix (HADM) allograft patch. However, the traditional patch augmentation with a suture-bridge configuration is complicated and time consuming. Another method to alleviate impingement between the repaired tendon and acromion, similar to the ballooning effect in the subacromial space, is the acromiograft technique. However, a thin acromion may lead to fractures, and such a graft is less likely to incorporate with the repaired tendon. To address these concerns, we developed a new technique that enhances healing through direct contact with the repaired tendon, alleviates impingement with a spacer effect, and simplifies the procedure while ensuring adequate medial coverage including the musculotendinous junction. This article describes our \"patch cushioning technique\" using an HADM allograft. The present report provides a purely technical description of the procedure.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome comparison of lower trapezius tendon transfer and arthroscopic rotator cuff tear repair using muscle advancement for massive rotator cuff tear: a systematic review.","authors":"Jun Lang, Vivek Kumar Morya, Kyu-Cheol Noh","doi":"10.5397/cise.2025.00171","DOIUrl":"https://doi.org/10.5397/cise.2025.00171","url":null,"abstract":"<p><p>This systematic review evaluates the clinical outcomes of two distinct, arthroscopic techniques for the surgical repair of massive rotator cuff tears; lower trapezius tendon transfer (LTT transfer) and muscle advancement (MA). Eleven studies, involving 433 patients, selected based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, were analyzed. The findings reveal that MA significantly improves functional outcomes, demonstrated by higher Constant-Murley scores (mean difference: 26.26 vs. 18.31, P<0.001), University of California, Los Angeles (UCLA) shoulder scores (14.95 vs. 8.3, P<0.001), acromiohumeral distance (AHD; 1.94 mm vs. 0.40 mm, P<0.001), and greater abduction recovery (46.48° vs. 31.86°, P=0.030). However, VAS (visual analog scale) score was better reduced in the LTT transfer groups i.e.-3.69 vs. -2.33, P<0.001., external rotation improvement (25.67° vs. 7.74°, P<0.001), and demonstrated lower retear rates (11.89% vs. 19.42%, P=0.031). The complication profiles differed between techniques: LTT transfer carried a higher risk of graft rupture (2.64% vs. 0%, P=0.031), while arthroscopic MA was associated with increased postoperative stiffness (2.91% vs. 0%, P=0.011). Based on these results, arthroscopic MA is recommended for younger, active patients with mobile residual tissue to optimize abduction and AHD restoration. In contrast, LTT transfer is better suited for cases involving massive defects requiring dynamic stabilization and external rotation recovery. These findings emphasize the importance of individualized surgical planning that considers tear severity, tissue viability, and patient functional demands. Despite limitations stemming from retrospective study designs and clinical heterogeneity, this review highlights the distinct clinical advantages and appropriate indications for both techniques.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Humeral head avascular necrosis: etiology, diagnosis, and management.","authors":"Elisabeth Kaza, Garret Neel, Scott Feeley, Kelly Kilcoyne, Daniel Song","doi":"10.5397/cise.2025.00493","DOIUrl":"https://doi.org/10.5397/cise.2025.00493","url":null,"abstract":"<p><p>Humeral head avascular necrosis (AVN) can cause significant shoulder morbidity and represents the second most common site of nontraumatic osteonecrosis after the femoral head. The pathophysiology centers on disrupted blood supply, ultimately leading to bone death and structural compromise. It is associated with various etiologies, including trauma, iatrogenic factors, hematologic conditions, lifestyle factors, certain environmental exposures, and systemic diseases. Diagnosis relies on a combination of clinical assessment and radiographic evaluation, with magnetic resonance imaging serving as the most sensitive modality for early detection. The Cruess classification system guides treatment decisions. Although conservative measures are used in early stages, they carry a risk of progression, as they do not alter the disease course-unlike surgical techniques such as core decompression. Arthroplasty is reserved for later stages with evidence of collapse, with research suggesting that the use of pyrocarbon in hemiarthroplasty may help reduce glenoid erosion. This review provides a comprehensive overview of humeral head osteonecrosis, emphasizing its etiology, clinical evaluation, imaging findings, and treatment strategies. It highlights the growing support for early operative intervention over conservative management, emerging treatment modalities such as biologic augmentation and allografting, and promising new materials like pyrocarbon in hemiarthroplasty to mitigate glenoid erosion.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparative analysis of manual glenoid version measurement using two-dimensional and three-dimensional computed tomography imaging techniques.","authors":"Maxwell S Renna, Ashley I Simpson","doi":"10.5397/cise.2025.00318","DOIUrl":"10.5397/cise.2025.00318","url":null,"abstract":"<p><strong>Background: </strong>Accurate measurement of glenoid version is essential for optimal implant positioning in shoulder arthroplasty. This study compared the accuracy and reliability of unformatted two-dimensional computed tomography (2D-CT), formatted 2D-CT, and three-dimensional CT (3D-CT) reconstructions in measuring glenoid version.</p><p><strong>Methods: </strong>Shoulder CT scans for arthroplasty were analyzed retrospectively. Glenoid version was measured at the estimated glenoid midpoint using unformatted and formatted 2D-CT in the scapular plane. Measurements from 3D-CT reconstructions using the Corrected Friedman Method were used as the control. Inter- and intra-observer reliability was calculated as well as minimally detectable difference.</p><p><strong>Results: </strong>Sixty-five CT scans were analyzed (mean age, 61.7 years). Mean glenoid version was -3.48° (standard deviation [SD], 8.7°) on unformatted 2D-CT, -3.27° (SD, 8.15°) on formatted 2D-CT, and -4.25° (SD, 7.92°) on 3D-CT. Although no significant difference in mean values was observed (analysis of variance, P=0.245), formatted 2D-CT measurements were within 6° of 3D-CT in 95.4% of cases versus 83.1% for unformatted 2D-CT (P=0.023). Directional error occurred in 27.7% of unformatted scans and 16.9% of formatted scans. Inter-observer reliability was highest for 3D-CT (intraclass correlation coefficient [ICC]=0.83; 95% CI, 0.74-0.89), and intra-observer agreement was strongest for 3D-CT (ICC=0.91; 95% CI, 0.86-0.94), followed by formatted 2D-CT (ICC=0.83; 95% CI, 0.73-0.89) and unformatted 2D-CT (ICC=0.77; 95% CI, 0.65-0.85).</p><p><strong>Conclusions: </strong>3D-CT reconstructions are widely considered the most accurate and reproducible method for glenoid version assessment, supported by multiple comparative imaging studies. Formatted 2D-CT provides a reliable alternative when 3D-CT is unavailable, significantly outperforming unformatted 2D-CT in both agreement with the 3D reference and intra- and inter-observer reliability. Level of evidence: IV.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12415454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144754600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Allograft-prosthetic composite versus megaprosthesis for proximal humerus reconstruction after tumor resection: a meta-analysis of clinical outcomes.","authors":"Mohammad Daher, Mohamad Y Fares, Steve S Gill, Peter Boufadel, Andrew R Jensen, William C Eward, Adam Z Khan, John G Horneff, Joseph A Abboud","doi":"10.5397/cise.2025.00388","DOIUrl":"10.5397/cise.2025.00388","url":null,"abstract":"<p><strong>Background: </strong>Allograft prosthetic composite (APC) and megaprosthesis (MP) have both been used to reconstruct the proximal humerus after its resection due to primary or secondary tumors. However, varied results have been reported in the literature with no consensus on which reconstruction has better overall outcomes.</p><p><strong>Methods: </strong>PubMed, Cochrane, and Google Scholar (pages 1-20) were queried through September 2024. The compared outcomes consisted of adverse events, patient-reported outcomes measures, and range of motion. Ten studies and 400 patients were included, with 115 in the APC group and 285 in the MP group.</p><p><strong>Results: </strong>The APC group had a higher rate of reoperations (odds ratio, 2.50; 95% CI, 1.40-4.45; P=0.002) than did the MP group over an average follow-up of 7.0 years. However, better postoperative flexion (mean difference, 10.11; 95% CI, 5.33-14.90; P<0.001) and Musculoskeletal Tumor Society scores (mean difference, 3.73; 95% CI, 1.37- 6.08; P=0.002) were seen in the APC group.</p><p><strong>Conclusions: </strong>The present study shows a lower rate of revision with the use of MP but better functional outcomes and forward flexion with APC as the surgical option for proximal humerus reconstruction. Level of evidence: III.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12415450/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144754601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of acromioclavicular and coracoclavicular ligament stability on acromioclavicular joint dislocation: insights from a cadaveric study.","authors":"Fumiya Hattori, Nobuyasu Ochiai, Eiko Hashimoto, Yohei Shimada, Shohei Ise, Kenta Inagaki, Yu Hiraoka, Seiji Ohtori","doi":"10.5397/cise.2025.00157","DOIUrl":"10.5397/cise.2025.00157","url":null,"abstract":"<p><strong>Background: </strong>Acromioclavicular (AC) joint (ACJ) dislocation can lead to superior clavicular instability when the AC and coracoclavicular (CC) ligaments are torn. No previous study has assessed the effects of combined AC-CC ligament resections in fresh-frozen cadavers with preserved soft tissues around the thorax and shoulder girdle. This study aimed to develop such an ACJ dislocation model and evaluate stability following ligament resections.</p><p><strong>Methods: </strong>Nine fresh-frozen cadaver shoulders (mean age, 86.6 years) without clavicular fractures or ACJ osteoarthritis were used. Each specimen included the thoracic spine, scapula, clavicle, and shoulder. Biomechanical testing was performed with a customized system to assess displacement and evaluate superior and posterior stability. Three conditions were compared: intact ligaments, AC ligament resection, and AC-CC ligament resection.</p><p><strong>Results: </strong>Superior translations were 0.0 mm (intact), 1.1 mm (AC resection), and 9.6 mm (AC-CC resection). Posterior translations were 0.0 mm, 3.2 mm, and 9.0 mm, respectively. The AC-CC resection group showed significantly increased translations compared to the intact and AC resection groups. No significant difference was observed between the intact and AC resection groups in superior translation. Posterior translation increased progressively from intact to AC and then AC-CC resection.</p><p><strong>Conclusions: </strong>This is the first study to assess both superior and posterior ACJ stability using cadavers with preserved soft tissues. Our findings demonstrate the importance of the AC and CC ligaments in maintaining ACJ stability. Notably, the AC ligament contributes to posterior stability, indicating the need for reconstruction to achieve overall joint stability. Level of evidence: Controlled laboratory study.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12415459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nonoperative management of terrible triad injuries: clinical outcomes of 39 cases.","authors":"Shai Factor, Sagi Kaz, Tamir Pritsch, Gilad Eisenberg, Ron Gurel, Yishai Rosenblatt","doi":"10.5397/cise.2025.00381","DOIUrl":"10.5397/cise.2025.00381","url":null,"abstract":"<p><strong>Background: </strong>Terrible triad injury (TTI) poses therapeutic challenges in joint stability and functional recovery. While surgery has traditionally been preferred, recent interest in nonoperative management for select cases has emerged, with studies suggesting positive outcomes for carefully chosen patients.</p><p><strong>Methods: </strong>This retrospective study, conducted at a tertiary medical center, included patients treated conservatively for TTI between 2014 and 2022. Patients younger than 18 years with open or pathological fractures or multiple injuries were excluded. Conservative treatment was chosen for elbows with good alignment, minimal displacement, and no motion block. Progress was monitored clinically and radiographically. Functional outcomes were assessed using the Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder, and Hand (DASH) score.</p><p><strong>Results: </strong>Thirty-nine patients (59% male; mean age, 44.7±18.3 years) were included, with a mean follow-up of 78.5±29.4 months. Falls (46%) and scooter accidents (36%) were the primary injury mechanisms. Radial head fractures comprised Mason type 1 (36%), type 2 (54%), and type 3 (10%), while coronoid fractures were Regan-Morrey type 1 (69%), type 2 (28%), or type 3 (3%). Final range of motion averaged 128.2° flexion, with an 8.2° extension deficit and 85° forearm rotation. The MEPS was excellent in 11, good in 19, and fair in 9 patients; the mean DASH score among all fractures was 12.6. Five patients (13%) required subsequent surgery, and mechanical clicking was reported in 16 patients (41%).</p><p><strong>Conclusions: </strong>Nonoperative treatment of TTI might be a viable option for selected patients, yielding generally satisfactory outcomes and an acceptable complication rate. Level of evidence: IV.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12415446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}