JSES International最新文献

{"title":"Analysis of healthy glenohumeral arthrokinematics using four-dimensional computed tomography throughout internal rotation and forward elevation","authors":"Kylie K. Paliani MESc ,&nbsp;James C. Hunter PhD ,&nbsp;James A. Johnson PhD ,&nbsp;Ting-Yim Lee PhD, FCCPM ,&nbsp;George S. Athwal MD, FRCSC ,&nbsp;Emily A. Lalone PhD","doi":"10.1016/j.jseint.2024.08.193","DOIUrl":"10.1016/j.jseint.2024.08.193","url":null,"abstract":"<div><h3>Background</h3><div>The glenohumeral (GH) joint is the most mobile joint in the human body and can translate, as well as rotate in its socket. Currently, it is not well established in literature how much the healthy humeral head translates, and how that changes overtime as people age. The objective of this study is to quantify GH joint proximity and translation in healthy participants and determine if there are any age-related, position-related, or direction-related differences.</div></div><div><h3>Methods</h3><div>Thirty-one participants were recruited for this study and split into 2 cohorts: young (aged ≤ 37 years) and old (aged ≥ 45 years). Four-dimensional computed tomography scans were taken as these participants completed internal rotation (IR) to the back and forward elevation. Three-dimensional bone models of the humerus and scapula were created using 3D Slicer. An interbone distance algorithm and an iterative closest point algorithm were used to determine GH joint proximity and translation, respectively.</div></div><div><h3>Results</h3><div>This study found that older participants displayed significantly closer joint proximity (63% of glenoid surface was within 4 mm of humeral head) during the middle of IR, compared to younger participants (52% of glenoid surface within 4 mm of humeral head). Additionally, younger participants had significantly more translation in the superior/inferior direction (16% of glenoid height) compared to the anterior/posterior direction (10% of glenoid width) throughout IR.</div></div><div><h3>Conclusion</h3><div>This study demonstrates the significance of translational movements within the GH joint throughout IR and forward elevation, which will aid implant manufacturers in designing implants that will allow for more normalized GH translations.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 2","pages":"Pages 501-510"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143593959","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":"Analysis of factors influencing optimal humeral-sided reconstruction in anatomic total shoulder arthroplasty","authors":"Kevin Salomon BS ,&nbsp;Raúl Roura BA ,&nbsp;Giovanni Ayala MD ,&nbsp;Lauren Wilder MS ,&nbsp;Logan Kolakowski MD ,&nbsp;Peter Simon PhD ,&nbsp;Mark A. Frankle MD","doi":"10.1016/j.jseint.2024.10.005","DOIUrl":"10.1016/j.jseint.2024.10.005","url":null,"abstract":"<div><h3>Background</h3><div>The introduction of different humeral implants for the treatment of osteoarthritis was intended to improve the ability to anatomically reconstruct the proximal humerus. New technology should ideally lead to improvements in optimal reconstruction. The primary aim of this study was to compare three humeral implant types (long stem, short stem, and stemless) to replicate the proximal humeral anatomy and assess the impact of transitions across each stem type, including initial learning curves.</div></div><div><h3>Methods</h3><div>This was a retrospective review of 298 patients (175 males and 123 females) who underwent anatomic total shoulder arthroplasty utilizing three following stem types: 145 long stem, 102 short stem, and 51 stemless implants. An AP radiograph which met a criterion of optimal/orthogonal view of the humeral head and stem was selected for every included patient. A best fit circle, an articular surface circle and postoperative measure of neck-shaft angle (NSA) was measured by two independent observers. The distance between the centers of two circles (center of rotation [COR] shift) and NSA were then compared for each stem type. In order to assess transitions in technology, two sets of patients in the stemmed groups were selected: initial year (79 long stem, 62 short stem) and final year (66 long, 40 short) of utilization. A cumulative sum control chart analysis was used to assess the learning curves of each of the stem types by the initial year of utilization according to the radiographic measurement of COR shift.</div></div><div><h3>Results</h3><div>The stemless implant showed best reconstruction with a mean COR shift of 3.0 ± 1.6 mm and NSA of 137 ± 6° (<em>P</em> &lt; .001). The transition from long stem to short stem utilization showed significantly worse COR shift and NSA, 3.3 ± 2.1 mm to 4.1 ± 1.9 mm and 138.5 ± 4.4° to 141.0 ± 4.4° (max <em>P</em> = .032), respectively. The impact of transitions to newer technology demonstrated an increased operative time (100 to 128 and 135 min). The cumulative sum control char learning curves demonstrated a completion of the learning phases at 12 cases for both the long and short stem designs, but there was no identifiable learning phase for the stemless implant, suggesting an immediate entry to the consolidation phase.</div></div><div><h3>Conclusion</h3><div>When assessing reconstruction of the premorbid shoulder joint, the stemless implant had the greatest efficacy and shortest learning curve. Stemless anatomic humeral reconstruction is more replicable in recreating the anatomic shape of the humerus and is quicker to master compared to standard or short stemmed implants but did have a greater initial operative time.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 2","pages":"Pages 458-465"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143593953","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":"Core curriculum of shoulder and elbow surgery: the proposal from the European Society for Surgery of the Shoulder and Elbow","authors":"Manuel Ribeiro da Silva MD, PhD ,&nbsp;Alexander Van Tongel MD, PhD ,&nbsp;Philippe Collin MD ,&nbsp;Emilio Calvo MD, PhD, MBA ,&nbsp;Mehmet Demirhan MD, PhD ,&nbsp;Stefan Bauer MD, PhD ,&nbsp;Olga Savvidou MD, PhD ,&nbsp;Peter Domos MD, FRCS(Tr&Orth) ,&nbsp;Hannan Mullett MB FRCS (Tr&Ortho), PhD ,&nbsp;Roman Brzoska MD, PhD ,&nbsp;Filippo Castoldi MD, PhD ,&nbsp;Kilian Wegmann MD, PhD ,&nbsp;Patric Raiss MD","doi":"10.1016/j.jseint.2024.10.010","DOIUrl":"10.1016/j.jseint.2024.10.010","url":null,"abstract":"<div><h3>Background</h3><div>Subspecialization in orthopedic surgery has become the standard approach due to the expanding body of medical knowledge. Shoulder and elbow surgery is a growing subspecialty, but it still faces challenges with undefined training standards, unclear competency levels, and a lack of delineated professional responsibilities. To address this, the European Society for Surgery of the Shoulder and Elbow-societe european chirurgie epaule et coude (ESSSE-SECEC) aims to create a core curriculum (CC) to standardize knowledge and skills within this field.</div></div><div><h3>Methods</h3><div>The ESSSE-SECEC Qualification Committee developed a CC through a task force established in 2022. The curriculum is divided into 2 major sections, shoulder and elbow, further categorized into 5 areas: Basic Science, Diagnosis, Pathology, Nonoperative Treatment, and Surgical Treatment. The content was developed, reviewed, and approved by leading experts within the Society.</div></div><div><h3>Results</h3><div>The CC contains 72 headings and 259 specific subjects, encompassing key areas of knowledge, practical skills, and behavioral attitudes necessary for competence in shoulder and elbow surgery, offering a detailed framework for the subspecialty.</div></div><div><h3>Conclusion</h3><div>The ESSSE-SECEC CC establishes a foundational standard for shoulder and elbow surgeons. It provides a clear framework for knowledge and competency, supporting the future development of training and assessment tools within the subspecialty. Additionally, it aims to solidify the subspecialty’s identity and serve as a key tool for competency assessments within ESSSE-SECEC and beyond.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 2","pages":"Pages 343-345"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143593713","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":"Short-term clinical and radiologic outcomes of reverse total shoulder arthroplasty with navigation system in the Asian population: a retrospective comparative study","authors":"Jae Soo Kim MD ,&nbsp;Su Cheol Kim MD ,&nbsp;Jong Hun Park MD ,&nbsp;Hyun Gon Kim MD ,&nbsp;Dong Hyun Kim MD ,&nbsp;Hyoung Seok Jung MD ,&nbsp;Sang Min Lee CES ,&nbsp;Jae Chul Yoo MD","doi":"10.1016/j.jseint.2024.09.025","DOIUrl":"10.1016/j.jseint.2024.09.025","url":null,"abstract":"<div><h3>Background</h3><div>In reverse total arthroplasty (rTSA), glenoid component positioning is a critical factor for outcomes especially in Asian populations with smaller glenoids. The purpose of this study was to compare the clinical and radiologic outcomes of rTSA with and without the navigation system with a minimum follow-up of 2 years in the Asian population.</div></div><div><h3>Methods</h3><div>This was a retrospective comparative study of 33 rTSAs with the navigation system (NAV group) and 40 conventional rTSAs (CON group). Radiologic measurements regarding the position of the glenoid component, glenoid vault perforation by the central cage, and scapular notching, as well as clinical outcomes including range of motion, functional scores, and complications were compared. Number, length, and angulation of screws were assessed.</div></div><div><h3>Results</h3><div>The mean age was 73.9 ± 5.9 years with a mean follow-up of 30.1 ± 6.4 months. The NAV group more frequently utilized augmented baseplate (<em>P</em> &lt; .001), showed less superior inclination (<em>P</em> = .030) and had lower incidence of glenoid vault perforation (<em>P</em> = .040). The length of superior (<em>P</em> = .001) and inferior screws (<em>P</em> = .045) was longer in the NAV group. In the NAV group compared to the CON group, more inferior orientation of superior screws (<em>P</em> &lt; .001), more anterior orientation for inferior screws (<em>P</em> = .031), and anterior screws (<em>P</em> = .003) were observed. The NAV group showed significantly less penetration into the suprascapular fossa by a superior screw (<em>P</em> = .007). Final range of motion, functional scores, and complications showed no significant differences between the 2 groups.</div></div><div><h3>Conclusion</h3><div>In the short-term follow-up, the use of a navigation system in rTSA showed no significant difference in clinical outcomes and complications compared to conventional implantation. However, it enabled a lower superior inclination and a reduced glenoid vault perforation by the central cage, simultaneously allowing for the insertion of longer peripheral screws in a safer direction compared to conventional implantation.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 2","pages":"Pages 422-430"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143594052","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":"Predictive factors of intraoperative conversion to reverse total shoulder arthroplasty in patients with primary glenohumeral arthritis","authors":"Garrett V. Christensen MD,&nbsp;Maria F. Bozoghlian MD,&nbsp;Arman C. Hlas BS,&nbsp;Joseph M. Rund MD,&nbsp;Joseph W. Galvin DO,&nbsp;Brendan M. Patterson MD, MPH","doi":"10.1016/j.jseint.2024.09.026","DOIUrl":"10.1016/j.jseint.2024.09.026","url":null,"abstract":"<div><h3>Background</h3><div>Many factors play a role in decision making for arthroplasty type in patients with glenohumeral osteoarthritis (GHOA). The purpose of this study was to evaluate preoperative and intraoperative factors that might predict the need for reverse total shoulder arthroplasty (rTSA) vs. anatomic total shoulder arthroplasty (aTSA) for patients with primary GHOA. Secondarily, American Shoulder and Elbow Surgeons (ASES) were compared.</div></div><div><h3>Methods</h3><div>Patients with primary GHOA indicated for aTSA vs. rTSA were identified. Preoperative records were reviewed for demographics, range of motion, rotator cuff strength, and glenoid morphology. Operative reports were assessed to identify intraoperatively rotator cuff pathology and glenoid deficiency. ASES scores at 2 years postoperative were collected.</div></div><div><h3>Results</h3><div>One hundred eleven patients were included from 2018 to 2021. Ninety-four patients underwent aTSA, while 17 were intraoperatively converted to rTSA. There were no significant differences in age, body mass index, or preoperative Walch classification between cohorts. rTSA patients had significantly decreased preoperative external rotation (<em>P</em> = .006). External rotation ≤30° was the only preoperative predictive factor for performing rTSA vs. aTSA (<em>P</em> = .0004). The most common reason for intraoperative transition to rTSA was rotator cuff deficiency. At 2-year follow-up, median ASES scores were 94.2 (interquartile range 85-96.7) and 88.3 (interquartile range 73.3-94.5) for aTSA and rTSA, respectively (<em>P</em> = .097).</div></div><div><h3>Conclusion</h3><div>Many patients with primary GHOA are well-served with aTSA. However, there are patients with primary GHOA in which rTSA may be ideal given rotator cuff deficiency or glenoid defects felt to limit aTSA glenoid component placement. This study highlights the need for preoperative external rotation and intraoperative evaluation of rotator cuff integrity and glenoid bone stock.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 2","pages":"Pages 431-435"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143594053","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":"Increased postoperative deltoid signal seen after suprapectoral biceps tenodesis: potential risk to the anterior branch of the axillary nerve","authors":"Cara H. Lai MD ,&nbsp;Alexander J. Hoffer MD, MSc, FRCSC ,&nbsp;Megan L. Anderson BA ,&nbsp;Josh Bodrero DO ,&nbsp;Roman Austin BS ,&nbsp;John M. Tokish MD","doi":"10.1016/j.jseint.2024.09.019","DOIUrl":"10.1016/j.jseint.2024.09.019","url":null,"abstract":"<div><h3>Background</h3><div>Arthroscopic suprapectoral biceps tenodesis is a common procedure for lesions of the long head of the biceps in the setting of anterior shoulder pain. However, the distal portal poses a theoretical risk to the terminal branches of the axillary nerve as the nerve travels from posterior to anterior to innervate the anterior deltoid. The purpose of this retrospective cohort study was to assess for axillary nerve branch injury, identified by deltoid signal change in postoperative magnetic resonance imaging (MRI) in patients who underwent an arthroscopic suprapectoral biceps tenodesis.</div></div><div><h3>Methods</h3><div>Patients who underwent rotator cuff repair with a concomitant arthroscopic suprapectoral biceps tenodesis had a postoperative MRI, and at least 1 year of follow-up was included. The incidence of increased deltoid signal consistent with injury to an anterior branch of the axillary nerve on proton density fat-saturated sequences was collected. Age, sex, body mass index (BMI), and patient-reported outcome measures (PROMs), including the American Shoulder and Elbow Surgeons Shoulder (ASES) score, patient-reported outcomes measurement information system pain, physical function, and upper extremity scores, and single assessment numeric evaluation score were compared in patients with and without increased deltoid signal on postoperative MRI. <em>P</em> &lt; .05 was used for significance.</div></div><div><h3>Results</h3><div>Twenty-four patients were eligible for inclusion (9 female, average age 59.0 ± 10.1, BMI 27.6 ± 6.7). Edema-like signals within the anterior deltoid musculature was observed in 9 patients on postoperative MRI. Two patients had a second follow-up MRI performed, which demonstrated resolution of signal, and one patient required a second surgery for release of adhesions. Patients with increased deltoid signal had higher BMI (<em>P</em> = .03). There was no difference in any other demographic or postoperative patient-reported outcome measure between patients with increased signal and those without at any follow-up time point. No patient demonstrated persistent weakness or numbness in the axillary nerve distribution at final follow-up.</div></div><div><h3>Discussion</h3><div>Over one third of patients in our cohort had MRI evidence of axillary nerve branch injury as seen on proton density fat-saturated MRI sequences postoperatively. The distal arthroscopic portal for a suprapectoral biceps tenodesis may place anterior terminal branches of the axillary nerve at risk for injury. Additional investigation and strategies for avoidance of nerve injury in this area should be pursued.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 2","pages":"Pages 366-372"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143593834","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":"Clinical, functional and radiographic outcomes of inverted-bearing reverse shoulder arthroplasty at minimum two year follow-up","authors":"Daniel Paccot MD,&nbsp;John Matheson MD, FRCSC,&nbsp;Steve Lu,&nbsp;Thamer Al-Raiyes MD,&nbsp;Darren Drosdowech MD, FRCSC","doi":"10.1016/j.jseint.2024.10.003","DOIUrl":"10.1016/j.jseint.2024.10.003","url":null,"abstract":"<div><h3>Background</h3><div>Inverted-Bearing Reverse Shoulder Arthroplasty (IB-RSA) is an alternative reverse bearing construct characterized by an ultrahigh molecular weight polyethylene glenosphere combined with a cobalt-chromium metallic humeral liner. This concept was designed both to minimize bearing wear as well as reduce the potential for scapular notching (SN) seen with more traditional-bearing RSA systems. This study reports on clinical outcomes, functional scores, pain scores, and radiographic incidence of SN in a series of IB-RSA at a minimum of two-year follow-up.</div></div><div><h3>Methods</h3><div>A retrospective study was conducted on patients who underwent an IB-RSA between 2016 and 2019, with a minimum follow-up period of two years. Patients were evaluated clinically for disabilities of the arm, shoulder and hand (DASH) score, American Shoulder and Elbow Surgeons score (ASES), EQ-5D Health Questionnaire, Global Rating of Change score (GRC), Single Assessment Numeric Evaluation score (SANE) and range of motion (ROM). Presence and grade of radiographic SN was assessed using the classification of Sirveaux at 6, 12, 24 months and at the last x-ray available.</div></div><div><h3>Results</h3><div>61 consecutive patients were assessed at a mean postoperative follow-up of 37 months (range, 24-72 months). IB-RSA exhibited high overall outcome scores including DASH (38.3 +/−5), ASES (83 +/− 6), GRC (4 +/−0.6), and SANE (83 +/−11). ROM was assessed in 41 patients with 135 ± 21 of elevation, 23 ± 12 of external rotation, and 5 ± 2 for internal rotation. SN was radiographically present in 23 (38%) patients (twenty grade 1, three grade 2) in the final follow-up, with all cases showing evidence of mechanical notching while no grade 3 or 4 cases were observed. The SN did not progress in most of the patients after the first year (<em>P</em> &gt; .05). The presence of SN did not influence on clinical outcome scores as DASH, ASES, EQ-5D Health Questionnaire, GRC, SANE (<em>P</em> &gt; .05), or active ROM (<em>P</em> &gt; .05).</div></div><div><h3>Conclusion</h3><div>IB-RSA demonstrates high patient-reported and functional outcome scores at a minimum of two years follow-up. We report only low-grade SN with little progression after the first year. There was no correlation between SN and clinical outcomes.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 2","pages":"Pages 453-457"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143593952","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":"Lateralization has minimal biomechanical impact on tuberosity fixation with the use of a stem-based repair and a 135° humeral implant in reverse shoulder arthroplasty for 4-part proximal humerus fracture","authors":"Michael J. Bercik Jr. MD ,&nbsp;Patrick Denard MD ,&nbsp;Michelle H. McGarry MS ,&nbsp;Genevieve Fraipont BA ,&nbsp;Victor T. Hung BS ,&nbsp;Thay Q. Lee PhD ,&nbsp;ShARC Group","doi":"10.1016/j.jseint.2024.11.001","DOIUrl":"10.1016/j.jseint.2024.11.001","url":null,"abstract":"<div><h3>Background</h3><div>Lateralization in reverse shoulder arthroplasty (RSA) has many proven and potential benefits. Concern over the increase in tension on the tuberosities imparted by glenoid lateralization and the subsequent effect on tuberosity healing may limit its use in the setting of RSA performed for fracture. This study evaluated whether glenoid lateralization increased tuberosity fracture gapping in a biomechanical model of a 4-part proximal humerus fracture with a stem-based tuberosity repair. We hypothesized that increased lateralization would increase fracture gapping.</div></div><div><h3>Methods</h3><div>Eight cadaveric shoulders (mean age, 62 +/− 2.4 years; range 52-70 years) were tested with a custom testing system that permits loading of rotator cuff muscles and humerothoracic muscles. A 4-part proximal humerus fracture was simulated and then repaired with a stem-based tuberosity repair. The repaired tuberosities were cycled in internal and external rotation with 1.1-Nm torque at 2 mm and 6 mm of glenoid lateralization. For the 6-mm lateralization RSA, the torque was then increased to reach the range of motion (ROM) values achieved with the 2-mm lateralized RSA and cycled 10 times, followed by doubling the torque values for 10 cycles. ROM, muscle length and fracture gapping were assessed at 2 mm and 6 mm of glenoid lateralization.</div></div><div><h3>Results</h3><div>Internal rotation and total ROM demonstrated a significant decrease in the 6-mm RSA when compared to the 2-mm RSA (<em>P</em> &lt; .05). The 6-mm lateralized RSA significantly increased rotator cuff muscle lengths when compared to the 2-mm lateralized RSA condition except for infraspinatus by an average of 2.7 ± 1.9 mm (<em>P</em> &lt; .05). There was no significant gapping of the proximal fracture for any condition. There was a significant increase in the gapping of the distal fracture gap in the 6-mm lateralized component condition only after 10 cycles of doubled rotational torque, which measured 1.9 ± 1.5 mm (<em>P</em> = .031).</div></div><div><h3>Discussion</h3><div>We hypothesized that lateralization would increase fracture gapping. Fracture gapping did not occur proximally and only occurred at a slight amount distally after 10 cycles of doubled rotational torque. This may have implications on the choice of glenoid components when performing a RSA for fracture.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 2","pages":"Pages 486-491"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143593957","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 proposal for computed tomography–based algorithm for the management of radial head and neck fractures: the Proximal and Articular Radial fractures Management (PARMa) classification","authors":"Filippo Calderazzi MD, PhD ,&nbsp;Davide Donelli MD ,&nbsp;Cristina Galavotti MD ,&nbsp;Alessandro Nosenzo MD ,&nbsp;Paolo Bastia MD ,&nbsp;Enricomaria Lunini MD ,&nbsp;Marco Paterlini MD ,&nbsp;Giorgio Concari MD ,&nbsp;Alessandra Maresca MD ,&nbsp;Alessandro Marinelli MD","doi":"10.1016/j.jseint.2024.09.031","DOIUrl":"10.1016/j.jseint.2024.09.031","url":null,"abstract":"<div><h3>Background</h3><div>Owing to the great variety of fracture patterns and limitations of the standard radiographic investigation, all the already available classification systems for radial head and neck fractures (RHNFs) are limited by a poor-to-moderate degree of intraobserver and interobserver reliability. Although computed tomography (CT) is being increasingly used to better understand the fracture characteristics, a CT-based classification system of RHNFs is still lacking. Therefore, in this agreement study, we aimed to propose a classification system based on two-dimensional and three-dimensional (2D/3D) CT to test the hypothesis that this classification has good intraobserver and interobserver reliability. We have also provided a treatment algorithm.</div></div><div><h3>Methods</h3><div>Our proposed classification—Proximal and Articular Radial fractures Management (PARMa)—is based on 2D/3D CT imaging. It is divided into four types based on different fractures patterns. The 2D/3D scans of 90 RHNFs were evaluated in a blinded fashion by eight orthopedic and one radiology consultant, according to the proposed classification. The first phase of observation aimed to estimate the interobserver agreement. The second phase involved a new observation, 4 weeks after the first analysis, and estimated the intraobserver reliability. The standard radiographs of these 90 fractures were also evaluated by the same observers, with the same timing and methods, based on the same classification. Cohen's Kappa was applied for intraobserver agreement. Fleiss's Kappa was used both within and among the evaluators. Kendall's coefficient of concordance was employed to determine the strength of association among the appraisers’ rankings. Furthermore, Krippendorff's alpha was chosen as an adjunctive analysis to assess between evaluators’ agreement.</div></div><div><h3>Results</h3><div>For the intraobserver agreement, Fleiss’ Kappa statistics confirmed the consistency (overall kappa values: 0.70-0.82). Cohen’s Kappa statistics aligned with Fleiss’ Kappa, with similar kappa values and significant <em>P</em> values (<em>P</em> &lt; .001). For interobserver agreement, Fleiss’ Kappa statistics for between appraisers showed moderate-to-substantial agreement, with kappa values ranging from 0.54 to 0.82 for different responses. The results relating to the appraisers' observation of standard radiographs showed that the overall Fleiss’ Kappa values for intraobserver agreement ranged from 0.34 to 0.82, whereas Fleiss’ Kappa statistics for interobserver agreement ranged from 0.40 to 0.69.</div></div><div><h3>Conclusions</h3><div>The proposed classification system is expected to be reliable, reproducible, and useful for preoperative planning and surgical management. Both 2D and 3D CT allow the identification of the magnitude and position of displacement and articular surface involvement.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 2","pages":"Pages 549-561"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143593906","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":"Radial head arthroplasty vs. open reduction and internal fixation in Mason 3 radial head fractures: meta-analysis of prospective trials","authors":"Domenico De Mauro MD ,&nbsp;Sami Abou Chakra ,&nbsp;Francesco Liuzza MD ,&nbsp;Amarildo Smakaj MD ,&nbsp;Giuseppe Rovere MD, PhD ,&nbsp;Giulio Maccauro MD (Prof.) ,&nbsp;Omar El Ezzo MD","doi":"10.1016/j.jseint.2024.08.180","DOIUrl":"10.1016/j.jseint.2024.08.180","url":null,"abstract":"<div><h3>Background</h3><div>Radial head fractures (RHF) represent about one-third of all elbow fractures, comprising approximately 2%-5% of all fractures sustained. The aims of this systematic review and meta-analysis are as follows: (i) to compare complications rate in patients undergoing radial head arthroplasty (RHA) or open reduction and internal fixation as surgical treatments for Mason type 3 RHF; (ii) to compare clinical outcome and functional score in patients undergoing RHA or ORIF in Mason type 3 RHF.</div></div><div><h3>Methods</h3><div>Following the preferred reporting items for systematic reviews and meta-analyses guidelines, a comprehensive literature systematic review of literature was conducted up to March 2024. All prospective studies were included. The analysis employed the log odds ratio (OR) and 95% confidence interval (CI) as the outcome measure.</div></div><div><h3>Results</h3><div>Six studies were incorporated into the systematic review. A total of three studies, published between 2009 and 2021, were included in the meta-analysis. A cohort of 169 patients affected by Mason 3 RHFs was collected. The ORIF group included 65 patients, and 26 events of complications after ORIF were observed. RHA group, instead, consisted of 70 patients, and 8 events of complications were identified.</div></div><div><h3>Conclusion</h3><div>Our findings reveal that the Mason type 3 RHFs treated with open reduction and internal fixation, exhibits a higher risk of complications compared to those patients treated with RHA. Moreover, the standardized mean difference analysis suggests that the ORIF group demonstrates a lower mean Broberg and Morrey Elbow score in comparison to the RHA group, with a higher functional recovery in RHA group.</div></div>","PeriodicalId":34444,"journal":{"name":"JSES International","volume":"9 1","pages":"Pages 260-267"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081060","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}