Journal of Shoulder and Elbow Surgery最新文献

{"title":"OUTCOMES OF AN ANTERIOR BONE BLOCK TECHNIQUE WITH ILIAC CREST ALLOGRAFT FOR THE MANAGEMENT OF ANTEROINFERIOR SHOULDER INSTABILITY WITH SUBCRITICAL GLENOID DEFECTS.","authors":"María J Espejo Reina, Cristina Delgado, Raquel Ruiz Díaz, Jorge Díaz Heredia, Cristina Asenjo Gismero, Miguel A Ruiz Iban","doi":"10.1016/j.jse.2025.02.022","DOIUrl":"https://doi.org/10.1016/j.jse.2025.02.022","url":null,"abstract":"<p><strong>Background: </strong>Glenoid bone defects play a significant role in anterior shoulder instability. Their management is controversial, and the use of anterior bone grafting is one appealing option. The purpose of this study is to assess the clinical and radiological outcomes at five-years follow-up of an arthroscopic bone block procedure with iliac crest allograft for the management of subcritical glenoid bone loss in subjects with recurrent anterior shoulder instability.</p><p><strong>Methods: </strong>Prospective longitudinal study of a consecutive case-series of subjects with anterior glenohumeral instability and subcritical (between 8% and 17%) glenoid bone defects managed with an arthroscopic bone block procedure with iliac crest allograft fixed with a double-button system associated with a Bankart repair, and, when necessary, a Remplissage. Preoperative Computed tomogram (CT) scans were used to quantify the dimensions of the glenoid and the humeral bone defects. Postoperative CT scans one-month after surgery and at one-year follow-up were used to assess the graft's positioning, integration and resorption. Clinical assessment was performed using the Constant-Murley (CS) and Rowe (RS) scores preoperatively and at least three years follow-up.</p><p><strong>Results: </strong>Fourteen subjects were included (all male, median age 27 years, interquartile range [IQR]=5.75), with a median of 8 (IQR=14) dislocation episodes before surgery and a median preoperative glenoid bone defect of 13% (IQR=14%, range: 9.3 to 15.4%). A remplissage was added in 12/14 cases (85.7%). Graft position was excellent in all cases (100%) in the axial plane and in 12 of 14 (85.7%) in the sagittal plane. The median reconstructed glenoid surface in the postoperative CT scan was 99.4% (IQR 2,1%, range: 96.6% to 100%). One-year postoperative CT scans showed bone resorption of ≥ 20% of volume in 13/14 cases (93%), with a median resorption of 80.3% (IQR=40.8%) of the graft volume. Graft integration was observed in 6/14 cases (42.8%). The median reconstructed glenoid surface decreased to 93.6% (IQR 2%, range: 87.5% to 97.3%) (p<0.0001). At the latest follow-up (58.9 months [IQR=11.2]: range: 39.6 to 67.8), two subjects (14.3%) presented with recurrence of instability. There were substantial improvements in the RS (from 25 [5] to 95 [6.2], p<0.0001) and in the CS (from 84 [5] to 94.5 [4.2] points, p<0.0001) at the final follow-up.</p><p><strong>Conclusions: </strong>Arthroscopic bone block procedure employing an iliac crest allograft achieves accurate graft positioning and good clinical outcomes with low recurrence rates at a mean of five years follow-up. However, early graft resorption and low consolidation rates are worrisome issues that must be considered.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674878","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":"SMR TT Augmented 360 baseplates, how do they compare to standard baseplates in reverse shoulder arthroplasty: minimum 2 years clinical and radiographic follow-up.","authors":"Ian Verrall, Idah Chatindiara, Adam C S Stoneham, Ryan Gao, Peter C Poon","doi":"10.1016/j.jse.2025.02.024","DOIUrl":"https://doi.org/10.1016/j.jse.2025.02.024","url":null,"abstract":"<p><strong>Background: </strong>Reverse Total Shoulder Arthroplasty (rTSA) is a popular surgical option for end stage arthritis, rotator cuff arthropathy or proximal humerus fractures. The treatment of patients with glenoid bone loss and deformity, however, remains challenging. Modern implant systems now have the option of wedge-shaped augmented baseplates to supplement deficient glenoid bone and omit the need for excessive glenoid reaming or the use of bone graft.This study set out to establish if the new augmented base plates were clinically and radiologically comparable to standard baseplates.</p><p><strong>Methods: </strong>A retrospective review of prospectively collected data was conducted on all patients who received the SMR 360 TT Augmented baseplate (Lima Corporate, Udine, Italy) between January 2020 and March 2022. All data were collected as part of the hospital prospective database from which a comparative sample of patients who received a standard baseplate was obtained. Minimum follow-up period was 2 years. Preoperative clinical information was recorded using pain score (1-5), Oxford Shoulder Score (OSS), American Shoulder and Elbow Surgeons (ASES) score, and Range of motion. The same clinical scores were collected at two-year follow-up with radiological assessments.</p><p><strong>Results: </strong>A total of 104 patients were included in this study, with 52 in the Augmented group and 52 in the Standard Group. At minimum two years follow-up there were no statistically significant differences between the two groups in OSS, pain score or range of motion at two years. Post operative ASES scores were 73 ± 22 in the augment group and 82 ± 15 in the standard baseplate group; this difference was statistically - but not clinically - significant. There was a statistically significant difference in the size of overhang with the Augmented Group having average glenoid overhang of 5.0 ± 1.9mm, while the Standard Group had an average of 6.5 ± 1.8mm. There was no other statistically or clinically significant difference in any other radiological outcome DISCUSSION: In both groups, it was possible to achieve a well-fixed stable rTSA with improved functional and radiological outcomes at two-year follow-up. Augmented baseplates were not clinically inferior to standard baseplates across any measure. This study demonstrates that augmented baseplates appear to be a safe alternative to other techniques such as eccentric reaming or Boney Increased Offset Reverse Shoulder Arthroplasty (BIO-RSA) with reliable patient outcomes.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674879","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":"Improving Readability of Shoulder and Elbow Surgery Online Patient Education Material with Chat Generative Pretrained Transformer (ChatGPT) 4.","authors":"Krishna Chandra, Umar Ghilzai, Jad Lawand, Abdullah Ghali, Benjamin Fiedler, Adil S Ahmed","doi":"10.1016/j.jse.2025.02.025","DOIUrl":"https://doi.org/10.1016/j.jse.2025.02.025","url":null,"abstract":"<p><strong>Background: </strong>Health literacy is crucial for effective doctor-patient communication, particularly for surgical patients who need to comprehend complex procedures and care protocols. The American Medical Association and National Institutes of Health suggest patient education materials be at a sixth to eighth-grade reading level. Despite this, many online materials for orthopedic surgeries, including shoulder and elbow procedures are written above this level. ChatGPT-4, an AI language model, may help simplify these materials and improve readability given poor health literacy in patient populations.</p><p><strong>Methods: </strong>Thirty excerpts of patient-facing information on shoulder and elbow surgeries were selected from academic and professional medical sources a variety of shoulder and elbow orthopedic surgical topics. Original readability was assessed using the SMOG (Simple Measure of Gobbledygook) Index. ChatGPT then analyzed readability and simplified the text to a sixth- to eighth-grade level. To simplify the text while maintaining medical accuracy, the following prompt was used: \"Rewrite this text at a 6th to 8th grade level without losing information.\" ChatGPT achieved this by defining medical terminology, using common language equivalents, and restructuring information for easier readability. Simplified text was re-evaluated for readability by both SMOG Index and ChatGPT and accuracy by study authors.</p><p><strong>Results: </strong>Original excerpts had an average SMOG readability score of 10.1, requiring about a tenth grade reading level. ChatGPT's initial analysis averaged slightly higher at 10.3 (p<0.001). Following simplification, the both the SMOG readability score and ChatGPT significantly dropped to 8.3, and 7.7, respectively, aligning closer to recommended readability levels (p<0.001). ChatGPT also provided targeted feedback on areas for readability improvement.</p><p><strong>Conclusions: </strong>ChatGPT-4 demonstrated utility in analyzing and simplifying shoulder and elbow surgery patient education materials, lowering readability to near-recommended levels. By providing specific suggestions for simplification, ChatGPT streamlined the revision process, enhancing potential patient understanding and engagement. However, human review remains necessary to ensure clinical accuracy in AI-simplified materials.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674876","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":"A Novel Methodology for Establishing MCID and SCB Thresholds for Patient-Reported Outcome Measures Following Reverse Total Shoulder Arthroplasty.","authors":"Avanish Yendluri, Ara Alexanian, Alexander C Lee, Rohit R Chari, Michael N Megafu, Leesa M Galatz, William N Levine, Bradford O Parsons, John D Kelly, Robert L Parisien","doi":"10.1016/j.jse.2025.02.018","DOIUrl":"https://doi.org/10.1016/j.jse.2025.02.018","url":null,"abstract":"<p><strong>Background: </strong>Increasing reliance on Patient Reported Outcome Measures (PROMs) following Reverse Total Shoulder Arthroplasty (rTSA) has resulted in variability in the thresholds for minimum clinically important difference (MCID) and substantial clinical benefit (SCB) reported in the literature. In this study, we aimed to identify the best threshold values for MCID and SCB for common rTSA PROMs.</p><p><strong>Methods: </strong>The PubMed, Embase, MEDLINE, Cochrane Library, and Google Scholar databases were queried for studies published from January 1, 2000-March 1, 2024 that identified clinically significant thresholds for PROMs following rTSA. The threshold calculation method, anchor questions/response options, follow-up duration, and confidence intervals were extracted. A novel hierarchical methodology evaluated various threshold calculation characteristics to identify the best MCID and SCB values following rTSA.</p><p><strong>Results: </strong>We included 37 studies for analysis comprising 11,960 patients. Using our methodology, the MCID values from the literature we recommend for ASES, SST, Constant, UCLA, SPADI, and VAS following rTSA are 8.9, 3.7, 9.3, 2.9, 20, and 1.4 respectively. The recommended MCID threshold values for ASES and SST were from Werner and McLaughlin, respectively. The recommended thresholds for Constant and UCLA were from Zhou, while the thresholds for SPADI and VAS were from Simovitch. Using our methodology, the SCB threshold values from the literature we recommend for ASES following rTSA are 28.3 for glenohumeral osteoarthritis and 23.1 for rotator cuff arthropathy from Puzzitiello. For SST, Constant, UCLA, SPADI, and VAS, the SCB values we recommend are 3.2, 13.6, 10.4, 42.7, and 2.6 respectively. The recommended SCB thresholds for SST, Constant, UCLA, SPADI, and VAS were all from Simovitch.</p><p><strong>Conclusion: </strong>We present recommended MCID and SCB values identified through our comprehensive methodology and recommend how these thresholds should be calculated for common rTSA PROMs moving forward. With increasing use and dependence on MCID and SCB values for PROMs, these recommended threshold values for MCID and SCB will help standardize assessment of clinically significant improvement for patients undergoing rTSA.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634901","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":"Bridging Reconstruction for Massive Rotator Cuff Tears has a Low Rate of Arthritic Progression and Maintained Excellent Clinical Outcomes for a Minimum 5-year Follow-up.","authors":"Jillian Karpyshyn, Kazuha Kizaki, Jie Ma, Felicia Licht, Ivan Wong","doi":"10.1016/j.jse.2025.01.051","DOIUrl":"https://doi.org/10.1016/j.jse.2025.01.051","url":null,"abstract":"<p><strong>Background: </strong>Bridging reconstruction (BRR) using human dermal allograft has emerged as a promising technique for large to massive rotator cuff tears allowing anatomical reconstruction of the rotator cuff, and preventing excessive repair tension, but little is known on the mid to long term results of this technique. The purpose of this study was to evaluate progression of rotator cuff arthropathy, graft healing, and clinical outcomes in patients following BRR for large to massive rotator cuff tears with a minimum 5-year follow-up.</p><p><strong>Methods: </strong>A retrospective chart review of prospectively collected data was conducted for all patients who underwent BRR between 2012 and 2017. Patients who underwent BRR for large to massive rotator cuff tears and had a minimum 5-year radiographic follow-up or early re-operation were included. Patients who had a re-operation prior to the 5-year time point were included for calculation of graft failure rate, however, were excluded from the other outcome measures. The primary outcome was progression of rotator cuff arthropathy on standard radiographs at 5 years. Secondary outcome measures included acromiohumeral interval (AHI), MRI evaluation of graft healing, and Western Ontario Rotator Cuff Index (WORC) at final follow-up.</p><p><strong>Results: </strong>Forty-five patients met inclusion criteria and were included in this study. Nine patients (20%) underwent reoperation due to graft retear before the 5-year time point and were included in the analysis of graft failure but were excluded from the x-ray and functional analysis. Thirty-six patients had radiographic follow-up at a mean 6.44 years and were included in the final analysis. Two patients (5.5%) demonstrated progression of RCA. Sixty-five percent of patients had a healed graft, 23% had a partial tear and 12% had a complete retear of the graft. The WORC scores (N=33) significantly improved from 70.1 (SD=12.87) preoperatively to 24.7 (SD=21.9) at the most recent follow-up (p<0.001). Ninety-four percent of patients achieved the MCID of the WORC score.</p><p><strong>Conclusion: </strong>The results of this study show that bridging reconstruction with dermal allograft has promising results over a 5-year follow-up with low progression to rotator cuff arthropathy and favorable graft healing rates. Patient reported outcomes significantly improved postoperatively with 94% of patients achieving the MCID, highlighting the efficacy of this technique in preserving shoulder function and integrity.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634227","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":"Osteolysis and outcome after total elbow arthroplasty (TEA): Impact of proximal ulna dorsal angulation (PUDA) and radio-capitellar ratio (RCR).","authors":"Claire Bastard, Patrick Goetti, Emilie Sandman, Stephane Leduc, Benoit Benoit, Patrick Tohmé, Eliane Lecours, Dominique M Rouleau","doi":"10.1016/j.jse.2025.01.049","DOIUrl":"https://doi.org/10.1016/j.jse.2025.01.049","url":null,"abstract":"<p><strong>Background: </strong>Osteolysis after Total Elbow Arthroplasty (TEA) remains a major concern, with an average 13% to 15% loosening rate at 7 years. Two new radiological parameters of elbow anatomy could play a role in this complication: the Posterior Ulnar Dorsal Angulation (PUDA) and the Radio-Capitellar Ratio (RCR). The primary objective of this study was to evaluate the association between PUDA and RCR on loosening after TEA.</p><p><strong>Methods: </strong>This retrospective single-center study included all patients who underwent TEA from 1996 to 2021 with a minimum follow-up of 2 years. Patient evaluation included Range of Motion (ROM), and function (Q-DASH, PREE, MEPS). To assess implant position and limb length discrepancy, new bilateral upper limb radiographs were taken. Lateral elbow radiographs were taken to measure PUDA and RCR on the TEA side and native side. PUDA was considered high when > 7°, and RCR was abnormal when <-5% or >13%. Radiographs were analyzed by an independent evaluator to assess loosening.</p><p><strong>Results: </strong>Thirty-four TEAs from 30 patients available for assessment were included. The mean age was 64 years (range 42 to 86), and 90% (n=27) were females. TEA was performed following trauma in 13 patients and secondary to degenerative conditions in 17 patients. The mean follow-up was 7.4 years. The mean PUDA and RCR were 6.7 and -1.2%, respectively. PUDA was high in 33% of patients, and RCR was abnormal in 53%. The MEPS score was significantly better in patients with a lower PUDA compared to those with a higher PUDA, 87 (± 13) and 73 (± 17), p = 0.038, respectively. A higher PUDA was not associated with humeral or ulnar component loosening (Humeral component: 40% vs. 9% loosening, p = 0.053; Ulnar component: 20% vs. 5% loosening, p = 0.251). Functional scores and loosening rates were not impacted by differences in RCR.</p><p><strong>Conclusions: </strong>PUDA had an impact on functional scores, with significantly better MEPS in patients with lower PUDA. PUDA was not statistically related to loosening of the humeral or ulnar components. RCR had no impact on loosening and outcomes after TEA in our study.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634423","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":"Proximal Ulna Angular Measurements in Elbow Dislocations: Radiographic Insights into Simple vs. Complex Injuries.","authors":"Cafer Ozgur Hancerli, Gürkan Caliskan, Halil Buyukdogan, Abdulhamit Misir","doi":"10.1016/j.jse.2025.02.016","DOIUrl":"https://doi.org/10.1016/j.jse.2025.02.016","url":null,"abstract":"<p><strong>Background: </strong>Elbow dislocations are common injuries, classified as simple or complex based on the presence of fractures. While the stabilizing structures of the elbow have been well-studied, the influence of proximal ulna anatomical variations on the risk and severity of dislocations remains unclear. This study aimed to evaluate Proximal Ulna Dorsal Angulation (PUDA), Proximal Ulnar Varus Angle (PUVA), and Olecranodiaphyseal Angle (ODA) in healthy individuals, patients with simple elbow dislocations, and those with complex elbow dislocations. We hypothesized significant differences in these angles between the groups.</p><p><strong>Methods: </strong>A comparative cross-sectional study was conducted including healthy controls (n=182), patients with simple elbow dislocations (n=112), and patients with complex elbow dislocations (n=52). Standardized anteroposterior and lateral elbow radiographs were obtained to measure PUDA, PUVA, and ODA. Radiographic measurements were conducted by two independent observers to ensure reliability. The study aimed to determine anatomical differences that could influence the likelihood and severity of elbow dislocations.</p><p><strong>Results: </strong>ODA was significantly lower in patients with complex elbow dislocations compared to both healthy controls and those with simple dislocations. Patients with radial head fractures had significantly lower ODA values than those without fractures. PUDA showed small differences between right and left elbows, but these differences had limited clinical relevance. Lower ODA was independently associated with the development of radial head fractures, indicating its potential as a factor of injury severity.</p><p><strong>Conclusion: </strong>ODA serves as a significant anatomical marker that can differentiate between simple and complex elbow dislocations and is associated with fracture risk, particularly in complex dislocations. These findings suggest that assessing ODA may aid in evaluating elbow stability and planning treatment strategies for dislocation injuries.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634438","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":"Zone specific bone density evaluation of the acromion may predict postoperative acromion stress fracture in patients undergoing a reverse total shoulder arthroplasty.","authors":"Christopher A Colasanti, Charles C Lin, Jay M Levin, Michelle S Shen, Erel Ben-Ari, Erin Alaia, Ryan W Simovitch, Joseph D Zuckerman","doi":"10.1016/j.jse.2025.02.013","DOIUrl":"https://doi.org/10.1016/j.jse.2025.02.013","url":null,"abstract":"<p><strong>Background: </strong>The goal of this study was to utilize preoperative computed-tomography(CT) scans to identify differences in the Hounsfield units(HU) of the acromion in patients who did and did not develop a postoperative acromial and scapular-spine fracture(ASF) after primary reverse total shoulder arthroplasty (rTSA).</p><p><strong>Methods: </strong>A retrospective analysis was performed at a single institution. All patients undergoing a rTSA with either a 135° neck/shaft angle(NSA) humeral inlay design combined with a lateralized center-of-rotation(COR) glenosphere or a 145° NSA onlay combined with a medialized COR glenosphere design between 2011-2021 with a minimum follow-up of 24-months were included. Demographic characteristics and clinical outcome metric scores were recorded. Preoperative CT scans were analyzed to obtain acromion trabecular bone density measurements in HU in each zone of the scapula based on the Levy classification. Radiographic parameters were evaluated to determine their association with ASF.</p><p><strong>Results: </strong>In total 263-patients were included, 140-patients with a 135° NSA humeral-inlay design;123-patients with a 145° NSA humeral-onlay design. There were no significant differences in baseline demographics between cohorts. The rate of ASF was 6.4%(9/140) for the 135° NSA-inlay-design versus 2.4%(3/123) in the 145° NSA-onlay design. In the non-fracture cohort there was a linear increase in bone density from zone-1(173.9HU)→zone-3(396.5HU)(lateral→medial). In the fracture cohort there was a decrease in bone density from zone-1(282.6HU)→zone-3(154.5HU). Measuring preoperative bone density in all Levy specific fracture-zones resulted in an AUC of 0.96 correlating to excellent predictive value. A threshold cutoff of 99.9 resulted in a sensitivity of 91.6% and specificity of 75.3%. A HU of 99.9 in any of the three-zones resulted in OR 5.1(p<0.0001) for sustaining an ASF postoperatively. A threshold of<50HU was associated with an 8-times higher-likelihood of developing a fracture in that specific zone. Greater than 5° of superior tilt in combination with ≥24mm of distalization was associated with an OR 6.4(p=0.0004) of sustaining an ASF.</p><p><strong>Conclusion: </strong>The current study demonstrates an accurate method of measuring HU at each of the described Levy fracture zones with excellent predictability of patients who are at risk of an ASF following rTSA. Additionally, we found that a HU threshold of <50 HU at any of the three Levy zones was associated with a nearly 8 times higher likelihood of developing a fracture in that specific zone. Lastly, we found that >5° of superior tilt in combination with ≥24mm of distalization was associated with 6.4 times higher likelihood of sustaining an ASF agnostic to prosthesis design.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634592","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":"Delays beyond Five Days to Surgery Does Not Affect Outcome Following Plate and Screw Fixation of Proximal Humerus Fractures.","authors":"Carolyn F Herbosa, Jack C Adams, Abhishek Ganta, Sanjit Konda, Kenneth A Egol","doi":"10.1016/j.jse.2025.02.019","DOIUrl":"https://doi.org/10.1016/j.jse.2025.02.019","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study is to compare the quality and clinical outcomes of patients who underwent open reduction internal fixation for a proximal humerus fracture in a \"timely manner\" which was defined to be within 5 days of injury compared to those with \"delayed intervention\" (>5 Days) to determine the effect this had.</p><p><strong>Methods: </strong>This IRB-approved study evaluated patients who sustained a proximal humerus fracture treated with plate and screw fixation (ORIF) between January 2004 and October 2022 and had time from injury to surgery documented. Patients were grouped based on the time to surgery (TTS) - Less than 5 Days (L5) vs. More than 5 Days (M5). TTS was also evaluated as a continuous variable. Univariable and multivariable analysis compared patient demographics, injury/surgical characteristics, postoperative complications, and clinical outcomes to determine effect of TTS. Clinical outcomes included shoulder range of motion (ROM) and Disabilities of the Arm, Shoulder, and Hand (DASH) score at least 1 year following the date of injury. Standard statistical tests were used (p<0.05 considered significant).</p><p><strong>Results: </strong>A total of 175 patients met criteria and were analyzed: Seventy-four (42.2%) were L5 and 101 (57.8%) were M5. The cohorts were similar in age, sex, race, BMI, and CCI. Both cohorts had, based on the Neer classification, similar fracture patterns (p=0.68). Complications rates were similar (16% vs. 15%, p=0.81). These postoperative complications included AVN, infection, malunion, nonunion, screw penetration, loss of reduction, nerve symptoms, and painful hardware which were similar for both cohorts (p=0.26). The shoulder mobility of patients at the 1 year time point was similar for all patients regardless of TTS. ROM included active (139±32^o vs. 142±29^o, p=0.61) and passive (152±24^o vs. 152±24^o, p=0.96) forward elevation, and external rotation (52±19^o vs. 55±21^o, p=0.24). Finally, the DASH scores for both groups were similar (15.36±17.72 vs. 20.06±18.96, p=0.09). Multivariable analysis confirmed that timing of surgery was not associated with complications or functional outcomes. However, piecewise analysis demonstrated at a delay of 14 days (151±25^o vs. 161±19^o, p=0.04, β = 0.29, 95% CI = 1.05-28.80) and 21 days (149±25^o vs. 161±19^o, p=0.03, β= -0.27, 95% CI = -41.71- -2.89) surgery was associated with less passive forward elevation.</p><p><strong>Conclusion: </strong>Timing of surgery did not impact outcomes of patients who underwent open reduction internal fixation for proximal humerus fractures. Surgical intervention after 14 days was associated with diminished passive forward elevation only.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634172","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":"Optimal Timing of Reverse Total Shoulder Arthroplasty for Proximal Humerus Fractures.","authors":"Jake Goguen, Jessica Forbes, Garrett R Jackson, Aghdas Movassaghi, Hans Lapica, Howard Routman, Vani J Sabesan","doi":"10.1016/j.jse.2025.01.050","DOIUrl":"https://doi.org/10.1016/j.jse.2025.01.050","url":null,"abstract":"<p><strong>Background: </strong>Reverse total shoulder arthroplasty (rTSA) has recently emerged as a popular operative management option for complex proximal humeral fractures (PHFx) in the elderly. Although rTSA seemingly provides satisfactory clinical and functional outcomes in patients with complex PHFxs, little is known about the clinical and functional outcomes of patients with delayed rTSA treatment of proximal humerus fractures. The purpose of our study was to compare postoperative clinical outcomes and complications in patients treated with rTSA for acute PHFx versus chronic PHFxs.</p><p><strong>Methods: </strong>A retrospective review was conducted to identify all patients who underwent primary rTSA for the treatment of a PHFx from January 2010 to December 2022. Patients were separated into two groups based on the timing from PHFx injury to surgery: 1) acute (<6 weeks from date of injury to rTSA) PHFx group and 2) chronic (≥6 weeks) PHFx group. Preoperative and postoperative clinical outcomes including range of motion, simple shoulder test (SST), Constant score (Constant), University of California Los Angeles (UCLA) shoulder rating scale, Shoulder Pain and Disability Index (SPADI), Shoulder Arthroplasty Smart Score (SAS), and American Shoulder and Elbow Surgeons (ASES) shoulder score were recorded and assessed using paired t-test.</p><p><strong>Results: </strong>Sixty-one patients (Acute Group = 43 patients, Chronic Group = 18 patients) were analyzed. Patient demographics were comparable between both groups. Patients in the acute group had surgery significantly earlier than those in the chronic group (2.0 weeks vs 49.6 weeks, P <.001). There were no significant differences in range of motion, clinical and functional outcome scores, or complications between the two groups. The overall complication rate was 2%. The only complication occurred in the acute group and was a shoulder dislocation secondary to a fall. No significance in complication rates was found between the two groups (P = .518).</p><p><strong>Conclusions: </strong>Patients treated in the acute or chronic setting with an rTSA result in comparable clinical and functional outcomes with minimal complications. Ultimately, patients and surgeons can work together for optimal timing of rTSA for proximal humerus fractures in the elderly without sacrificing improvements in function or patient-reported outcomes.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634212","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}