European Journal of Orthopaedic Surgery and Traumatology最新文献

{"title":"Arthroscopic ACL repair with suture tape augmentation: clinical, functional, and gait analysis outcomes at minimum 3-year follow-up.","authors":"Rachit Saggar, Vikram Arun Mhaskar, Rohit Bansal","doi":"10.1007/s00590-024-04161-9","DOIUrl":"https://doi.org/10.1007/s00590-024-04161-9","url":null,"abstract":"<p><strong>Introduction: </strong>Recent advancements in surgical techniques have led to renewed interest in ACL repair, particularly for acute, proximal tears. Suture tape augmentation (STA) has emerged as a promising technique to support ACL healing while preserving native tissue and potentially improving outcomes. This study aims to evaluate the outcomes of ACL repair with STA in patients with acute, proximal ACL tears.</p><p><strong>Methods: </strong>We retrospectively reviewed patients who underwent ACL repair with STA between June 2018 and October 2020. Inclusion criteria were acute (< 6 weeks) ACL rupture, Sherman type I tears, and minimum follow-up of 3 years. Exclusion criteria included mid-substance or distal ACL tears and previous knee surgeries. Clinical evaluation involved stability tests, PROMs, and gait analysis using Prokin WalkerView. Second-look arthroscopy and histological analysis were conducted on a subset of patients.</p><p><strong>Results: </strong>Twelve consecutive patients (7 males and 5 females) with a mean age of 27.4 ± 7.9 years and mean BMI of 23.3 ± 1.6 kg/m²were included. Time to operation was 19.5 ± 8.7 days. Mean follow-up duration was 53.2 ± 9.4 months. One patient experienced a traumatic re-rupture. One had a contralateral ACL tear and one experienced hardware irritation. Clinical tests were negative for instability in all patients. Post-operative IKDC, Lysholm, and FJS-12 scores showed significant improvement (p < 0.001). All patients (100%) achieved minimal clinically important difference for all PROMs. Walking gait analysis revealed high symmetry indices for range of motion (93.50%) and step length (95.80%) with near symmetrical loading. Second-look arthroscopy showed intact repairs with healthy tissue morphology and integration. Histology revealed increased cellularity, high nuclear density, and preservation of vascular and neural components indicated by CD34 and S-100 markers.</p><p><strong>Conclusions: </strong>Arthroscopic ACL repair with STA provides favourable clinical, functional, and histological outcomes with low re-rupture rates when performed on acute, proximal ACL tears. This technique demonstrates fair-to-good PROMs, functional stability, and near-normal gait parameters.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"35 1","pages":"39"},"PeriodicalIF":1.4,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between lower limb muscle strength and musculoskeletal ambulation disability symptom complex in patients with medial meniscus posterior root tears.","authors":"Mikao Fukuba, Koki Kawada, Yuki Okazaki, Yoshimi Katayama, Masanori Hamada, Toshifumi Ozaki, Takayuki Furumatsu","doi":"10.1007/s00590-024-04158-4","DOIUrl":"10.1007/s00590-024-04158-4","url":null,"abstract":"<p><strong>Purpose: </strong>In this study, we aimed to evaluate the changes in and the relationship between lower limb muscle strength and physical function before and after medial meniscus posterior root (MMPR) repair.</p><p><strong>Methods: </strong>Thirty-three patients who underwent MMPR repair were evaluated. Pain was evaluated with the numerical rating scale (NRS), and knee flexor/extensor muscle strength was assessed using a handheld dynamometer. Physical function was evaluated using a timed up and go (TUG) test. The NRS, knee flexor/extensor muscle strength, and TUG were compared preoperatively and 1 year postoperatively using the Wilcoxon signed-rank test. The correlation of patient characteristics, NRS score, knee flexor/extensor muscle strength, and preoperative TUG with the postoperative TUG was analyzed using Spearman's correlation coefficient.</p><p><strong>Results: </strong>NRS (3.5 ± 2.1 to 0.1 ± 0.5 points), knee flexor strength (111.9 ± 50.2 to 146.7 ± 51.5 Nm), knee extensor strength (181.9 ± 92.8 to 256.9 ± 107.1 Nm), and TUG (12.3 ± 5.7 to 9.2 ± 2.2 s) all improved significantly from preoperatively to 1 year postoperatively (p < 0.001). The postoperative TUG was negatively correlated with the preoperative TUG (r = 0.578, p < 0.001), preoperative knee flexor muscle strength (r = - 0.355, p = 0.042), preoperative knee extensor muscle strength (r = - 0.437, p = 0.010), and postoperative knee extensor muscle strength (r = - 0.478, p = 0.004).</p><p><strong>Conclusion: </strong>In patients undergoing MMPR repair, surgery and rehabilitation significantly improve lower limb muscle strength and physical function. There was a significant correlation between lower limb muscle strength and TUG, and further strengthening of the lower limb muscles from the preoperative level is desirable to improve patients' physical function further.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"35 1","pages":"40"},"PeriodicalIF":1.4,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11638297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814598","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":"Hoffa fractures are slower to heal than entire condyle fractures of the distal femur: an analysis of type 33B fractures.","authors":"Christopher J Pettit, Sanjit R Konda, Abhishek Ganta, Nirmal C Tejwani, Kenneth A Egol","doi":"10.1007/s00590-024-04118-y","DOIUrl":"https://doi.org/10.1007/s00590-024-04118-y","url":null,"abstract":"<p><strong>Purpose: </strong>To examine patient demographic and clinical outcomes associated with partial articular distal femoral fractures.</p><p><strong>Methods: </strong>An IRB-approved study was conducted on a consecutive series of patients being treated for isolated partial articular distal femoral fractures at a single academic medical center between August, 2011 and July, 2023. Patient demographics, hospital quality measures and outcomes for each patient were reviewed. All fractures were fixed using screws alone or plate and screw constructs. Fractures were grouped into isolated entire medial or lateral condyle (OTA/AO 33B1 or B2) and posterior unicondylar (Hoffa) fractures (OTA/AO 33B3.2). Cohorts were compared for clinical, radiographic and complication outcomes using Chi-Square Tests and ANOVA tests.</p><p><strong>Results: </strong>A total of 30 patients were identified with a mean of 55.2 years. There were 16 (53.3%) isolated medial/lateral condylar fractures and 14 (46.7%) Hoffa fractures. There were no differences between the two fracture types in terms of baseline demographics. There was no difference in terms of length of stay or in-hospital complications between the fracture types. All fractures united. There was also no difference in range of knee motion at latest follow-up visit. Hoffa fractures required a longer time for radiographic healing (4.5 months vs. 3.05 months, p = 0.012).</p><p><strong>Conclusion: </strong>Hoffa fractures require longer time to radiographic healing compared to other partial articular distal femoral fractures; however no other differences were seen based on fracture patterns.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"35 1","pages":"38"},"PeriodicalIF":1.4,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances in Artificial Intelligence for automated knee osteoarthritis classification using the IKDC system.","authors":"Facundo Manuel Segura, Florencio Pablo Segura, María Paz Lucero Zudaire, Florencio Vicente Segura","doi":"10.1007/s00590-024-04124-0","DOIUrl":"https://doi.org/10.1007/s00590-024-04124-0","url":null,"abstract":"<p><strong>Introduction: </strong>Knee osteoarthritis is one of the most prevalent and debilitating musculoskeletal diseases, with a high incidence among the elderly population. Early detection and accurate classification can improve clinical outcomes for affected patients.</p><p><strong>Objective: </strong>This study investigates the use of artificial intelligence (AI) and computer vision for automated detection and classification of knee osteoarthritis using the IKDC classification system. The aim was to develop an automated system for this purpose and evaluate its accuracy in classifying disease severity.</p><p><strong>Materials and methods: </strong>A public dataset containing radiographic knee images with varying degrees of osteoarthritis, previously classified according to the IKDC scale, was utilized. Images were processed using LandingLens software, an advanced computer vision platform facilitating AI model development and implementation. A machine learning model based on the ConvNext architecture-a convolutional neural network-was trained on 1901 images and evaluated using 380 test images.</p><p><strong>Results: </strong>The model demonstrated an overall accuracy of 95.16% in classifying knee osteoarthritis according to the IKDC scale, with a sensitivity of 95.11%. Class-specific accuracies were 92.40% for class A, 93.20% for class B, 98.45% for class C, and 95.69% for class D. These results highlight the model's capability to distinguish between different severity grades of osteoarthritis with high accuracy.</p><p><strong>Conclusion: </strong>This study underscores the efficacy of AI and computer vision in automating knee osteoarthritis detection, providing a precise and reliable tool for physicians in disease diagnosis. Integrating these technologies into clinical practice has the potential to enhance efficiency and consistency in patient evaluation, potentially leading to improved clinical outcomes and more personalized medical care.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"35 1","pages":"32"},"PeriodicalIF":1.4,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vitamin D deficiency in hip fracture patients is associated with an increased mortality risk.","authors":"John M Bayram, Hariprasath Kanesan, Nicholas D Clement","doi":"10.1007/s00590-024-04162-8","DOIUrl":"10.1007/s00590-024-04162-8","url":null,"abstract":"<p><strong>Purpose: </strong>The aims were to assess whether vitamin D deficiency influenced mortality risk and length of acute hospital stay in patients presenting with a hip fracture.</p><p><strong>Methods: </strong>A retrospective study was undertaken including all patients aged over 50 years that were admitted with a hip fracture to a single centre during a 24-month period. Serum vitamin D levels on admission, patient demographics, perioperative variables and mortality were collected. Cox regression analysis was utilised to determine the independent association between serum vitamin D levels and patient mortality.</p><p><strong>Results: </strong>The cohort consisted of 1510 patients with a mean age of 81.3 years and 1107 (71.4%) were female. 876 (58.0%) were vitamin D deficient (< 50 nmol/l). The median follow up was 405 (IQR 249 to 610) days. During follow-up there were 464 deaths (30.7%). Vitamin D deficiency was independently associated with higher mortality risk (hazard ratio [HR] 1.26, 95% confidence interval (CI) 1.03 to 1.53, P = 0.022). Male sex (HR 1.64, 95% CI 1.34 to 2.01, P < 0.001) was also associated with a higher mortality risk. Vitamin D deficiency was not associated with length of hospital stay (median difference 0 days, P = 0.207).</p><p><strong>Conclusion: </strong>Vitamin D deficiency was independently associated with increased mortality in hip fracture patients, though this finding may be influenced by lack of comprehensive adjustment for comorbidity. While the value of routine serum vitamin D measurement is debated, supplementation during hospital stays is important to reduce falls and fracture risks associated with deficiency.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"35 1","pages":"33"},"PeriodicalIF":1.4,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11611993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774500","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":"Robotic arm-assisted versus conventional total knee arthroplasty: comparing complications, costs, and postoperative opioid use in propensity-matched cohorts.","authors":"Johnston Norton, Senthil Sambandam, Varatharaj Mounasamy, Robert C Weinschenk","doi":"10.1007/s00590-024-04077-4","DOIUrl":"10.1007/s00590-024-04077-4","url":null,"abstract":"<p><strong>Purpose: </strong>Limited literature exists substantiating benefits of robotic arm-assisted total knee arthroplasty (raTKA) over conventional total knee arthroplasty (cTKA). This study compared postoperative pain, complications, and costs between patients undergoing raTKA and cTKA using large, propensity score-matched cohorts. We hypothesize that the raTKA cohort will be associated with lower pain, lower anemia, and similar cost and other complications.</p><p><strong>Methods: </strong>A commercially available patient database was used for this study. Patients with raTKA and cTKA were identified with current procedural terminology and international classification of diseases (ICD-9/ICD-10) codes. Exclusions and propensity score matching were applied to mitigate confounding bias. Complication rates, costs, and postoperative opioid uses were then compared between groups.</p><p><strong>Results: </strong>Compared with patients with cTKAs (n = 31,105), patients with raTKAs (n = 6,221) had less postoperative opioid use (p < 0.01), lower rates of postoperative acute renal failure (OR 0.71; p < 0.01), anemia (OR 0.75; p < 0.01), and periprosthetic joint infection (OR 0.59; p = 0.04), and lower index costs ($875 vs. $1,169, p < 0.01).</p><p><strong>Conclusion: </strong>RaTKA was associated with less postoperative pain and complications compared with cTKA.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":" ","pages":"3917-3929"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term primary and revision modular dual-mobility cup total hip arthroplasty outcomes in high-risk dislocation patients: a retrospective study.","authors":"Martta Ruusiala, Hannu Miettinen, Jukka Kettunen, Heikki Kröger, Simo Miettinen","doi":"10.1007/s00590-024-04092-5","DOIUrl":"10.1007/s00590-024-04092-5","url":null,"abstract":"<p><strong>Purpose: </strong>Modular dual-mobility cups (MDMCs) have a lower risk for dislocation after total hip arthroplasty (THA). The primary aims of our study were to analyze implant survivorship and to determine complications, especially dislocation, and revision rates of primary THAs used for hip fracture patients and for revision THAs. Secondary aims were to evaluate mortality after MDMC surgery and to find out if introduction of MDMC at our institution (Kuopio University Hospital, Finland) have decreased dislocation rate.</p><p><strong>Methods: </strong>This retrospective cohort study consisted of 101 MDMC patients who were consecutively operated at our institution between April 1, 2018 and June 30, 2020. The implant survival rate, complications and mortality were evaluated with minimum of 2-year follow-up. Finnish Hospital Discharge Register was used to find out yearly dislocation rates following THA at our institution.</p><p><strong>Results: </strong>The cumulative estimate implant survival after MDMC in the primary THA group was 97% at 2 years, and in the revision THA group, it was 90% at 2 years. Dislocation was a rare complication in the primary THA group (1.4%), while it was common in revision THA group (12.9%). The cumulative estimate for mortality after MDMC in the primary THA group was 13% at 2 years, and in the revision group, it was also 13% at 2 years. The yearly number of patients who had re-hospitalization period due to THA dislocation decreased 46% after implementation of MDMC.</p><p><strong>Conclusion: </strong>Short-term survival and complication rates after MDMC were excellent after primary THA and moderate after revision THA. Implementation of MDMC THA for hip fracture patients seems to have effectively decrease dislocation rate during a short follow-up.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":" ","pages":"3981-3988"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11519307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156531","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":"Comparative analysis of patient-reported outcomes in total knee arthroplasty and total hip arthroplasty: adjusting for demographic influences.","authors":"Kentaro Iwakiri, Shingo Maeda, Yoichi Ohta, Yukihide Minoda, Akio Kobayashi, Hiroaki Nakamura","doi":"10.1007/s00590-024-04097-0","DOIUrl":"10.1007/s00590-024-04097-0","url":null,"abstract":"<p><strong>Purpose: </strong>Total knee arthroplasty (TKA) has consistently demonstrated lower patient satisfaction compared to total hip arthroplasty (THA). However, prior investigations failed to account for the patients' demographic characteristics. This study aimed to conduct a comparative analysis of patient-reported outcomes between TKA and THA while adjusting for patient background.</p><p><strong>Methods: </strong>A total of 326 primary TKAs and 259 THAs conducted at a single center were assessed using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores preoperatively and at 3 months, 1 year, and 2 years postoperatively. Notably, TKA patients exhibited advanced age and higher body mass index (BMI) than their THA counterparts. To mitigate the impact of these differences, we employed propensity score-matched data, adjusting for background characteristics such as age, gender, BMI, and diagnosis.</p><p><strong>Results: </strong>THA consistently demonstrated significantly superior WOMAC total, pain, and stiffness scores compared to TKA at 3 months, 1 year, and 2 years postoperatively. Nevertheless, no statistically significant disparity in WOMAC physical function scores was observed between the two groups at 3 months and 1 year postoperatively in the matched data (3 months, p = 0.131; 1 year, p = 0.269).</p><p><strong>Conclusion: </strong>In contrast to earlier findings, our analysis of propensity score-matched data revealed no significant differences in WOMAC physical function scores between the TKA and THA groups at 3 months and 1 year postoperatively. The distinctive background factors observed in patients undergoing TKA and THA, notably advanced age and higher BMI, coupled with the delayed improvement timeline in TKA's WOMAC scores compared to that of THA, have the potential to impact patient-reported outcomes. Consequently, clinicians should be mindful of the potential impact of patient background on variations in patient-reported outcome measures following total joint arthroplasty.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":" ","pages":"4009-4017"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comprehensive scoring system for the diagnosis and staging of adhesive capsulitis: development, application, and implications.","authors":"Fabio Vita, Danilo Donati, Roberto Tedeschi, Marco Miceli, Paolo Spinnato, Flavio Origlio, Enrico Guerra, Marco Cavallo, Salvatore Massimo Stella, Luigi Tarallo, Giuseppe Porcellini, Stefano Galletti, Cesare Faldini","doi":"10.1007/s00590-024-04098-z","DOIUrl":"10.1007/s00590-024-04098-z","url":null,"abstract":"<p><strong>Introduction: </strong>Adhesive capsulitis (AC), often referred to as frozen shoulder, presents a diagnostic challenge due to its insidious onset and progressive nature. The condition is characterized by pain and restricted motion in the shoulder, with a predilection for individuals between 40 and 60 years of age. A novel scoring system was developed to enhance the accuracy of diagnosing AC and distinguishing between its stages, aiming to streamline clinical decision-making and treatment planning.</p><p><strong>Methods: </strong>A cohort of patients with symptoms suggestive of AC was assessed using the new scoring system, which integrates clinical, radiological, and patient history factors. Parameters included comorbidities like diabetes mellitus, recent immobility, rotator cuff tears, and specific ultrasound findings. Patients were scored and categorized into definitive AC, uncertain diagnosis, or exclusion from AC, with scores > 7, 6-2, and < 2, respectively.</p><p><strong>Results: </strong>The scoring system effectively categorized patients, with those scoring > 7 demonstrating pronounced symptoms and ultrasound changes consistent with Phase 2 AC. Patients with scores between 6 and 2 were classified into uncertain Phase 1 or Phase 3, necessitating further observation. Scores < 2 effectively excluded AC, indicating a need to explore alternative diagnoses.</p><p><strong>Conclusion: </strong>The structured scoring system demonstrated potential as a comprehensive tool for diagnosing AC. By quantitatively assessing a range of contributory factors, it allowed for the stratification of the disease into distinct stages. This system is anticipated to improve early diagnosis and the precision of treatment interventions, although further validation in larger cohorts is warranted.</p><p><strong>Level of evidence: </strong>II-III.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":" ","pages":"4113-4121"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11519084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331657","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":"Non-union of the greater tuberosity in patients undergoing reverse total shoulder arthroplasty for proximal humerus fracture: Is it associated with worse outcomes?","authors":"Dimitrios V Papadopoulos, Vasiliki Kakogeorgou, James R Mullen, Vasileios Kontogeorgakos, Vasileios S Nikolaou, George Babis","doi":"10.1007/s00590-024-04108-0","DOIUrl":"10.1007/s00590-024-04108-0","url":null,"abstract":"<p><strong>Background: </strong>4-part proximal humerus fractures are complex injuries that are often associated with comminution of the greater tuberosity. The purpose of this study is to evaluate the functional outcomes of 4-part humerus fractures that are treated with reverse total shoulder arthroplasty (rTSA) and correlate these outcomes with the healing status of the greater tuberosity.</p><p><strong>Material and methods: </strong>A retrospective observational study was performed including 65 patients who underwent rTSA following a 4-part proximal humerus fracture. These patients were categorized into 3 groups according to the healing status of the greater tuberosity: patients with healed greater tuberosity in an anatomical position (group A, n = 43), patients with non-union of the greater tuberosity but in anatomical position (group B, n = 14), and patients with resorption or non-union of the greater tuberosity not in anatomical position (group C, n = 8). The Constant-Murley score and range of motion were recorded for each patient at 12 months postoperatively. The clinical and radiographical outcomes of the 3 groups were compared.</p><p><strong>Results: </strong>Patients with healed greater tuberosity (group A) had higher range of motion compared to patients with greater tuberosity migration or reabsorption (group C) regarding forward flexion (130° vs 80°, p < 0.001), abduction (110° vs 65°, p < 0.001) and external rotation (20° vs 10°, p = 0.004). However, no significant changes regarding forward flexion (130° vs 125°, p = 0.67), abduction (110° vs 100°, p = 0.60) and external rotation (20° vs 25°, p = 0.37) were noted between patients with healed greater tuberosity (group A) and those with non-united greater tuberosity that remained attached to the humeral prosthesis (group B). Similarly, Constant- Murley score was similar between patients of group A and group B (65.0 vs 61.5, p = 0.53), while it was higher in patients of group A compared to those of group C (65.0 vs 39.0, p = 0.053).</p><p><strong>Conclusions: </strong>The outcomes of this study indicate that reliable recovery regarding range of motion and functional status can be achieved in patients who undergo rTSA due to 4-part proximal humerus fractures, as long as the greater tuberosity remains in close proximity to the humeral prosthesis, even if it has signs of non-union with no continuity to the adjacent humerus.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":" ","pages":"4065-4071"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}