JSES International最新文献

{"title":"ANTIBIOTIC PROPHYLAXIS IN SHOULDER ARTHROPLASTY – increased number of early infection revisions in patients treated with clindamycin compared to cefuroxime","authors":"Jenni Harjula MD, Mari Kanerva MD, PhD, Juha Kukkonen MD, PhD, Kaisa Lehtimäki MD, Joel Kostensalo M.S.c, Ville Äärimaa MD, PhD","doi":"10.1016/j.jseint.2026.101774","DOIUrl":"10.1016/j.jseint.2026.101774","url":null,"abstract":"<div><h3>Background</h3><div>Periprosthetic joint infection (PJI) is a serious complication following shoulder arthroplasty (SA). The purpose of this study was to compare the risk of early infection revision in patients given either clindamycin or cefuroxime antibiotic prophylaxis at time of surgery.</div></div><div>Periprosthetic joint infection (PJI) is a serious complication following shoulder arthroplasty (SA). The purpose of this study was to compare the risk of early infection revision in patients given either clindamycin or cefuroxime antibiotic prophylaxis at time of surgery.</div><div><h3>Methods</h3><div>We analyzed electronically recorded data from the Finnish Shoulder Arthroplasty Registry from 2016 to 2021. The primary endpoint was revision due to infection within one year after surgery. Hazard ratios (HR) with 95% confidence intervals were calculated using Cox proportional hazards regression to compare clindamycin and cefuroxime prophylaxis. Age and sex were included as covariates in the model. Because revision indications were frequently missing, sensitivity analyses were conducted using predefined time-based scenarios.</div></div><div>We analyzed electronically recorded data from the Finnish Shoulder Arthroplasty Registry from 2016 to 2021. The primary endpoint was revision due to infection within one year after surgery. Hazard ratios (HR) with 95% confidence intervals were calculated using Cox proportional hazards regression to compare clindamycin and cefuroxime prophylaxis. Age and sex were included as covariates in the model. Because revision indications were frequently missing, sensitivity analyses were conducted using predefined time-based scenarios.</div><div><h3>Results</h3><div>There were 3595 registered primary shoulder arthroplasties during the study period. Of these, 1382 (38%) received clindamycin, and 1050 (29%) cefuroxime prophylaxis; prophylaxis information was missing for 969 (27%) arthroplasties. There were 87 (2.4%) revisions within one year (among these 12 (14%) were recorded as infection-related, and in 63 cases (76%) the reason for revision was missing). Six infection revisions occurred in the clindamycin group, and one in the cefuroxime group. In the analysis including only confirmed infections the adjusted HR for infection revision with clindamycin compared with cefuroxime was 4.51 (CI 0.54-37.56; p=0.16). In the sensitivity analyses accounting for missing revision indications HR estimates ranged from 1.78 to 3.19, respectively. The absolute difference in one-year infection-free survival between groups ranged from 0.3 to 0.9 percentage points, favoring cefuroxime.</div></div><div>There were 3595 registered primary shoulder arthroplasties during the study period. Of these, 1382 (38%) received clindamycin, and 1050 (29%) cefuroxime prophylaxis; prophylaxis information was missing for 969 (27%) arthroplasties. There were 87 (2.4%) revisions within one year (among these 12 (14%) were recorded as infection-relate","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 6","pages":"Article 101774"},"PeriodicalIF":2.0,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148870925","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":"Arthroscopic double-screw Latarjet versus arthroscopic button-fixed Latarjet with Bankart repair","authors":"Shinji Imai MD, PhD","doi":"10.1016/j.jseint.2026.101738","DOIUrl":"10.1016/j.jseint.2026.101738","url":null,"abstract":"<div><h3>Background</h3><div>The arthroscopic double-screw (DS) Latarjet procedure has been associated with low recurrence rates, a high sports return rate (SRR), and favorable clinical scores. Arthroscopic button-fixed Latarjet with Bankart repair (BB Latarjet) has been reported recently. Our hypthesis was that there were no statistically significant differences in the graft union rate, SRR, and complication rate between the arthroscopic BB Latarjet and the arthroscopic DS Latarjet, which has been considered advantageous because of its higher initial fixation strength using 2 screws.</div></div><div><h3>Methods</h3><div>Between 2019 and 2023, 32 patients underwent the arthroscopic BB Latarjet procedure (mean follow-up: 2.5 ± 0.5 years), and 39 patients underwent the arthroscopic DS Latarjet procedure (mean follow-up: 4.4 ± 1.4 years). Clinical outcomes, including visual analog scale scores for pain and instability, Rowe score, American Shoulder and Elbow Surgeons score, University of California, Los Angeles score,Subjective Shoulder Value, and ranges of external rotation, incidence of graft malpositioning, neurological complications, and progression of osteoarthritis, were compared between the 2 groups at the 2-year post-operative time point. Graft union rate and SRR were compared at 3-month, 6-month, 9-month, and 2-year post-operative time point.</div></div><div><h3>Results</h3><div>Neither group experienced redislocation by the 2-year post-operative time point. No significant differences were observed at 2 years in visual analog scale scores for instability (<em>P</em> = .102) or pain (<em>P</em> = .50), Rowe score (<em>P</em> = .428), American Shoulder and Elbow Surgeons score (<em>P</em> = .677), or University of California, Los Angeles score (<em>P</em> = .433). At 3 months post-operatively, 32 cases (82.1%) achieved graft union in the DS group, whereas only 11 cases (34.4%) achieved graft union in the BB group (<em>P</em> &lt; .01). However, computed tomography-based evaluation at the 2-year post-operative time point demonstrated no significant difference in graft union rate between the DS group (92.3%) and the BB group (81.3%) (<em>P</em> = .716). At 6 months post-operatively, the SRR in the BB group remained lower (43.8%, 14 cases), whereas the SRR in the DS group reached 76.9% (30 cases) (<em>P</em> = .159). Nevertheless, no significant difference in SRR was observed between the DS group (94.9%) and the BB group (93.8%) at the 2-year post-operative time point (<em>P</em> = .847). In contrast, the BB group exhibited fewer cases of vertical graft malpositioning (<em>P</em> = .049) and fewer neurological complications (<em>P</em> = .049).</div></div><div><h3>Conclusion</h3><div>There were no significant differences between BB Latarjet and DS Latarjet in terms of osseous union rate, SRR, recurrent instability rate, and overall complication rate at 2-year post-operative time point.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 4","pages":"Article 101738"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13320031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148369027","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":"Latarjet in lateral decubitus vs. beach-chair: effect on screw inclination and coracoid graft positioning—A single-surgeon comparative series","authors":"Ali Kalhor FRACS","doi":"10.1016/j.jseint.2026.101741","DOIUrl":"10.1016/j.jseint.2026.101741","url":null,"abstract":"<div><h3>Background</h3><div>The Latarjet procedure has traditionally been performed in the beach-chair position. Optimizing graft position is one of the key factors to reduce failure, prevent redislocation, and minimize the risk of future arthritis.</div></div><div><h3>Methods</h3><div>Seventeen consecutive Latarjet procedures were reviewed (8 beach-chair; 9 lazy lateral decubitus) performed between January 2020 and July 2025. All procedures were carried out with 2 partially threaded screws through the plate (Arthrex) and labrocapsular repair to position the bone block extra-articularly. In the lateral position, the procedure was performed with a modified surgical sequence, with coracoid harvesting undertaken first, followed by glenoid preparation. All patients underwent computed tomography scanning at 4 months to measure screw inclination angle, vertical and medial–lateral position of the graft, as well as early resorption and bony union.</div></div><div><h3>Results</h3><div>All patients were male. The average age of the beach-chair and lateral groups was 27.4 and 32 years, respectively. The mean screw-to-glenoid face angle was 40.5° in the beach-chair group compared to 28.0° in the lateral group (<em>P</em> = .008). The average medial/lateral positioning of the graft was +4.6 ± 1.2 in the beach-chair versus 1.0 ± 2.8 mm in the lateral group. Vertical graft position and resorption of the superior aspect of the graft did not show significant differences between the 2 groups.</div></div><div><h3>Conclusion</h3><div>The Latarjet procedure performed in the lateral decubitus position and changing surgical flow were associated with improvement of screw angle and medial/lateral graft positioning compared with the beach-chair position.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 4","pages":"Article 101741"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13321013/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148369874","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":"A rotator cuff sparing deltopectoral approach to intramedullary nail of humeral fractures","authors":"Tom R. Doyle MB, MCh,&nbsp;Jessica M. Welch BS,&nbsp;Eoghan T. Hurley MB MCh PhD,&nbsp;Jay M. Levin MD, MBA,&nbsp;John R. Wickman MD,&nbsp;Christopher S. Klifto MD","doi":"10.1016/j.jseint.2026.101733","DOIUrl":"10.1016/j.jseint.2026.101733","url":null,"abstract":"<div><h3>Background</h3><div>Intramedullary nail (IMNs) for humeral fractures have been associated with iatrogenic rotator cuff damage resulting in poor shoulder function and pain. The purpose of this study was to evaluate nail positioning, clinical outcomes, and complications following IMN using a rotator cuff-sparing approach via the rotator interval.</div></div><div><h3>Methods</h3><div>A retrospective review of patients who underwent an IMN for a humeral fracture with a minimum of 12 months follow-up at a single institution was carried out. Patients who underwent a mini-open deltopectoral approach utilizing the rotator interval were eligible. Clinical outcomes assessed included the American Shoulder and Elbow Surgeons, Single Assessment Numeric Evaluation, and visual analog scale scores, impingement, patient satisfaction, and range of motion (ROM). Nail positioning was assessed on radiographic follow up as were complications.</div></div><div><h3>Results</h3><div>There were 22 patients available for radiological follow-up and 20 for clinical follow-up, of which 68.2% were female, the mean age was 67.7 ± 11.7 years, body mass index was 29.7 ± 8.8, and the mean follow-up was 25.9 ± 9.5 months. There were 7 proximal humerus fractures (4 II-part and 3 III-part fractures) and 15 fracture of the proximal shaft. The mean American Shoulder and Elbow Surgeons score was 87.9 ± 12.7, and the mean Single Assessment Numeric Evaluation score was 88.3 ± 12.8. The mean ROM in forward flexion was 149° ± 24°, abduction was 137° ± 27°, and external rotation was 47° ± 16°. There were no significant differences between fracture types for any outcome score or ROM. All nails were buried or flush with the humeral head on lateral x-rays the entry point was graded as central in 77% and anterior in 23% of patients. On AP x-rays, the entry point was graded as central in 87% of cases and lateral in 13%. The mean visual analog scale score was 0.7 ± 1.0, No patients reported persistent shoulder pain, and there were no revision or reoperations required. There was 1 case of delayed union with a broken locking screw and 1 case of adhesive capsulitis.</div></div><div><h3>Conclusion</h3><div>Intramedullary nail of humeral fractures using a third generation nail and a rotator cuff sparing deltopectoral approach results in accurate nail positioning, a low risk of iatrogenic shoulder pain, as well as good ROM and functional outcomes; however, further comparative studies are required.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 4","pages":"Article 101733"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13321026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370142","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":"High retear rates despite clinical improvement after arthroscopic partial repair for large to massive rotator cuff tears","authors":"Chang Hee Baek MD,&nbsp;Bo Taek Kim MD,&nbsp;Jung Gon Kim MD,&nbsp;Chaemoon Lim MD,&nbsp;Truong Nguyen Khanh Hung MD,&nbsp;Hai Le Dinh MD,&nbsp;Phuoc Hau Huynh MD,&nbsp;Phuoc Tho Pham MD","doi":"10.1016/j.jseint.2026.101746","DOIUrl":"10.1016/j.jseint.2026.101746","url":null,"abstract":"<div><h3>Background</h3><div>Management of large to massive rotator cuff tears (RCTs) remains challenging, particularly when complete anatomic repair is not feasible. The current study aims to evaluate short-term clinical outcomes and complications following arthroscopic partial repair of large to massive RCT with incomplete footprint coverage and to compare outcomes according to concomitant subscapularis repair and post-operative rotator cuff integrity.</div></div><div><h3>Methods</h3><div>Patients who underwent arthroscopic partial repair of the supraspinatus tendon, with or without associated infraspinatus tears, and incomplete footprint coverage between July 2022 and April 2023 were retrospectively identified. Inclusion criteria included intraoperative confirmation of incomplete anatomic footprint coverage, an anteroposterior tear size ≥ 3 cm, and the presence of either an intact subscapularis tendon or a reparable concomitant subscapularis tear (Lafosse type ≤3). Patients were excluded if they were lost to follow-up, had a history of prior shoulder instability surgery, or had insufficient clinical or radiologic data. Clinical outcomes were evaluated pre-operatively and at final follow-up using the visual analog scale for pain, Constant score, American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation score, active range of motion (ROM), and shoulder strength. Radiologic assessment included evaluation of repair integrity, acromiohumeral distance, and progression of glenohumeral arthritis.</div></div><div><h3>Results</h3><div>After excluding 15 patients, 142 patients were included in the final analysis. At a mean follow-up of 26.2 months, significant improvements were observed in all pain, patient-reported outcome measures, ROM, and strength (all <em>P</em> &lt; .001). Post-operative retear was identified in 43 patients (30.3%). Clinical outcomes did not differ significantly between patients with intact subscapularis tendons and those who underwent concomitant subscapularis repair. However, patients with intact post-operative repair integrity demonstrated significantly superior pain relief, functional scores, ROM, and strength compared with those who experienced retears (all <em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>Arthroscopic partial repair with incomplete footprint coverage was associated with significant short-term improvements in pain, function, ROM, and strength in patients with large to massive RCT. Outcomes were similar between patients with intact subscapularis tendons and those undergoing concomitant repair of reparable subscapularis tears. However, post-operative structural failure occurred in 30.3% of patients and was associated with inferior outcomes and frequent revision surgery. These findings should be interpreted cautiously given the retrospective design, absence of a comparator group, and short-term follow-up.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 4","pages":"Article 101746"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13321019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148369940","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":"The subacromial index: a novel radiological parameter associated with rotator cuff tears","authors":"Çağrı Üner MD,&nbsp;Sancar Serbest MD","doi":"10.1016/j.jseint.2026.101742","DOIUrl":"10.1016/j.jseint.2026.101742","url":null,"abstract":"<div><h3>Background</h3><div>Previous studies have demonstrated associations between radiological parameters such as the acromial index (AI), critical shoulder angle, and lateral acromial angle and rotator cuff tears (RCTs). The aim of this study was to evaluate the relationship between RCTs and a novel measurement method termed the subacromial index (SAI), which has not been previously described in the literature, and to compare this parameter with established radiological measurements.</div></div><div><h3>Methods</h3><div>This retrospective study evaluated 132 patients who underwent shoulder magnetic resonance imaging between January 2017 and March 2021. The study population was categorized into 2 groups according to the presence or absence of RCTs. Demographic variables and radiological parameters, including age, sex, AI, critical shoulder angle, lateral acromial angle, SAI, and subacromiohumeral distance (SHD), were assessed. Receiver-operating characteristic curve analysis was used to determine cutoff values, and multivariable as well as stratified logistic regression analyses were performed to identify factors associated with RCTs.</div></div><div><h3>Results</h3><div>Patients with RCTs were older and more frequently female. In the RCT group, AI and critical shoulder angle values were higher, whereas SAI and SHD values were significantly lower. Receiver-operating characteristic analysis demonstrated that older age, female sex, increased AI and critical shoulder angle, and decreased SAI and SHD were associated with RCTs. In the multivariable analysis including demographic variables, age and AI were identified as the strongest factors associated with RCTs. In the stratified analysis excluding demographic variables, the SAI remained significantly associated with RCTs.</div></div><div><h3>Conclusion</h3><div>The SAI, which simultaneously reflects acromial length and inclination, is significantly associated with RCTs. Although age and AI remain the strongest factors overall, the SAI provides additional anatomical information regarding RCT risk independent of demographic factors.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 4","pages":"Article 101742"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13321025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148369971","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":"Improving bone mineral density assessment in total shoulder arthroplasty: assessment of phantom-calibrated Hounsfield units in the glenoid and proximal humerus","authors":"Saagar Dhanjani BA,&nbsp;Clarence Cabatu DO,&nbsp;Kishan S. Shah BS,&nbsp;Tim Wang MD,&nbsp;Darryl D. D'Lima MD, PhD,&nbsp;Heinz R. Hoenecke MD","doi":"10.1016/j.jseint.2026.101730","DOIUrl":"10.1016/j.jseint.2026.101730","url":null,"abstract":"<div><h3>Background</h3><div>Bone mineral density (BMD) plays a critical role in the success of total shoulder arthroplasty, as poor bone quality is associated with poor implant fixation, particularly in short stem and stemless designs that rely on metaphyseal fixation. However, dual-energy X-ray absorptiometry (DEXA) scans are not routinely obtained pre-operatively. Computed tomography–derived Hounsfield units (HUs) have emerged as a potential surrogate for BMD assessment, but HU values can have high variability, which limits accuracy. Phantom calibration may standardize HU values, but its benefit in the shoulder remains unclear. This study aimed to compare correlations of standard and phantom-calibrated (PC)-HU with DEXA-derived BMD, assess their diagnostic performance with receiver operating characteristic analysis, and identify HU thresholds for osteoporosis detection.</div></div><div><h3>Materials and methods</h3><div>A retrospective analysis was performed on 84 shoulders from 76 patients, with some patients contributing bilateral shoulders. All patients underwent both shoulder computed tomography and DEXA within 1 year of total shoulder arthroplasty. Demographics, clinical information, and behavioral factors were collected. HU values were measured from the glenoid and proximal humerus and were calibrated to mg/cc using a phantom. Correlations between HU and DEXA T-scores in the femoral neck, total hip, and spine were evaluated using Spearman correlation. Receiver operating characteristic curve analysis was used to identify optimal HU thresholds for osteoporosis classification.</div></div><div><h3>Results</h3><div>Both standard and PC HU (mg/cc) values of the glenoid and proximal humerus significantly correlated with DEXA T-scores (<em>P</em> &lt; .001), though standard HU generally demonstrated stronger correlations. Optimal thresholds for identifying osteoporosis were 185.38 for the non-PC glenoid (sensitivity = 83.3%, specificity = 65.7%) and 30.90 for the proximal humerus (sensitivity = 78.6%, specificity = 75%). The PC glenoid threshold of 236.44 yielded slightly higher sensitivity (90.9%) but lower specificity (59.0%). PC proximal humerus HU did not demonstrate significant discriminatory power.</div></div><div><h3>Conclusion</h3><div>The optimal thresholds for identifying osteoporosis were 185.38 HU for the non-PC glenoid, 30.90 HU for the non-PC proximal humerus, and 236.44 mg/cc for the PC glenoid. Both standard and PC HU values of the glenoid and proximal humerus significantly correlated with DEXA T-scores, although standard HU generally showed stronger correlations. These findings suggest that phantom-based calibration at these sites may offer no additional benefit in assessing systemic BMD.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 4","pages":"Article 101730"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13311812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148353944","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":"Acromial morphology: reliability of computer tomography–based assessment and association with age: a study of 420 patients","authors":"Yohan Gagnard MD,&nbsp;Florent Baldairon MD,&nbsp;Thomas Mereb MD,&nbsp;Geoffrey Ginot MD,&nbsp;Philippe Clavert MD, PhD","doi":"10.1016/j.jseint.2026.101745","DOIUrl":"10.1016/j.jseint.2026.101745","url":null,"abstract":"<div><h3>Background</h3><div>Acromial morphology is considered an important factor in the pathophysiology and development of subacromial impingement and rotator cuff disorders. The Bigliani classification remains widely used to describe acromial shape in both clinical practice and research, mainly because of its simplicity; however, its reliability on computed tomography (CT) imaging, including CT arthrography, has been poorly investigated. In addition, the relationship between acromial morphology and age remains unclear. The primary objective of this study was to assess the intrarater and inter-rater reliability of the Bigliani classification on CT imaging. The secondary objective was to analyze the association between acromial morphology and age.</div></div><div><h3>Methods</h3><div>This was a single-center retrospective observational study. Five shoulder surgeons with different levels of experience independently assessed the morphology of 420 acromions using standardized slices derived from three-dimensional CT reconstructions. Acromial morphology was classified according to the Bigliani classification. All evaluations were performed in a blinded fashion.</div></div><div><h3>Results</h3><div>Among the 2,100 evaluations performed, 28.7% of acromions were classified as type I, 59.7% as type II, and 11.6% as type III. The Bigliani classification demonstrated good intrarater reliability (κ = 0.61) but poor inter-rater reliability (κ_f = 0.32). A significant association was observed between age and acromial morphology.</div></div><div><h3>Conclusion</h3><div>Even with optimized CT imaging, the Bigliani classification demonstrated good intrarater reliability but poor inter-rater reliability for the assessment of acromial morphology. A significant association between age and acromial morphology was identified. These results should be interpreted with caution, as this study was designed as a methodological evaluation of a widely used classification system rather than to establish clinical or causal relationships, with potential implications for clinical decision-making and research reproducibility.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 4","pages":"Article 101745"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13319669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370087","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":"Selective serotonin re-uptake inhibitors and risks of post-operative hematoma after elbow fracture surgery","authors":"Kevin Y. Heo MD,&nbsp;Haley N. Tornberg MD,&nbsp;Arielle Wallenstein BS,&nbsp;Nicole A. Zelenski MD","doi":"10.1016/j.jseint.2026.101736","DOIUrl":"10.1016/j.jseint.2026.101736","url":null,"abstract":"<div><h3>Background</h3><div>Selective serotonin re-uptake inhibitors (SSRIs) and serotonin-norepinephrine re-uptake inhibitors (SNRIs) are commonly prescribed medications for depression, anxiety, and other comorbid psychiatric conditions. However, these medications can have off-target effects, such as lowering platelet serotonin levels and reducing the ability of platelets to aggregate, which may lead to higher rates of post-operative bleeding. The aim of this paper was to determine if SSRIs/SNRIs increase the risk of post-operative hematoma formation following traumatic elbow surgery.</div></div><div><h3>Methods</h3><div>Adult patients who underwent elbow fracture surgery between 2009 and 2022 were reviewed retrospectively utilizing a national administrative claims database. Exclusion criteria included patients who sustained a pathological fracture, open fracture, had an active infection, or hematologic disorder at the time of surgery. Patients were divided into those who were not prescribed SSRIs/SNRIs (control) and those prescribed SSRIs/SNRIs within 90 days pre-operatively (treatment). Patient cohorts were then propensity-score matched in a 1:3 ratio. Multivariable logistic regression was performed to assess 30- and 90-day outcomes.</div></div><div><h3>Results</h3><div>Over 6,000 patients were included in the initial query. After propensity-score matching, 985 patients were included in the control group (no SSRI/SNRI) and 2,494 patients in the treatment (SSRI/SNRI) group. At 30 days post-operatively, patients in the treatment group had a significantly greater rate of Surgical Site Infection (SSI) (3.4% vs. 2.2%; <em>P</em> = .04). There was no significant difference in rates of 30-day hematomas between the 2 cohorts. At 90 days post-operatively, there was a statistically significant difference in complications for patients treated with SSRI/SNRIs, including a higher rate of SSI (5.4% vs. 3.3%; <em>P</em> = .01) and hematoma formation (1.2% vs. 0.6%; <em>P</em> = .04).</div></div><div><h3>Conclusion</h3><div>SSRIs and SNRIs are commonly prescribed to patients for a variety of psychiatric conditions. These medications often go unnoticed in the pre-operative surgical assessment; however, this retrospective study suggests an association between SSRI/SNRI use and higher odds of SSI and hematoma formation.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 4","pages":"Article 101736"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13319675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148369994","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":"Prognostic value of the Mayo-Fundación Jiménez Díaz classification for nonsurgical proximal humerus fractures: a morphological approach to predicting functional outcomes","authors":"Gustavo Armando Tafoya-Arreguín MD, MSc,&nbsp;José Rene Castillo-González MD,&nbsp;Carlos Omar Sepúlveda-Cadena MD,&nbsp;José de Jesus Martinez-Ruiz MD,&nbsp;Jaime Briseno-Ramírez MD, PhD","doi":"10.1016/j.jseint.2026.101743","DOIUrl":"10.1016/j.jseint.2026.101743","url":null,"abstract":"<div><h3>Background</h3><div>Current classification systems for proximal humerus fractures (PHFs) often fail to provide a reliable functional prognosis. The Mayo-Fundación Jiménez Díaz (FJD) classification aims to address this by focusing on specific morphological patterns. The purpose of this study was to evaluate the prognostic value of the Mayo-FJD classification and determine if fracture morphology outweighs patient-specific factors like age, gender, and limb dominance in predicting clinical success.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted on 149 patients with PHFs initially managed nonsurgically (minimum 24-month follow-up). Fractures were categorized into 9 types based on the Mayo-FJD system. Clinical outcomes were assessed using University of California at Los Angeles, Constant, and Quick Disabilities of the Arm, Shoulder and Hand scores and range of motion. Multivariate regression analysis was performed to adjust for age, gender, and limb dominance.</div></div><div><h3>Results</h3><div>Highly significant differences were found across all functional scores and range of motion among classification groups (<em>P</em> &lt; .0001). Type 5 fractures (valgus impacted) showed the best outcomes (Constant 76.7), while Type 9 (disengaged neck) represented the poorest results (University of California at Los Angeles 9.9) and a 100% conversion rate to reverse shoulder arthroplasty; this reflects the failure of initial nonoperative management. Multivariate analysis confirmed that the Mayo-FJD fracture type was the strongest independent predictor of outcome (<em>P</em> &lt; .0001), whereas gender and limb dominance were not statistically significant (<em>P</em> &gt; .05).</div></div><div><h3>Conclusion</h3><div>The Mayo-FJD classification is a robust tool for predicting functional outcomes and surgical failure in PHFs. Fracture morphology is a more critical determinant of clinical success than patient-specific variables, providing surgeons with a reliable framework for therapeutic planning and patient counseling.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"10 4","pages":"Article 101743"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13320024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370006","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}