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Revista Brasileira de Ortopedia Oct 2023The objectives of this study are to compare absolute values of acromial index (AI) and critical shoulder angle (CSA) obtained in both radiographs and magnetic...
The objectives of this study are to compare absolute values of acromial index (AI) and critical shoulder angle (CSA) obtained in both radiographs and magnetic resonance image (MRI) of the shoulder; and to compare the interobserver and intra-observer agreement for AI and CSA values measured in these image modalities. Patients who had medical indication of investigating shoulders conditions through radiographs and MRI were included. Images were taken to two fellowship-trained shoulder surgeons, which conducted measurements of AI and CSA in radiographs and in MRI. Twelve weeks after the first evaluation, a second evaluation was conducted. Inter- and intra-observer reliability was presented as an Intraclass Correlation Coefficient (ICC) and agreement was classified according to Landis & Koch criteria. The differences between two measurements were evaluated using Bland-Altman plots. 134 shoulders in 124 subjects were included. Mean intra-observer ICC for CSA in X-rays and in MRI were 0.936 and 0.940, respectively; for AI, 0.908 and 0.022. Mean inter-observer ICC for CSA were 0.892 and 0.752 in X-rays and MRI respectively; for AI, ICC values were 0.849 and 0.685. All individual analysis reached statistical power ( < 0.001). Mean difference for AI values measured in X-rays and in MRI was 0.01 and 0.03 for observers 1 and 2, respectively. Mean difference for CSA values obtained in X-rays and MRI was 0.16 and 0.58 for observers 1 and 2, respectively. Both MRI and X-rays provided high intra- and interobserver agreement for measurement of AI and CSA. Absolute values found for AI and CSA were highly correlated in both image modalities. These findings suggest that MRI is a suitable method to measure AI and CSA. , Diagnostic Study.
PubMed: 37908539
DOI: 10.1055/s-0043-1776136 -
Cureus Sep 2023Purpose of the study The use of tourniquets during surgery of the distal humerus can improve visibility and reduce surgical time. However, the available operating field...
Purpose of the study The use of tourniquets during surgery of the distal humerus can improve visibility and reduce surgical time. However, the available operating field can be limited due to the size and placement of the tourniquet. This proof-of-concept study aimed to determine if sterile tourniquets can provide a wider surgical field compared to non-sterile tourniquets for procedures around the distal humerus. Methods Volunteers (n = 5) were positioned to simulate access to the distal humerus. The distance from the posterior corner of the acromion to the tip of the olecranon was measured. Participants were draped according to the standard protocol for the use of a non-sterile or sterile tourniquet for distal humerus and humeral shaft fractures. Two non-sterile pneumatic tourniquets (standard and narrow) and two sterile tourniquets (pneumatic and elastic exsanguination) were tested. The surgical field was measured from the sterile drape or tourniquet proximally to the tip of the olecranon. A one-way repeated measures ANOVA was conducted to examine the effect of each tourniquet on the surgical field. Results The sterile elastic exsanguination tourniquet had the largest available field with a mean of 24.4 cm (71% of arm available for incision after application), followed by the sterile pneumatic tourniquet of 20.0 cm (58%), narrow non-sterile pneumatic of 19.2 cm (55%), and standard non-sterile pneumatic of 17.0 cm (49%). Repeated measures ANOVA determined that mean surgical field length is statistically significant between tourniquet devices (F (1.729, 6.914) = 21.783, p = .001). The surgical field length was statistically significantly increased from a non-sterile standard tourniquet to a sterile elastic tourniquet (7.4 (95% CI, 2.9-11.9) cm, p = .008) but not the other two tourniquet devices tested. Conclusion The use of certain types of sterile tourniquets can provide a wider surgical field compared to non-sterile tourniquets for procedures around the distal humerus, specifically the sterile elastic exsanguination tourniquet providing a statistically significant mean gain of 7.4 cm from the non-sterile tourniquets. These findings suggest that the use of sterile tourniquets should be considered more frequently in surgery of the distal humerus, and a sterile exsanguinating tourniquet could be considered for midshaft humeral fractures, facilitating safer exposure of the radial nerve and reduced blood loss.
PubMed: 37900452
DOI: 10.7759/cureus.46148 -
Animals : An Open Access Journal From... Oct 2023(1) Background: Myostatin (MSTN) is a protein that regulates skeletal muscle development and plays a crucial role in maintaining animal body composition and muscle...
(1) Background: Myostatin (MSTN) is a protein that regulates skeletal muscle development and plays a crucial role in maintaining animal body composition and muscle structure. The loss-of-function mutation of gene can induce the muscle hypertrophic phenotype. (2) Methods: Growth indexes and blood parameters of the cattle of different months were analyzed via multiple linear regression. (3) Results: Compared with the control group, the body shape parameters of F2 cattle were improved, especially the body weight, cross height, and hip height, representing significant development of hindquarters, and the coat color of the F2 generation returned to the yellow of Luxi cattle. As adults, gene-edited bulls have a tall, wide acromion and a deep, wide chest. Both the forequarters and hindquarters are double-muscled with clear muscle masses. The multiple linear regression demonstrates that gene-edited hybrid beef cattle gained weight due to the higher height of the hindquarters. Significant differences in blood glucose, calcium, and low-density lipoprotein. Serum insulin levels decreased significantly at 24 months of age. gene editing improves the adaptability of cattle. (4) Conclusions: Our findings suggest that breeding with gene-edited Luxi bulls can improve the growth and performance of hybrid cattle, with potential benefits for both farmers and consumers.
PubMed: 37893940
DOI: 10.3390/ani13203216 -
Journal of Shoulder and Elbow Surgery May 2024Lateralization and distalization in reverse shoulder arthroplasty (RSA) can be measured on anteroposterior (AP) radiographs using 2 previously described angles:...
BACKGROUND
Lateralization and distalization in reverse shoulder arthroplasty (RSA) can be measured on anteroposterior (AP) radiographs using 2 previously described angles: lateralization shoulder angle (LSA) and distalization shoulder angle (DSA). However, these 2 angles measure global lateralization and distalization but do not allow to differentiate how much lateralization or distalization are attributable to the glenoid and the humerus. We hypothesized that new angles could allow us to separately measure glenoid vs. humeral lateralization and distalization. A more precise understanding of independent glenoid and humeral contributions to lateralization and distalization may be beneficial in subsequent clinical research.
METHOD
Retrospective analysis of postoperative AP radiographs of 100 patients who underwent primary RSA for cuff-tear arthropathy, massive cuff tear, or glenohumeral osteoarthritis were analyzed. The new angles that we proposed use well-known bony landmarks (the acromion, glenoid, and humerus) and the most lateral point of the glenosphere, which we termed the "glenoid pivot point" (GPP). For lateralization, we used the GPP to split LSA into 2 new angles: glenoid lateralization angle (GLA) and humeral lateralization angle (HLA). For distalization, we introduced the modified distalization shoulder angle (mDSA) that can also be split into 2 new angles: glenoid distalization angle (GDA) and humeral distalization angle (HDA). Three orthopedic surgeons measured the new angles, using the online tool Tyche. Mean values with overall and individual standard deviations as well as intraclass correlation coefficients (ICCs) were calculated.
RESULTS
Because the angles form a triangle, the following equations can be made: LSA = GLA + HLA, and mDSA = GDA + HDA. All angles showed excellent inter- and intraobserver reliability (ICC = 0.92-0.97) with low means of individual standard deviations that indicate a precision of 2° for each angle.
CONCLUSION
Use of the most lateral part of the glenosphere (termed glenoid pivot point) allows us to separately measure glenoid vs. humeral lateralization and distalization. The 4 new angles (HLA, GLA, GDA, HDA) described in the present study can be used on true AP radiographs, routinely obtained after shoulder replacement, and the measured angles may be used with all types of reverse prostheses available.
Topics: Humans; Arthroplasty, Replacement, Shoulder; Shoulder Joint; Shoulder Prosthesis; Retrospective Studies; Reproducibility of Results; Range of Motion, Articular; Humerus
PubMed: 37890767
DOI: 10.1016/j.jse.2023.09.026 -
Acta Ortopedica Mexicana 2023arthroscopic surgical treatment of rotator cuff tendon injuries has replaced open surgery as the first treatment option. Different surgical techniques have been... (Observational Study)
Observational Study
INTRODUCTION
arthroscopic surgical treatment of rotator cuff tendon injuries has replaced open surgery as the first treatment option. Different surgical techniques have been described for massive or irreparable ruptures, and recently, a new device that consists of a biodegradable subacromial spacer between the humeral head and the acromion has been used. The present study aims to analyse the results of this implant in our experience.
MATERIAL AND METHODS
we conducted an observational and retrospective study of all patients undergoing subacromial spacer implantation at our centre from 2017 to 2019. Patients were assessed pre- and postoperatively using the Constant, DASH and VAS scales.
RESULTS
a total of 43 patients met the inclusion criteria and the minimum follow-up of 24 months. The mean DASH scale score went from 53.6 at preoperative assessment to 27.9 at postoperative assessment (p = 0.026). There was also a significant improvement in the Constant scale from a mean of 37.9 to 61.8 (p = 0.037). In terms of pain assessment, the mean VAS went from a mean of 7.44 to 3.38 (p = 0.916). In 90% of patients no complications or need for further interventions were objectified.
CONCLUSIONS
the subacromial balloon has shown favorable results in our series of patients, so it could be a valid treatment option in patients with non-repairable rotator cuff tears.
Topics: Humans; Rotator Cuff Injuries; Rotator Cuff; Retrospective Studies; Arthroscopy; Rupture; Treatment Outcome; Range of Motion, Articular
PubMed: 37857391
DOI: No ID Found -
Cureus Aug 2023Introduction Subacromial impingement syndrome (SIS) is a common shoulder disorder characterized by pain and limited range of motion in the shoulder joint. It is...
Introduction Subacromial impingement syndrome (SIS) is a common shoulder disorder characterized by pain and limited range of motion in the shoulder joint. It is frequently attributed to the compression or impingement of the rotator cuff tendons and bursa between the humeral head and the acromion process of the scapula during arm elevation. Subacromial impingement syndrome may arise as a result of the morphology of the acromion process, a bony protrusion at the top of the scapula that is important in the biomechanics of the shoulder joint. In order to detect potential anatomical differences that can predispose people to subacromial impingement syndrome, medical professionals and researchers need to have a thorough understanding of the morphometry and morphology of the acromion process. Aims and objectives The aim of the present study was to measure the morphometric and morphological characteristics of the acromion process in dried human scapulae that belonged to the North Indian population. Materials and methods This was a cross-sectional study that was carried out on 120 undamaged adult human scapula, of which 52 belonged to the right side and 68 belonged to the left side. Our study focused on analyzing the morphology of the acromion process as well as determining its maximum length, maximum breadth, acromio-coracoid distance, acromio-glenoid distance, and thickness. A statistical analysis of the observed parameters was carried out using the chi-square test and independent t-test with the help of Statistical Package for the Social Sciences (SPSS, IBM Corp., Armonk, NY) 24.0. Statistical significance was set at 0.05 (if the P-value ≤ 0.05, it is significant). Results We observed that the quadrangular shape (51.67%) of the acromion process was most commonly reported in our study, while the tubular (9.99%) shape was the least common. The difference in the incidences of various shapes of the acromion process on the right and left sides of the scapula was found to be statistically significant (p-value ≤ 0.05). In this study, the curved or type II acromion process was the most common type (53.34%) observed, while the least common shape reported was the hooked type (18.33%). The average length of the right acromion process was 44.52±6.61 mm, and the left acromion process was 45.13±6.35 mm. For the breadth, the right acromion had an average value of 28.31±4.67 mm, while the left had an average of 28.34±4.92 mm. The thickness of the right acromion measured 7.10±1.73 mm, and the left acromion was 7.53±1.44 mm. The acromio-coracoid distance on the right side was 34.59 ± 6.47 mm, and the left side was 37.46±6.22 mm. The acromio-glenoid distance was measured to be 32.31±5.87 mm on the right side and 33.18±5.39 mm on the left side. Conclusions Planning and carrying out an acromioplasty require an understanding of the morphometric parameters of the acromion process. Although there is a paucity of research on its morphometric evaluation in the North Indian population, the surgeons would be able to use these data as a reference.
PubMed: 37779751
DOI: 10.7759/cureus.44329 -
Cureus Aug 2023Unilateral shoulder dislocation is known to be one of the most common joint dislocations. However, simultaneous bilateral shoulder dislocations are rare, especially...
Unilateral shoulder dislocation is known to be one of the most common joint dislocations. However, simultaneous bilateral shoulder dislocations are rare, especially anterior dislocations. We report a case of an 84-year-old woman who presented to the urgency room with symmetrical bilateral anterior shoulder dislocation 12 hours after falling on a treadmill. She presented with bilateral pain, functional impairment, prominent acromion, flattened shoulder, and, in the right upper limb, paresthesias on the dorsum of the hand and extension deficit of the fingers. Closed reduction of both shoulders was performed under sedation, and she was immobilized bilaterally with an arm sling in internal rotation. A full recovery was achieved six months after the injury.
PubMed: 37736445
DOI: 10.7759/cureus.43852 -
JSES International Sep 2023Acromion stress fractures (ASF) or scapular spine fractures (SSF) following reverse total shoulder arthroplasty (RTSA) are common complications with impaired clinical...
BACKGROUND
Acromion stress fractures (ASF) or scapular spine fractures (SSF) following reverse total shoulder arthroplasty (RTSA) are common complications with impaired clinical outcome. The underlying biomechanical factors remain unclear. The aim of this study was to evaluate basic demographic and radiographic parameters predicting occurrence of different types of ASF/SSF in a large single-center study cohort.
METHODS
A total of 860 RTSA (805 patients) with available minimum follow-up of 2 years were implanted between 2005 and 2018 at a tertiary academic center. All RTSA with subsequent ASF/SSF (n = 45 in 43 shoulders [42 patients, 5%]) were identified and classified as Levy I to III. Predictive demographic, surgical, and radiographic factors were evaluated for each subtype and compared to the control group (817 RTSA, 763 patients). The radiographic analysis included critical shoulder angle, lateralization shoulder angle (LSA), distalization shoulder angle (DSA), acromio-humeral distance (ACHD), acromial thickness, deltoid tuberosity index, deltoid length, and center of rotation.
RESULTS
Of the 45 ASF/SSF in 42 patients, 8 were classified as Levy I, 21 as Levy II, and 16 as Levy III. Demographic analysis revealed indication as risk factor for Levy I fractures, higher American Society of Anesthesiologists score as risk for Levy type II fractures and higher age as risk factor for Levy type III fractures. None of the measured radiographic parameters were predictive for occurrence of Levy type I and Levy type II ASF. However, analysis of Levy III SSF revealed a higher postoperative LSA (89° ± 10° vs. 83° ± 9°, = .015), a lower postoperative DSA (45° ± 8° vs. 53° ± 12°, = .002), less distalization (ACHD of 33 ± 8 mm vs. 38 ± 10 mm, = .049), and a more medial center of rotation preoperatively (COR-LA 16 ± 8 mm vs. 12 ± 7 mm, = .048) as predictive radiographic factors.
CONCLUSION
The present analysis showed a significant association of higher postoperative LSA, lower DSA, a lower ACHD, and higher age as predictive factor only for Levy type III fractures. Some of these factors can be surgically influenced and this knowledge can be of value for preoperative planning and surgical execution to avoid these complications.
PubMed: 37719815
DOI: 10.1016/j.jseint.2023.04.006 -
International Journal of Surgery Case... Sep 2023The combination of an open acromion fracture with a massive rotator cuff tear is an exceptional lesion, rarely described in the literature. It generally occurs after...
INTRODUCTION AND IMPORTANCE
The combination of an open acromion fracture with a massive rotator cuff tear is an exceptional lesion, rarely described in the literature. It generally occurs after open shoulder trauma, and requires well-codified therapeutic measures to avoid complications that could keep the patient from being as autonomous as possible and able to perform daily activities.
CASE PRESENTATION
We report the case of a 26-year-old patient with a wound on the posterior surface of the left shoulder following an attack. Standard X-ray showed a fracture of the acromion. Surgical exploration revealed a rupture of the supraspinatus and infraspinatus tendons. Internal fixation with a cancellous screw was performed for the acromion fracture after rotator cuff tendons repair. At the last follow-up, we obtained very encouraging functional and radiological results.
CLINICAL DISCUSSION
This combination of lesions is extremely rare, and few authors have discussed it. There is no universally accepted surgical technique for the repair of this type of injury, and too many techniques have been described.
CONCLUSION
It's a rare and serious shoulder injury, compromising the functional prognosis of the injured upper limb, hence the importance of correct initial medical and surgical management to avoid the development of chronic injuries with severe functional and professional repercussions for the patient.
PubMed: 37666163
DOI: 10.1016/j.ijscr.2023.108712 -
Cureus Aug 2023An 85-year-old male underwent open reduction and internal fixation (ORIF) for a displaced acromion stress fracture that occurred two years prior. The complete fracture...
An 85-year-old male underwent open reduction and internal fixation (ORIF) for a displaced acromion stress fracture that occurred two years prior. The complete fracture occurred two months after an ipsilateral reverse total shoulder arthroplasty (RTSA). Four weeks after his RTSA, the pain was felt at the posterior-superior shoulder with activities of his daily living as a rancher, reflecting non-compliant use. A stress fracture was suspected but not detected radiographically. Four weeks later, higher pain occurred after he lifted a hay bale, and a displaced basilar acromion fracture was detected. Non-operative management spanned 20 months, which he ultimately deemed unacceptable because of pain with minor activities. ORIF was then done. Approximately 10 months after the ORIF surgery, both plates sustained fatigue breakage; however, the fracture consolidated, and his pain remained low. He is the oldest patient described to ultimately have a successful acromion fracture ORIF and only the third reported acromion fracture ORIF in octogenarians following RTSA. We report the ORIF technique, its good outcome, and a literature review of elderly patients who had ORIF for this problem.
PubMed: 37664248
DOI: 10.7759/cureus.42865