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Journal of Shoulder and Elbow Surgery Dec 2023Acromial and scapular spine stress fractures are common complications post reverse shoulder arthroplasty. A systematic review with meta-analysis was conducted to... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Acromial and scapular spine stress fractures are common complications post reverse shoulder arthroplasty. A systematic review with meta-analysis was conducted to evaluate the clinical outcomes of conservatively treated acromial and scapular spine stress fractures post reverse shoulder arthroplasty in comparison to nonfracture control.
METHODS
Embase, MEDLINE, and Web of Science were searched on September 9, 2022, using various terms related to fracture, acromion, scapula, and reverse shoulder arthroplasty. Meta-analysis using a random effects model was performed on common outcome scores. Risk of bias was assessed using the Joanna Briggs Institute tools for case-controlled studies. Sensitivity analysis was performed for imputed standard deviations and studies with <20 participants.
RESULTS
Thirteen studies with a total of 339 fracture and 3142 control patients were included in the systematic review. Meta-analysis was performed on 12 studies assessing active forward flexion, abduction, external rotation, Constant-Murley score, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, pain score, Simple Shoulder Test, and Single Assessment Numeric Evaluation. Fracture patients experienced significantly poorer functional outcome compared with control patients when the fractures were managed conservatively. Levy III fractures tend to experience worse outcomes. Pain score did not demonstrate a statistically significant difference between the fracture and nonfracture cohort.
DISCUSSION
Currently, literature regarding surgical management is lacking, partially because of a dearth of high-quality literature but also hindered by a lack of standardized techniques. This review was limited by inclusion of studies of low evidence, small sample sizes, and inconsistency in outcome measurement and follow-up period. Overall, patients with acromial and scapular spine stress fractures treated conservatively are expected to have reduced shoulder function compared to nonfracture patients, with the spine of scapula fracture patients suffering the poorest outcomes. Future studies should aim to use the same sets of outcomes parameters to assess the patients at fixed time intervals and report outcomes stratified by Levy classification. This will enable interinstitutional collaboration and pooling of results.
Topics: Humans; Acromion; Fractures, Stress; Arthroplasty, Replacement, Shoulder; Conservative Treatment; Shoulder Joint; Retrospective Studies; Scapula; Pain; Treatment Outcome
PubMed: 37573934
DOI: 10.1016/j.jse.2023.07.011 -
Sensors (Basel, Switzerland) Aug 2023Monitoring shoulder kinematics, including the scapular segment, is of great relevance in the orthopaedic field. Among wearable systems, magneto-inertial measurement... (Review)
Review
Monitoring shoulder kinematics, including the scapular segment, is of great relevance in the orthopaedic field. Among wearable systems, magneto-inertial measurement units (M-IMUs) represent a valid alternative for applications in unstructured environments. The aim of this systematic literature review is to report and describe the existing methods to estimate 3D scapular movements through wearable systems integrating M-IMUs. A comprehensive search of PubMed, IEEE Xplore, and Web of Science was performed, and results were included up to May 2023. A total of 14 articles was included. The results showed high heterogeneity among studies regarding calibration procedures, tasks executed, and the population. Two different techniques were described, i.e., with the x-axis aligned with the cranial edge of the scapular spine or positioned on the flat surface of the acromion with the x-axis perpendicular to the scapular spine. Sensor placement affected the scapular motion and, also, the kinematic output. Further studies should be conducted to establish a universal protocol that reduces the variability among studies. Establishing a protocol that can be carried out without difficulty or pain by patients with shoulder musculoskeletal disorders could be of great clinical relevance for patients and clinicians to monitor 3D scapular kinematics in unstructured settings or during common clinical practice.
Topics: Humans; Biomechanical Phenomena; Scapula; Shoulder; Shoulder Joint; Range of Motion, Articular; Wearable Electronic Devices
PubMed: 37571723
DOI: 10.3390/s23156940 -
Journal of Shoulder and Elbow Surgery Nov 2023Although tranexamic acid (TXA) is being increasingly used in orthopedic arthroplasty and lower-extremity arthroscopic procedures, its use in arthroscopic rotator cuff... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Although tranexamic acid (TXA) is being increasingly used in orthopedic arthroplasty and lower-extremity arthroscopic procedures, its use in arthroscopic rotator cuff repair (ARCR) is less widely reported. The aim of this study was to evaluate the clinical effectiveness and safety of TXA administration in ARCR.
METHODS
A systematic review and meta-analysis of randomized controlled trials was performed to compare clinical outcomes in patients who underwent ARCR with or without TXA. Literature was retrieved using the Cochrane Library, MEDLINE, PubMed, and Embase electronic databases. The primary outcome of this study was visual clarity. Secondary outcomes contained total operative time, postoperative pain score, amount of blood loss, shoulder swelling (change in shoulder circumference), volume of irrigation fluid, number of adjustments of the pump pressure for irrigation, and adverse cardiovascular events.
RESULTS
Seven studies (3 and 4 with level I and II evidence, respectively), which included 272 and 265 patients who underwent arthroscopy with and without TXA, respectively, met the eligibility criteria. Pooled analysis showed significant improvements in visual clarity (mean difference, 9.10%; 95% CI, 4.05-14.15; P = .0004) and total operative time (mean difference, -11.24 minute; 95% CI, -19.90 to -2.57) associated with perioperative TXA application. None of the trials reported adverse events and complications associated with TXA.
CONCLUSION
The best available evidence indicates that TXA administration could significantly improve arthroscopic visual clarity and effectively save operative time in ARCR without increasing the incidence of adverse events. Furthermore, the optimal dose, route, and timing of TXA application in ARCR surgery remains to be validated by future high-level evidence studies.
Topics: Humans; Tranexamic Acid; Rotator Cuff; Arthroscopy; Shoulder; Rotator Cuff Injuries; Arthroplasty; Treatment Outcome
PubMed: 37468032
DOI: 10.1016/j.jse.2023.06.013 -
Archives of Orthopaedic and Trauma... Sep 2023There is no widely accepted standard for the classification and treatment of traumatic acromion/scapular spine fracture nonunion due to the scarcity of this condition... (Review)
Review
INTRODUCTION
There is no widely accepted standard for the classification and treatment of traumatic acromion/scapular spine fracture nonunion due to the scarcity of this condition and the confusion of terminology.
MATERIALS AND METHODS
PubMed and Scopus were searched using "scapular fracture" and "acromion fracture" or "scapular spine fracture" as search terms. The inclusion criteria were English full-text articles concerning acromion/scapular spine fracture nonunion that described patient characteristics and presented appropriate images. The exclusion criteria were cases without appropriate images. Citation tracking was conducted to find additional articles and notable full-text articles written in other languages. Fractures were classified using our newly proposed classification system.
RESULTS
Twenty-nine patients (19 men, 10 women) with 29 nonunions were identified. There were four type I, 15 type II, and 10 type III fracture nonunions. Only 11 fractures were isolated. The mean period from initial injury to final diagnosis was 35.2 ± 73.2 months (range 3-360 months) (n = 25). The most frequent cause of delayed diagnosis was conservative treatment for fracture in 11 patients, followed by oversight by the physician in 8. The most common reason for seeking medical advice was shoulder pain. Six patients received conservative therapy, and 23 received operative treatment. Fixation materials included various plates in 15 patients, and tension band wiring in 5. Bone grafting was performed in 16 patients (73%, 16/22). Of the 19 surgically treated patients with adequate follow-up, the outcome was rated excellent in 79%.
CONCLUSIONS
Isolated acromion/scapular spine fracture nonunion is rare. Fracture type II and III, arising in the anatomical scapular spine, accounted for 86% of the fractures. Computed tomography is required to prevent fracture oversight. Surgical therapy produces good stable results. However, it is important to select the appropriate surgical fixation method and material after considering the anatomical characteristics of the fracture and stress on the fractured portion.
LEVEL OF EVIDENCE
V.
Topics: Male; Humans; Female; Acromion; Spinal Fractures; Fractures, Bone; Scapula; Fracture Fixation, Internal; Fractures, Ununited; Shoulder Fractures; Treatment Outcome
PubMed: 37314525
DOI: 10.1007/s00402-023-04912-z -
Shoulder & Elbow Apr 2023There is limited evidence examining glenoid osteotomy as a treatment for posterior shoulder instability. (Review)
Review
BACKGROUND
There is limited evidence examining glenoid osteotomy as a treatment for posterior shoulder instability.
METHODS
A search of Medline, Embase, PubMed and Cochrane Central Register of Controlled Trials was conducted from the date of origin to 28th November 2019. Nine out of 3,408 retrieved studies met the inclusion criteria and quality was assessed using the Methodological Index for Non-randomized Studies tool.
RESULTS
In 356 shoulders, the main indication for osteotomy was excessive glenoid retroversion (greater than or equal to approximately -10°). The mean preoperative glenoid version was -15° (range, -35° to -5°). Post-operatively, the mean glenoid version was -6° (range, -28° to 13°) and an average correction of 10° (range, -1° to 30°) was observed. Range of motion increased significantly in most studies and all standardized outcome scores (Rowe, Constant-Murley, Oxford instability, Japan Shoulder Society Shoulder Instability Scoring and mean shoulder value) improved significantly with high rates of patient satisfaction (85%). A high complication rate (34%, = 120) was reported post-surgery, with frequent cases of persistent instability (20%, = 68) and fractures (e.g., glenoid neck and acromion) (4%, = 12). However, the revision rate was low (0.6%, = 2).
CONCLUSION
Glenoid osteotomy is an appropriate treatment for posterior shoulder instability secondary to excessive glenoid retroversion. However, the high rate of persistent instability should be considered when making treatment decisions. Systematic review; Level 4.
PubMed: 37035619
DOI: 10.1177/17585732211056053 -
Journal of Clinical Medicine Nov 2022Fractures of the acromion and the scapular spine are established complications of reverse shoulder arthroplasty (RSA), and when they occur, the continuous strain by the... (Review)
Review
Fractures of the acromion and the scapular spine are established complications of reverse shoulder arthroplasty (RSA), and when they occur, the continuous strain by the deltoid along the bony fragments makes healing difficult. Evidence on treatment specific outcomes is poor, making the definition of a gold standard fixation technique difficult. The purpose of this systematic review is to assess whether any particular fixation construct offers improved clinical and/or radiographic outcomes. A systematic review of the literature on fixation of acromial and scapular spine fractures following RSA was carried out based on the guidelines of PRISMA. The search was conducted on PubMed, Embase, OVID Medline, and CENTRAL databases with strict inclusion and exclusion criteria applied. Methodological quality assessment of each included study was done using the modified Coleman methodology score to asses MQOE. Selection of the studies, data extraction and methodological quality assessment was carried out by two of the authors independently. Only clinical studies reporting on fixation of the aforementioned fractures were considered. Fixation construct, fracture union and time to union, shoulder function and complications were investigated. Nine studies reported on fixation strategies for acromial and scapular spine fractures and were therefore included. The 18 reported results related to fractures in 17 patients; 1 was classified as a Levy Type I fracture, 10 as a Levy Type II fracture and the remaining 7 fractures were defined as Levy Type III. The most frequent fixation construct in type II scapular spine fractures was a single plate (used in 6 of the 10 cases), whereas dual platin was the most used fixation for Levy Type III fractures (5 out of 7). Radiographic union was reported in 15 out of 18 fractures, whereas 1 patient (6.7%) had a confirmed non-union of a Levy Type III scapular spine fracture, requiring revision fixation. There were 5 complications reported, with 2 patients undergoing removal of metal and 1 patient undergoing revision fixation. The Subjective Shoulder Value and Visual Analogue Scale pain score averaged 75% and 2.6 points, respectively. The absolute Constant Score and the ASES score averaged 48.2 and 78.3 points, respectively. With the available data, it is not possible to define a gold standard surgical fixation but it seems that even when fracture union can be achieved, functional outcomes are moderate and there is an increased complication rate. Future studies are required to establish a gold standard fixation technique.
PubMed: 36498600
DOI: 10.3390/jcm11237025 -
Clinics in Shoulder and Elbow Dec 2023Radiofrequency has seen an increase in use in orthopedics including cartilage lesion debridement in the hip and knee as well as many applications in arthroscopic... (Review)
Review
BACKGROUND
Radiofrequency has seen an increase in use in orthopedics including cartilage lesion debridement in the hip and knee as well as many applications in arthroscopic shoulder surgery. The purpose of this systematic review is to evaluate the safety and usage of radiofrequency in the shoulder.
METHODS
This systematic review was registered with PROSPERO (international registry) and followed the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) guidelines. Embase and PubMed were searched using: "shoulder," "rotator cuff," "biceps," "acromion" AND "monopolar," "bipolar," "ablation," "coblation," and "radiofrequency ablation." The title and abstract review were performed independently. Any discrepancies were addressed through open discussion.
RESULTS
A total of 63 studies were included. Radiofrequency is currently utilized in impingement syndrome, fracture fixation, instability, nerve injury, adhesive capsulitis, postoperative stiffness, and rotator cuff disease. Adverse events, namely superficial burns, are limited to case reports and case series, with higher-level evidence demonstrating safe use when used below the temperature threshold. Bipolar radiofrequency may decrease operative time and decrease the cost per case.
CONCLUSIONS
Shoulder radiofrequency has a wide scope of application in various shoulder pathologies. Shoulder radiofrequency is safe; however, requires practitioners to be cognizant of the potential for thermal burn injuries. Bipolar radiofrequency may represent a more efficacious and economic treatment modality. Safety precautions have been executed by institutions to cut down patient complications from shoulder radiofrequency. Future research is required to determine what measures can be taken to further minimize the risk of thermal burns.
PubMed: 36330719
DOI: 10.5397/cise.2022.01067 -
Shoulder & Elbow Oct 2022Thus, the purpose of the present study was to (1) characterize common postoperative complications and (2) quantify the rates of revision in patients undergoing... (Review)
Review
BACKGROUND
Thus, the purpose of the present study was to (1) characterize common postoperative complications and (2) quantify the rates of revision in patients undergoing hemiarthroplasty to reverse total shoulder arthroplasty revisional surgery. We hypothesize that hardware loosenings will be the most common complication to occur in the sample, with the humeral component being the most common loosening.
METHODS
This systematic review adhered to PRISMA reporting guideline. For our inclusion criteria, we included any study that contained intraoperative and/or postoperative complication data, and revision rates on patients who had undergone revision reverse total shoulder arthroplasty due to a failed hemiarthroplasty. Complications include neurologic injury, deep surgical site infections, hardware loosening/prosthetic instability, and postoperative fractures (acromion, glenoid, and humeral fractures).
RESULTS
The study contained 22 studies that assessed complications from shoulders that had revision reverse total shoulder arthroplasty from a hemiarthroplasty, with a total sample of 925 shoulders. We found that the most common complication to occur was hardware loosenings (5.3%), and of the hardware loosenings, humeral loosenings (3.8%) were the most common. The revision rate was found to be 10.7%.
CONCLUSION
This systematic review found that revision reverse total shoulder arthroplasty for failed hemiarthroplasty has a high overall complication and reintervention rates, specifically for hardware loosening and revision rates.
PubMed: 36199509
DOI: 10.1177/17585732211019390 -
Cureus Apr 2022The deltoid is the preferred site for intramuscular injection (IMI) because of its easy accessibility for drug and vaccine administration. Government immunization... (Review)
Review
The deltoid is the preferred site for intramuscular injection (IMI) because of its easy accessibility for drug and vaccine administration. Government immunization advisories, standard anatomy textbooks, and researchers have proposed various injection techniques and sites, but specific guidelines are lacking for the administration of IMIs in the increasingly used deltoid site. This study analyzes the procedures of administering IMIs in the deltoid related to the neurovascular network underlying the muscle and proposes a preferred site with the least chance of injury. The review protocol was submitted with PROSPERO (ID: 319251). PubMed, Google Scholar, and Websites of National Public Health Agencies were searched from 1950 up to 2022 for articles, advisories, and National Immunization Guidelines using Medical Subject Headings (MeSH) terms, including IMIs, deltoid muscle, safe injection sites, to identify recommendations for safer sites and techniques of administering deltoid IMIs. All the authors strictly adhered to a well-developed registered review protocol throughout the study and followed the risk of bias in systematic reviews (ROBIS) guidance tool. The proposed sites and landmark data were tabulated, and each site was analyzed based on the underlying neurovascular structures. Data were depicted by self-generated images. The initial search identified 174 articles. After applying the inclusion and exclusion criteria, 57 articles were shortlisted. Out of the 39 selected articles, 18 focused on the administration of deltoid IMIs, whereas seven focused on the variations in the underlying neurovascular structures in proximity to the deltoid muscle. The remaining 14 articles were the immunization guides issued by the National Public Health Agencies of the Government of India and abroad, whose data was used for comparison. Twelve deltoid IMI sites and techniques were identified. A site 1-3 fingerbreadths/5 cm below the mid-acromion point (7 studies); mid-deltoid site/densest part of the deltoid (1 study); a site at the middle third of the deltoid muscle (1 study); triangular injection site (1 study). Limitations included the unavailability of free access to complete text in many articles resulting in exclusion. The area around the shoulder joint and up to the lower level of the intertubercular sulcus is highly vascularized by the presence of many anomalous arterial patterns. To avoid injury, a safer site is proposed of 5 fingerbreadths/10 cm below the midpoint of the lateral border of the acromion. The authors received no specific funding for this study except for the journal publication charges.
PubMed: 35592188
DOI: 10.7759/cureus.24172 -
Journal of Clinical Medicine Jan 2022Acromial and scapular spine fractures after reverse total shoulder arthroplasty (RTSA) can be devastating complications leading to substantial functional impairments.... (Review)
Review
BACKGROUND
Acromial and scapular spine fractures after reverse total shoulder arthroplasty (RTSA) can be devastating complications leading to substantial functional impairments. The purpose of this study was to review factors associated with increased acromial and scapular spine strain after RTSA from a biomechanical standpoint.
METHODS
A systematic review of the literature was conducted based on PRISMA guidelines. PubMed, Embase, OVID Medline, and CENTRAL databases were searched and strict inclusion and exclusion criteria were applied. Each article was assessed using the modified Downs and Black checklist to appraise the quality of included studies. Study selection, extraction of data, and assessment of methodological quality were carried out independently by two of the authors. Only biomechanical studies were considered.
RESULTS
Six biomechanical studies evaluated factors associated with increased acromial and scapular spine strain and stress. Significant increases in acromial and scapular spine strain were found with increasing lateralization of the glenosphere in four of the included studies. In two studies, glenosphere inferiorization consistently reduced acromial strain. The results concerning humeral lateralization were variable between four studies. Humeral component neck-shaft angle had no significant effect on acromial strain as analysed in one study. One study showed that scapular spine strain was significantly increased with a more posteriorly oriented acromion (55° vs. 43°; < 0.001). Another study showed that the transection of the coracoacromial ligament increased scapular spine strain in all abduction angles ( < 0.05).
CONCLUSIONS
Glenoid lateralization was consistently associated with increased acromial and scapular spine strain, whereas inferiorization of the glenosphere reduced strain in the biomechanical studies analysed in this systematic review. Humeral-sided lateralization may increase or decrease acromial or scapular spine strain. Independent of different design parameters, the transection of the coracoacromial ligament resulted in significantly increased strains and scapular spine strains were also increased when the acromion was more posteriorly oriented. The results found in this systematic review of biomechanical in-silico and in-vitro studies may help in the surgical planning of RTSA to mitigate complications associated with acromion and scapular spine fracture.
PubMed: 35054057
DOI: 10.3390/jcm11020361