Journal of Shoulder and Elbow Surgery最新文献

{"title":"The Effect of Wrist Flexion/Extension on Radiocapitellar Joint Kinematics During Valgus Extension of the Elbow.","authors":"Dani Rotman, Masataka Minami, Jae-Man Kwak, Jorge Rojas Lievano, James S Fitzsimmons, Shawn W O'Driscoll","doi":"10.1016/j.jse.2025.02.040","DOIUrl":"https://doi.org/10.1016/j.jse.2025.02.040","url":null,"abstract":"<p><strong>Introduction: </strong>Osteochondritis dissecans (OCD) of the capitellum is prevalent among youth baseball pitchers. Repetitive shear forces during pitching are contributing factors. During the acceleration phase of pitching, the wrist joint moves from extension to flexion. The interplay between wrist position and elbow joint biomechanics has not been thoroughly examined, particularly within the radiocapitellar joint. This study aims to elucidate how different wrist positions affect the displacement of compression forces within the radiocapitellar joint during elbow extension and examine the change in contact pressure during simulated active wrist flexion and extension.</p><p><strong>Methods: </strong>Seven fresh frozen cadaveric upper limbs were mounted in a custom testing machine and tested under simulated throwing conditions. Radial head motion was tracked using an intra-articular thin-film pressure transducer mounted on the capitellum. The contact pressure and location of the center of force (COF) in the radiocapitellar joint were measured during three wrist positions by loading the wrist flexors and extensors: flexion, neutral, and extension.</p><p><strong>Results: </strong>Wrist flexion, compared to the neutral wrist position, displaced the COF significantly medially between 60° and 30° of elbow flexion (p<0.05). Wrist extension slightly directed the COF laterally compared to the neutral wrist, but the differences were not significant. The total horizontal displacement between the COF during active wrist flexion and extension ranged from 1.6mm to 1.8mm. Mean contact pressure was significantly higher with the wrist in extension from 80° to 40° of elbow angle and significantly lower with wrist flexion only at a 90° elbow angle (p<0.05).</p><p><strong>Discussion: </strong>This study demonstrated that simulated active wrist flexion shifts the COF medially, potentially reducing the risk of lateral OCD lesions. In contrast, wrist extension increases contact pressure, explaining the higher susceptibility to loading in the lateral compartment. These findings highlight the importance of wrist dynamics in pitching mechanics and suggest that minimizing wrist extension during practice may prevent OCD development.</p><p><strong>Conclusion: </strong>Wrist positions significantly influence the biomechanical behavior of the radiocapitellar joint during elbow extension. These insights are important for developing prevention and rehabilitation strategies for throwers at risk of OCD of the capitellum.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating Quotation Accuracy in Shoulder and Elbow Literature.","authors":"Eric H Lin, Brandon A Young, Cailan L Feingold, Edward Lee Major, Joseph N Liu, Austin V Stone","doi":"10.1016/j.jse.2025.02.041","DOIUrl":"https://doi.org/10.1016/j.jse.2025.02.041","url":null,"abstract":"<p><strong>Background: </strong>Citations in studies provide recognition of existing ideas and knowledge in research. This study aims to evaluate the quotation accuracy of citations in the orthopedic shoulder and elbow literature in both subscription and open access journals.</p><p><strong>Methods: </strong>The Journal of Shoulder and Elbow Surgery (JSES) and JSES Open Access/International were queried for five published articles in each of the first issues of 2018, 2021, and 2024. Articles were excluded if they were systematic reviews, meta-analyses, editorial commentaries, or letters to the editor. Within the full-text of each article, two independent reviewers evaluated the accuracy of each in-text citation. Quotation inaccuracies were categorized into one of seven types of inaccuracies. Inter-rater reliability was measured using Cohen's kappa. A two-proportion z-test was used to compare inaccuracy rates between journals. Univariate linear regressions and analysis of variance (ANOVA) were used to compare inaccuracy rates and different study characteristics.</p><p><strong>Results: </strong>There were 433 cited studies and 715 in-text citations in the 15 JSES articles and 496 cited studies and 856 in-text citations in the JSES Open Access/International articles. Cohen's kappa was 0.79, which is substantial agreement. There were significantly fewer quotation errors in the subscription JSES than JSES Open Access/International (16.9% vs. 22.5%, z=-2.78, p=0.006). The overall combined quotation inaccuracy rate was 20.0% (314/1571). The most common types of inaccuracy were failure to support assertion (36.3%) and assertions unrelated to referenced articles (22.0%). There was no significant correlation between quotation inaccuracy rate and number of authors, year, and number of citations. There were significantly higher quotation inaccuracy rates in studies with better level of evidence (p=0.035).</p><p><strong>Conclusion: </strong>Quotation inaccuracies were higher in open access journals compared to subscription journals in orthopedic shoulder and elbow literature with no improvement with time. Both authors and journals should take care to evaluate citations to ensure accurate presentation of referenced literature.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rotational Analysis of Varus-type Proximal Humerus Fractures: Implications for Fracture Reduction.","authors":"Alexander Gallant, Thomas Van Isterdael, Anne Karelse, Lieven De Wilde, Alexander Van Tongel","doi":"10.1016/j.jse.2025.02.036","DOIUrl":"https://doi.org/10.1016/j.jse.2025.02.036","url":null,"abstract":"<p><strong>Background: </strong>Varus-displaced proximal humerus fractures can be treated with closed reduction with or without internal fixation. However, the rationale behind the subsequent maneuvers of the closed reduction has not been evaluated. The aim of this study was to analyze the rotational displacement of the humeral diaphysis compared to the humeral head in three dimensions for varus-displaced proximal humerus fractures.</p><p><strong>Methods: </strong>151 3D reconstructions of CT scans of proximal humerus fractures were obtained in a retrospective cohort set-up. An axis system was defined in the humeral head as well as the diaphysis using the Mimics and 3-Matic software. Rotational analysis around the three anatomical axes (valgus-varus, internal-external rotation, flexion-extension) of these two axis systems was performed using MATLAB software. These were compared to normal values obtained on 87 3D reconstructed CT images of intact shoulders and divided into varus and valgus type fractures (one standard deviation below and above the average of intact humeri respectively), yielding 81 varus fractures. Statistical analysis was done using the Mann-Whitney U Test. After performing normality analysis, these rotations were correlated using the spearman's correlation coefficient.</p><p><strong>Results: </strong>81 varus-displaced proximal humerus fractures were analyzed. This showed that these fractures had a significantly more retroflexed diaphysis compared to intact humeri, and this for 2-part, 3-part and 4-part fractures (p < 0.001, p < 0.001 and p = 0.007 respectively). Three-part fractures showed a significantly more externally rotated diaphysis compared to intact humeri (p < 0.001). Furthermore, 3-part fractures showed a statistically significant positive correlation between displacement of the greater tuberosity and relative external rotation of the humeral diaphysis.</p><p><strong>Conclusions: </strong>Understanding fracture patterns allows for better treatment and reduction strategies. The findings of this study show that to obtain a good closed reduction of varus type proximal humerus fractures, the practitioner has to reduce any translation and the varus displacement of the humeral shaft, but should also take the relative retroflexion of the humeral shaft into account. For 3-part fractures, one should also reduce the external rotation of the diaphysis compared to the head.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of the underlying pathology and previous surgery on the long-term functional outcomes of reverse shoulder arthroplasty: a prospective cohort study with a minimum follow-up of 11 years.","authors":"Christian Suren, Michael Koch, Stefanie Hofstetter, Peter Rab, Ludwig Seebauer","doi":"10.1016/j.jse.2025.02.038","DOIUrl":"https://doi.org/10.1016/j.jse.2025.02.038","url":null,"abstract":"<p><strong>Background: </strong>Reverse shoulder arthroplasty (rTSA) is a successful treatment option for rotator cuff tear arthropathy (CTA). Since its introduction, the range of indications has been expanded while implant designs have been enhanced. The purpose of this study is to evaluate the long-term clinical, radiographic, and patient-reported outcomes of the Delta Xtend rTSA.</p><p><strong>Materials and methods: </strong>In this prospective cohort study, 108 consecutive patients who underwent implantation of rTSA using the DePuy Delta Xtend in 2008 were included. Patients were divided into four indication groups: CTA (60%), revision shoulder arthroplasty (15%), fracture sequelae (19%) and post-infectious arthropathy (6%). Clinical examination and radiographic follow-up were performed after 5 years and at long-term with a minimum follow-up of 11 years.</p><p><strong>Results: </strong>43 patients were eligible for follow-up with a median follow-up period of 12.5 years (range: 11.5 - 12.6 years, response rate 79%). The preoperative Constant Score (CS) was 19 [9 - 24], and the CS at follow-up was 56 [41 - 64] with a significant increase between implantation and latest follow-up (p < 0.001). No significant difference of the CS at follow-up was reported between the 4 groups. Between the mid-term follow-up and the latest follow-up, a significant decrease of the CS of 10 [2 - 14] was observed (p = 0.004), however no significant difference in the age- and sex correlated CS was reported (p = 0.13). Patients who underwent previous surgery before the index arthroplasty (51 [35 - 62]) had a significantly lower CS than patients without previous surgery (63 [58 - 66], p = 0.032). Patients with revision arthroplasty had a significantly lower range of motion at long-term follow-up than patients with CTA (p = 0.013). Implant survival was 95.3% after 11 years. Patients with fracture sequelae had a significantly higher risk for revision than patients with CTA (p = 0.04). Implant survival without revision for any complication was 89.7%, the overall complication rate was 12.5%.</p><p><strong>Conclusion: </strong>This study demonstrated favorable long-term outcomes of rTSA and a satisfactory survival rate using the Delta Xtend system. However, a significant decline of the functional outcome was observed since the mid-term follow-up. For indications other than CTA, the functional results are inferior, and the risk for revision is higher. Previous shoulder surgery prior to the index arthroplasty leads to a worse functional outcome and a higher risk of reoperation due to any complication.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Triceps Tendon Avulsions in Children and Young Adult patients: A commonly delayed diagnosis.","authors":"Hannah E Antonellis, Hannah L Young, Andrea S Bauer, Yi-Meng Yen, Carley B Vuillermin","doi":"10.1016/j.jse.2025.02.031","DOIUrl":"https://doi.org/10.1016/j.jse.2025.02.031","url":null,"abstract":"<p><strong>Background: </strong>Triceps tendon avulsions (TTAs) are rare injuries previously reported in active young men or elderly adults. Little information exists when this injury pattern presents in younger patients. TTAs are at risk of being missed or misdiagnosed at initial presentation, leading to delays in treatment and recovery. We hypothesized that formally diagnosed TTAs in young patients can be detected early on plain radiographs using the avulsion fleck sign, leading to earlier diagnosis and treatment.</p><p><strong>Methods: </strong>A retrospective case series of patients diagnosed with TTAs within the past 15 years at a tertiary pediatric referral center was reviewed. All patients were younger than 21 years of age at diagnosis. Patient demographics, injury characteristics, clinical presentation, comorbidities, and radiographs were investigated to describe the presentation of TTAs in younger patients. Radiographs and advanced imaging were reviewed to assess for the avulsion fleck sign and examine if TTA diagnoses could have been made earlier if this sign was recognized.</p><p><strong>Results: </strong>Nineteen patients met inclusion criteria, including 11 males and 8 females. The average age at time of injury was 14.95 years (range,12-19). 42.1% of subjects were injured during sports participation and 36.8% during play and daily activity. Only 2 patients had comorbidities. Initial radiographs occurred a median 0 days after injury (range,0-14, IQR:1). 1 out of the 19 patients had their TTA diagnosed at initial presentation on a lateral radiograph. 18 patients had advanced imaging leading to diagnosis. Diagnosis was made a median of 7 days after injury, ranging from 0 to 520 days. 1 in 4 patients were diagnosed more than a month after injury. On retrospective radiographic review, 17of19 patients had the avulsion fleck sign detectable on initial radiographs. Advanced imaging characterized the avulsion and led to the diagnosis of associated imaging in 14of16 patients.</p><p><strong>Conclusions: </strong>There is limited information about TTAs in younger populations. TTAs present in both young females and males, and occur during sports participation, play, and daily activity. 1 in 4 patients had a delay in diagnosis more than one month from injury. Although advanced imagining was commonly used to diagnose TTAs, plain radiographs showed a consistent finding of an avulsion fleck sign. Accurate interpretation of plain radiographs can lead to a faster diagnosis of TTAs. Advanced imaging is indicated to fully assess the injury including associated pathologies.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Smokeless Tobacco Use on Primary Total Shoulder Arthroplasty Outcomes.","authors":"Lawrence C Vanderham, Nikhil Vallabhaneni, John W Moore, Alexander S Guareschi, Brandon L Rogalski, Josef K Eichinger, Richard J Friedman","doi":"10.1016/j.jse.2025.02.037","DOIUrl":"https://doi.org/10.1016/j.jse.2025.02.037","url":null,"abstract":"<p><strong>Introduction: </strong>Total shoulder arthroplasty (TSA) is a common procedure performed to treat a variety of shoulder pathology. Smokeless tobacco use in the United States has increased in recent years and prior studies have found smokeless tobacco use to be associated with increased rates of medical and surgical complications following lower extremity total joint arthroplasty. The purpose of this study is to evaluate the effects of perioperative smokeless tobacco use on the short-term postoperative outcomes following primary TSA.</p><p><strong>Methods: </strong>The Nationwide Readmissions Database (NRD) was queried to identify patients who underwent primary TSA between 2016 and 2020. This cohort was further stratified into three cohorts: tobacco smokers, smokeless tobacco users, and non-tobacco users. Subjects in both tobacco cohorts were matched at a 1:3 ratio with non-tobacco users based on age, sex, and the presence of specific comorbid conditions. Demographics, postoperative complications, readmissions, revision, and mortality rates within 180 days of TSA were compared between the three groups.</p><p><strong>Results: </strong>Patients who use smokeless tobacco present with a greater mean Charlson Comorbidity Index (5.1% vs 1.8%) and concomitant alcohol use (5.1% vs 1.8%). Smokeless tobacco users experienced significantly higher rates of acute respiratory distress syndrome (1.9% vs 0.8%), sepsis (0.4% vs. 0.0%) and mortality (0.8% vs. 0.1) at 180 days.</p><p><strong>Conclusion: </strong>Patients undergoing primary TSA who use smokeless tobacco are at increased risk of mortality at 180 days and several medical postoperative complications including sepsis. Identifying these patients prior to their procedure and engaging in patient-centered discussion can help improve patient outcomes following primary TSA.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inconsistent Reporting of Risk Factors for Acromial Stress Fractures following Reverse Total Shoulder Arthroplasty: A Systematic Review.","authors":"Ryann A Davie, Karthik Nathan, Steven G Persaud, Lasun O Oladeji, Samuel A Taylor, Joshua S Dines, Michael C Fu, Gabriella E Ode, David M Dines, Lawrence V Gulotta, Christopher M Brusalis","doi":"10.1016/j.jse.2025.02.032","DOIUrl":"https://doi.org/10.1016/j.jse.2025.02.032","url":null,"abstract":"<p><strong>Background: </strong>Acromial stress fractures (ASFs) constitute one of the most common etiologies of impaired clinical outcomes following reverse total shoulder arthroplasty (rTSA). Elucidation of risk factors for ASFs may identify potential targets for preventive measures, however this reporting may be impeded by inconsistencies across studies. This study aimed to evaluate the variability with which risk factors associated with periprosthetic ASFs following rTSA are ascertained and reported.</p><p><strong>Methods: </strong>A systematic review was performed by querying PubMed, EMBASE, and Cochrane computerized databases from their inception through March 2024 to identify clinical outcome studies that reported at least one statistically significant risk factor associated with periprosthetic acromial stress fracture. Risk factors and study characteristics were aggregated.</p><p><strong>Results: </strong>Among 23 studies published from 2013 to 2024, 13 (56.5%) studies diagnosed ASFs by a combination of radiographs (XR) and/or computed tomography (CT). ASFs were diagnosed exclusively with XR in 8 of the 23 studies (34.8%). One study diagnosed ASFs exclusively with CT and another study did not specify the type of imaging modality used. Four studies (17.4%) reported on acromial stress reactions in symptomatic patients with negative radiographs. Ten studies (43.5%) utilized a fracture classification system to categorize ASFs, while the remaining 13 studies (56.5%) did not. Among 15 studies that identified patient characteristics as risk factors, osteoporosis (43.5%), female sex (30.4%), and diagnosis of rheumatoid arthritis (30.4%) were most commonly reported. Five studies identified rotator cuff arthropathy as a risk factor (21.7%). Postoperative radiographic parameters describing lateralization and distalization of the center of rotation demonstrated inconsistent associations with ASFs and were confounded by different systems and analysis techniques.</p><p><strong>Conclusions: </strong>The most commonly cited risk factors for acromial stress fractures following reverse total shoulder arthroplasty include osteoporosis, rheumatoid arthritis, female sex, and rotator cuff arthropathy. There remains significant discrepancies and inconsistencies in how ASFs following rTSA are defined, diagnosed, and reported on in the literature.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revision of reverse total shoulder arthroplasty: A scoping review of indications for revision, and revision outcomes, complications, and re-revisions.","authors":"Linda Wu, Mohammed Al-Asadi, Hassaan Abdel Khalik, Danielle Dagher, George Athwal, Moin Khan","doi":"10.1016/j.jse.2025.02.039","DOIUrl":"https://doi.org/10.1016/j.jse.2025.02.039","url":null,"abstract":"<p><strong>Background: </strong>The incidence of reverse total shoulder arthroplasty (RTSA) has been rising steadily over the last decade given broadening indications and increased familiarity with the procedure. With this increasing prevalence, the rate of revision of an RTSA has increased as well. Presently, there is a lack of clarity regarding outcomes after revision of an RTSA.</p><p><strong>Objective: </strong>The present review aimed to systematically examine studies assessing outcomes of revision RTSA following a failed primary RTSA or revision RTSA. Outcomes of interest include indications for revision, changes in patient-reported outcome measures (PROMs), postoperative complications, and re-revisions associated with revision RTSA.</p><p><strong>Method: </strong>A comprehensive search of MEDLINE, EMBASE, and Cochrane CENTRAL was conducted for relevant studies. Studies were included if they assessed outcomes in patients undergoing revision RTSA following a primary RTSA or a failed revision RTSA with a minimum follow-up of 12 months and reporting relevant clinical outcome measures. Descriptive statistics were calculated for reported outcomes. Quality assessment was performed using the methodological index for non-randomized studies (MINORS) instrument.</p><p><strong>Results: </strong>Sixteen studies were included in the final analysis, comprising 346 patients with 355 revised shoulders. The pooled cohort had a mean age of 69 years (range 63-73) and a mean follow-up of 39 months (range 12-67 months). The primary reasons for revision were dislocation or instability (30%), baseplate complications (25%), and infection (23%). The overall complication rate post-revision was 32%, with a re-revision rate of 27%. The most commonly reported postoperative complications included dislocation or instability (22%), fractures (18%), hematoma (15%), and baseplate issues including loosening, failure, and dissociation (12%). Major complications requiring re-revision surgery were led by dislocation or instability (28%), followed by baseplate complications (20%), infection (15%), and fracture (13%). Reported outcomes of revision RTSA are favorable with improvements in PROMs that exceed the minimal clinically important difference present in 83% of studies for ASES, 40% for SST, and 100% for both VAS pain and SANE scores.</p><p><strong>Conclusion: </strong>The most common indications for revision RTSA following failed primary or revision RTSA were dislocation or instability, baseplate issues and infection. One-third of patients after revision of a failed RTSA sustained a complication, most commonly being dislocation and periprosthetic fractures. While RTSA revision for failed RTSA yields favorable functional outcome scores, there remains a significant risk of complication which may require further revisions.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total elbow arthroplasty versus hemiarthroplasty for acute distal humeral fractures: A retrospective cohort study of revision rates in 366 consecutive patients.","authors":"Andreas Falkenberg Nielsen, Theis Muncholm Thillemann, Ali Al-Hamdani, Peter Kraglund Jacobsen, Jeppe Vejlgaard Rasmussen, Bo Sanderhoff Olsen","doi":"10.1016/j.jse.2025.02.034","DOIUrl":"https://doi.org/10.1016/j.jse.2025.02.034","url":null,"abstract":"<p><strong>Background: </strong>Elbow arthroplasty is an established treatment of distal humeral fractures not amenable to internal fixation. Total elbow arthroplasty (TEA) is the most common modality, but elbow hemiarthroplasty (EHA) is becoming more popular, and it is still unclear which option provides the best results. We hypothesized that EHA is associated with a lower revision rate than TEA, due to fewer mechanical complications.</p><p><strong>Methods: </strong>This study is a retrospective multi-center cohort study. We identified all patients with an acute distal humeral fracture treated with an elbow arthroplasty in Denmark in the period from January 1, 2008 until December 1, 2021. Data was collected retrospectively using electronic health records. Kaplan-Meier analysis was used to estimate the cumulative revision rates for TEA and EHA. Hazard ratios (HR) were estimated using the Cox proportional hazards model with mutual adjustment for age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, and implant type (TEA or EHA).</p><p><strong>Results: </strong>225 TEA and 141 EHA procedures were included. There were 21 revisions of TEAs and 11 of EHAs. The 2-, 5- and 10-year revision rates were 5.8% (95% confidence interval [CI] 2.5% - 9.2%), 8.6% (95% CI 4.4% - 12.8%) and 20.5% (95% CI 9.2% - 31.9%) for TEA, and 4.0% (95% CI 0.5% - 7.5%), 9.3% (95% CI 3.0% - 15.6%), and 18.7% (95% CI 4.8% - 32.7%) for EHA. After adjustment, the HR of revision for male patients was 3.8 (95% CI 1.6 - 9.1). The HR of revision for EHA was 0.9 (95% CI 0.4 - 1.9) with TEA as reference.</p><p><strong>Conclusion: </strong>We found comparable, but high revision rates of TEA and EHA after unreconstructable distal humeral fracture. An important finding was a four times higher risk of revision for male patients. Larger studies are needed for more reliable estimates.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shoulder Pain and Dysesthesia of the Hand: A Prospective Evaluation of 1201 Consecutive Patients Presenting for Shoulder Surgery.","authors":"Chen Zhang, Joseph Latif, Patrick Lam, George A C Murrell","doi":"10.1016/j.jse.2025.02.033","DOIUrl":"https://doi.org/10.1016/j.jse.2025.02.033","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to determine the prevalence and severity of numbness and tingling in the hand in patients presenting with disorders of the shoulder. This study also aimed to explore the potential associations of diagnosis of shoulder disorder, age, sex, duration of shoulder symptoms, work cover status, shoulder pain, shoulder function, and side of affected shoulder with hand dysesthesia to begin understanding the pathophysiology of this symptomology.</p><p><strong>Methods: </strong>This prospective cohort study was conducted at a single campus. The prevalence and severity of hand paresthesia and numbness were assessed using the modified Boston Carpal Tunnel Questionnaire. Shoulder status and pain were assessed using the L'Insalata Shoulder Questionnaire. Post hoc, patients were grouped by their diagnosis confirmed at surgery. Multivariate regression analyses were used to identify significant factors associated with hand dysesthesia.</p><p><strong>Results: </strong>A total of 1201 patients were included in the analysis. 22% to 45% of patients reported hand paresthesia and numbness, mostly of slight to medium severity, even though their primary diagnosis was a disorder of the shoulder. Patients with adhesive capsulitis had the highest prevalence of hand paresthesia (45%) and numbness (40%) while patients undergoing anatomic total shoulder arthroplasty had the lowest prevalence of preoperative hand paresthesia (22%) and numbness (22%). Multiple logistic regression analysis identified pain at rest as the most significant factor associated with of hand paresthesia and numbness. With each increasing level of pain at rest, patients were three times more likely to report hand paresthesia (OR: 3.00, 95% CI: 1.33 - 6.79) and numbness (OR: 3.02, 95% CI: 1.34 - 6.79). Patients with adhesive capsulitis were twice as likely to report hand numbness (OR: 1.59, 95%CI: 1.01 - 2.49) compared to patients with other shoulder disorders. Patients with self-reported stiff shoulders were also two times more likely to report worse hand paresthesia (OR: 1.66, 95%CI 1.03 to 2.66). Younger age, and deficit in shoulder internal rotation strength and range of motion were weak predictors of hand numbness and paresthesia.</p><p><strong>Conclusion: </strong>Approximately one-third of patients with common shoulder disorders also reported paresthesia and numbness in the ipsilateral hand, mostly of slight to moderate severity. Patients with adhesive capsulitis, painful, stiff, and weaker shoulders, were more likely to experience hand symptoms.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}