Reverse Shoulder Arthroplasty (RSA) may be indicated in displaced proximal humerus fractures in elderly patients. We hypothesized that tuberosity fixation and healing around the prosthesis would ...result in better outcomes and patient satisfaction.
Thirty-eight acute displaced or dislocated 3- and 4-part fractures in elderly patients were treated with reattachment of the tuberosities around a RSA. The mean age at surgery was 80 ± 4 years (range, 70-88 years). A specific reverse fracture stem that incorporated a cancellous bone autograft (harvested from the fractured head) and a standardized suturing technique for tuberosity fixation were used in all operations. Patients were evaluated and radiographed with a minimum 2-year follow-up (mean 36 ± 8 months).
The tuberosity union rate was 84% (32 of 38). There were 4 tuberosity resorptions and 2 tuberosity migrations with nonunion, which were associated with significantly lower subjective results (Subjective Shoulder Value of 65% vs. 83%, P = .029) and lower active mobility in forward elevation (115° ± 26° vs. 141° ± 25°, P = .023) and external rotation (11° ± 12° vs. 27° ± 12°, P = .010). Among the 5 disappointed patients, 3 presented with tuberosity resorption and 2 with tuberosity migration and nonunion.
Despite the advanced age of the patients, tuberosity reattachment and use of bone graft results in a high rate of tuberosity healing. Tuberosity reconstruction and healing in reverse shoulder arthroplasty for fractures improves active forward elevation, external rotation, and patient satisfaction.
Onset of radial neck osteolysis (RNO) has been reported after radial head replacement (RHR), but data are sparse regarding impact and risk factors. We therefore conducted a retrospective study, 1) to ...quantify RNO after RHR, 2) to assess clinical and radiological impact, and 3) to identify risk factors.
RNO prevalence is high, but functional impact is limited.
A single-center retrospective study included all patients undergoing RHR for acute radial head fracture between 2008 and 2017: 53 patients, with a mean age of 53.8±15.7 years range, 21–85 years. At a minimum 2 years’ follow-up, patients were assessed clinically on joint range of motion and Mayo Elbow Performance Score (MEPS) and radiologically on standard radiographs. Associations between RNO and various parameters were assessed.
At a mean 46.7±19.8 months’ follow-up range, 24–84 months, RNO was found in 54.7% of cases (29/53), with mean 4.0 ±2.8mm distal extension range, 1.2–13.4mm, corresponding to 13.4±7.3% of stem height range, 2.7–27.7%.
RNO at last follow-up was not significantly associated with reduced flexion-extension (121.9° versus 114.0°; p=0.11), pronation-supination (152.6° versus 138.3°; p=0.25) or MEPS (84.7 versus 84.8; p=0.97), or with higher rates of postoperative complications (11/29 (37.9%) versus 7/24 (29.2%); p=0.782) or surgical revision (11/29 (37.9%) versus 10/24 (41.7%); p=0.503).
RNO was significantly associated with cementless fixation (19/29 (65.5%) versus 7/24 (29.2%); p=0.01), unipolar prosthesis (21/29 (72.4%) versus 7/24 (29.2%); p=0.002), high filling-ratio, whether proximal (88% versus 77%; p=0.002), middle (84% versus 75%; p=0.007) or distal (69% versus 59%; p=0.032), and shorter radial stem (33.2mm versus 46.3mm; p=0.011). No demographic parameters showed significant association with RNO at last follow-up.
RNO was frequent after RHR, but without clinical or radiological impact in the present series. The risk factors identified here argue for involvement of stress shielding.
IV, cohort study.
The elbow: A new joint comes of age Mansat, Pierre; Carlier, Yacine; Clavert, Philippe
Orthopaedics & traumatology, surgery & research,
04/2021, Volume:
107, Issue:
2
Journal Article
Introduction
Anatomical variations of the lateral offset of the acromion (LOA) are supposed to be a factor favoring of the development of rotator cuff tears. The primary objective of this study is to ...quantify the inter-individual variations of the lateral offset of the acromion.
Methods
The morphology of 103 dried scapula was studied. Scapula with an os-acromiale, fractures and osteoarthritic changes of the glenoid cavity were excluded. We measured the distance between the medial edge of the spine and the supra-glenoidal tubercle of the glenoid fossa (
L
0
), as well as the distance between this medial point and the most lateral point of the acromion (
L
max
). Then, the acromial offset = (
L
max
−
L
0
), in absolute value (mm) and in relative value (% of
L
max
) were calculated.
Results
The absolute average offset is 3.2 cm (SD = 0.4040 cm), the relative average offset is 23.07% (SD = 2.195%). We observed a non-Gaussian distribution of the LOA, with two peaks of distribution of which average and the median offset measurements are situated between these two distributions.
Conclusion
This study shows that there are two different morphologies for the scapula, characterized by the lateral offset of their acromion: small or large lateral offset. Clinical implications in shoulder pathology seem important because the resultant of the constraints applied by the deltoid to the joint would favor either rotator cuff tears, or scapulohumeral arthrosis.
Le compagnonnage et la simple expérience ou pratique naïve (PN) permettent rarement d’atteindre un niveau expert en chirurgie, contrairement à la pratique délibérée (PD) où un expert analyse les ...erreurs de l’apprenant et lui fixe des objectifs pour améliorer sa performance. La performance de chirurgiens en formation serait-elle meilleure en utilisant une méthode d’apprentissage faisant appel à la PD plutôt qu’à la PN ? L’hypothèse principale était qu’en faisant appel à la PD, la progression de l’apprentissage serait plus rapide et/ou plus importante qu’en faisant appel à la PN.
L’objectif de ce travail était de comparer l’évolution de la courbe d’apprentissage de pose de plaques verrouillées de clavicule sur sawbone par des chirurgiens apprenants formés selon deux méthodes différentes, PN et PD.
Dix internes en chirurgie, répartis en 2 groupes de 5, ont posé chacun 6 plaques. Les 6 essais ont été filmés. Le groupe PN a vu une vidéo d’expert avant chaque pose. Le groupe PD a vu cette vidéo une fois puis, après chaque essai, l’expert leur a donné des conseils d’amélioration en analysant leur propre vidéo. La performance objective (PO) était mesurée par une grille d’évaluation standardisée (OSATS, avec un score allant de 10 à 50 points par essai), l’autoévaluation de la performance par une échelle numérique (de 0 à 10) et le stress par un indice d’analgésie-nociception (ANI, calculé par le biais de l’enregistrement du rythme cardiaque, de 0 à 100).
La PO moyenne au dernier essai de pose de plaque de clavicule était de 41,8 (groupe PN) et 48,2 (groupe PD) avec une progression moyenne du premier au dernier essai de 0,8 dans le groupe PN, et 5,1 dans le groupe PD. La progression moyenne de l’autoévaluation entre le premier et le dernier essai était de 3,4 (groupe PN) et 4,6 (groupe PD). La progression moyenne de l’ANI entre le premier et le dernier essai était de –4,5 (groupe PN) et +5 (groupe PD).
Les résultats de l’apprentissage d’une technique d’ostéosynthèse de pose de plaques de clavicule mesurés par un OSATS étaient meilleurs avec pratique délibérée qu’avec pratique naïve. La progression de l’autoévaluation de la performance était meilleure avec pratique délibérée mais avec un plus haut niveau de stress.
La pratique délibérée est une technique d’apprentissage du geste chirurgical qui vient en complément du compagnonnage et de l’expérience. Elle permet d’accourcir la courbe d’apprentissage et d’améliorer le niveau de performance des chirurgiens apprenants.
IV ; recherche non interventionnelle.
Companionship and simple experience or naive practice (NP) rarely lead to expert level surgery, in contrast to deliberate practice (DP) where an expert analyzes the learner's errors and sets goals to improve performance. The main hypothesis was that using PD for learning would result in faster and/or greater progress than using PN.
The objective of this work was to compare the evolution of the learning curve of clavicle locking plate placement on sawbone by surgeon learners trained with two different methods, PN and PD.
Ten surgical interns, splitted into 2 groups of 5 interns, each placed 6 plates. All 6 trials were filmed. PN group saw an expert video before each placement. DP group saw this video once and then, after each trial, the expert gave them tips for improvement by analyzing their own video. Objective performance (OP) was measured by a standardized evaluation grid (OSATS, with a score ranging from 10 to 50 points per trial), self-assessment of performance by a numerical scale (from 0 to 10) and stress by an analgesia-nociception index (ANI, calculated via heart rate recording, from 0 to 100).
The mean PO at the last trial of clavicle plate placement was 41.8 (PN group) and 48.2 (PD group), with a mean progression from first to last trial of 0.8 in the PN group, and 5.1 in the PD group. The mean progression of self-evaluation from the first to the last trial was 3.4 (PN group) and 4.6 (PD group). The mean progression of ANI between the first and last trials was –4.5 (PN group) and +5 (PD group).
The results of learning a clavicle plate osteosynthesis technique measured by OSATS were better with deliberate practice than with naive practice. Progression in self-assessed performance was better with deliberate practice, but with a higher level of stress.
Deliberate practice is a technique for learning the surgical gesture that complements companionship and experience. It shortens the learning curve and improves the performance level of learning surgeons.
IV; non-interventional research.
Companionship and simple experience or naive practice (NP) rarely lead to expert level surgery, in contrast to deliberate practice (DP) where an expert analyzes the learner's errors and sets goals to ...improve performance. The main hypothesis was that using DP for learning would result in faster and/or greater progress than using NP.
The objective of this work was to compare the evolution of the learning curve for clavicle locking plate placement on a sawbone model of a clavicle fracture, by surgical trainees learning via two different methods; NP and DP.
Ten surgical residents, divided into 2 groups of 5, each placed 6 plates. The 6 trials were filmed. The NP group saw an expert video before each placement. The DP group saw this video once and then received personalized advice from the expert for improvement, by analyzing their own video after each subsequent trial.
Objective performance (OP) was measured by a standardized evaluation grid (OSATS, with a score ranging from 10 to 50 points per trial), self-evaluation of performance by a numerical scale (from 0 to 10) and stress by an analgesia-nociception index (ANI, calculated by heart rate recording, from 0 to 100).
The mean OP at the last trial of clavicle plate placement was 41.8 (NP group) and 48.2 (DP group), with a mean progression from the first to last trials of 0.8 in the NP group, and 5.1 in the DP group. The mean progression in self-evaluation between the first and last trials was 3.4 (NP group) and 4.6 (DP group). The mean progression of the ANI between the first and last trials was -4.5 (NP group) and +5 (DP group).
The results of learning a clavicle plate osteosynthesis technique measured by OSATS were better with deliberate practice than with naive practice.
The progression in self-evaluated performance was better with deliberate practice, but with a higher stress level.
Deliberate practice is a technique for learning the surgical procedure which complements companionship and experience. It shortens the learning curve and improves the level of performance of surgical trainees.
IV; non-interventional research
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