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Journal of Orthopaedic Case Reports Jun 2024Osteonecrosis (ON) of the humeral head is defined as "avascular" when the death of bone is due to a disrupted blood supply. It is a known complication following proximal...
INTRODUCTION
Osteonecrosis (ON) of the humeral head is defined as "avascular" when the death of bone is due to a disrupted blood supply. It is a known complication following proximal humeral fractures and can lead to poor long-term outcomes and even additional revision surgeries.
CASE REPORT
Patient AP developed symptomatic ON, 3 years following repair of a 4-part valgus impacted proximal humerus fracture. The point of interest in this case is the length of time from injury at which she developed symptomatic ON. Following surgical repair, she was seen at standard intervals, 6 weeks, 3-, 6-, and 12- month follow-ups and demonstrated an excellent recovery. By the 1 year follow-up appointment, she had obtained a range of motion in her left shoulder of 170° forward elevation and 60° in external rotation. At this point, she was able to discontinue physical therapy and was radiographically and clinically healed. However, 2 years after, she began experiencing sudden onset of pain with shoulder ROM and progressive limitation. She was diagnosed with an ON of her proximal humerus. The patient was prescribed a 3-month course of corticosteroid, 3 months following her operation for a gynecological-related issue. However, with strong progress being made 9 months after this prescription, and problems occurring over 2 years after taking the medication, it is unclear whether the ON was related to her fracture pattern or developed as a result of the corticosteroid usage or a combination of the 2 due to a "double hit."
CONCLUSION
This case review points out the potential need for continued monitoring even after radiographic and clinical healing is achieved in these injuries.
PubMed: 38910973
DOI: 10.13107/jocr.2024.v14.i06.4510 -
Journal of Brachial Plexus and... Jan 2024To better understand the long-term hand and shoulder outcomes of upper brachial plexus birth injuries. We evaluated shoulder and hand function in 32 patients (13...
To better understand the long-term hand and shoulder outcomes of upper brachial plexus birth injuries. We evaluated shoulder and hand function in 32 patients (13 males; 19 females) with a C5/C6 birth injury history). All patients had undergone primary nerve surgery as infants, and 12 underwent a simultaneous shoulder procedure as they presented with a fixed internal rotation contracture of the shoulder. On average, all patients were evaluated and examined 15 years postoperatively. The shoulder function was evaluated using the Miami Shoulder Scale. Hand function was measured by the 9-hole peg test (9-HPT) and statistical analysis included comparison of 9-HPT time against normative data using the Student's -test. The cohort includes 22 right-hand-dominant and 10 left-hand-dominant patients. Mean age at surgery was 10 months; mean age at follow-up was 15 years ± 2 years 2 months. Cumulative shoulder function was "good" or "excellent" (Miami score) in 23 patients. For 9-HPT, 23 out of 32 patients seen had an involved hand with a significant alteration in function. Early nerve surgery in cases of upper brachial plexus birth injuries result in the desired outcome. To ensure timely and targeted therapy for any residual deficits, it is imperative that limitations in hand function among children with an Erb's palsy.
PubMed: 38910845
DOI: 10.1055/s-0044-1787151 -
Cureus May 2024Background The management of distal clavicle injuries with disruption of the coracoclavicular ligaments (CCLs) is challenging. The aim of this study was to assess the...
Early to Mid-term Results of Coracoclavicular Ligament Reconstruction Using the Infinity-Lock Button System in the Management of Traumatic Acromioclavicular Joint Dislocations and Lateral End of Clavicle Fractures.
Background The management of distal clavicle injuries with disruption of the coracoclavicular ligaments (CCLs) is challenging. The aim of this study was to assess the functional results of reconstructing the CCLs with the Infinity-Lock Button System using validated outcome measures, patient satisfaction scores, return to pre-injury activity, and complications. Methods A total of 28 cases of CCL disruption were assessed over a seven-year period, which included 14 lateral end-of-clavicle fractures and 14 acromioclavicular joint (ACJ) dislocations. All patients underwent stabilisation of the CCLs using the Infinity-Lock Button System. Patients were assessed preoperatively and postoperatively using validated outcome measures such as visual analogue scale (VAS), Oxford Shoulder Score (OSS), Quick Disabilities of Arm, Shoulder & Hand (Q-DASH) scores, return to pre-injury level of activities, patient satisfaction scores, and complications were reviewed. Results The mean age of patients was 36.7 years (18-74 years). The mean follow-up was 38.6 months (8-68 months). The mean time to surgery was 75.8 days (3-619 days). There was a statistically significant improvement in postoperative VAS, OSS, and Q-DASH scores compared to the preoperative (p-value <0.001). Out of the 28 participants, 23 (82.1%) returned to pre-injury level of activities, 25 (89.7%) reported 'good' or 'excellent' outcomes following the intervention, and none of the patients reported functional instability postoperatively. None of the patients required revision surgery or implant removal. Conclusion CCL reconstruction is vital in the management of clavicular injuries. This study demonstrates the safe use of the Infinity-Lock Button System in these injuries with statistically significant improvement in early patient-reported outcome measures, return to pre-injury level of activities, and subjective patient satisfaction.
PubMed: 38910766
DOI: 10.7759/cureus.60936 -
Cell Transplantation 2024Transplantation of mesenchymal stem cells (MSCs) is one of the hopeful treatments for spinal cord injury (SCI). Most current studies are in animals, and less in humans,... (Meta-Analysis)
Meta-Analysis
Transplantation of mesenchymal stem cells (MSCs) is one of the hopeful treatments for spinal cord injury (SCI). Most current studies are in animals, and less in humans, and the optimal transplantation strategy for MSCs is still controversial. In this article, we explore the optimal transplantation strategy of MSCs through a network meta-analysis of the effects of MSCs on SCI in animal models. PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science and Technology Journal Database (VIP), and Chinese Biomedical Literature Service System (SinoMed) databases were searched by computer for randomized controlled studies on MSCs for SCI. Two investigators independently completed the literature screening and data extraction based on the inclusion and exclusion criteria. RevMan 5.4 software was used to assess the quality of the included literature. Stata 16.0 software was used for standard meta-analysis and network meta-analysis. Standardized mean difference (SMD) was used for continuous variables to combine the statistics and calculate 95% confidence interval (95% CI). < 0.05 was considered a statistically significant difference. Cochrane's test and the value were used to indicate the magnitude of heterogeneity. A random-effects model was used if > 50% and < 0.10 indicated significant heterogeneity between studies, and conversely, a fixed-effects model was used. Evidence network diagrams were drawn based on direct comparisons between various interventions. The surface under the cumulative ranking curve area (SUCRA) was used to predict the ranking of the treatment effects of each intervention. A total of 32 animal studies were included in this article for analysis. The results of the standard meta-analysis showed that MSCs improved motor ability after SCI. The network meta-analysis showed that the best treatment effect was achieved for adipose tissue-derived mesenchymal stromal cells (ADMSCs) in terms of cell source and intrathecal (IT) in terms of transplantation modality. For transplantation timing, the best treatment effect was achieved when transplantation was performed in the subacute phase. The available literature suggests that IT transplantation using ADMSCs in the subacute phase may be the best transplantation strategy to improve functional impairment after SCI. Future high-quality studies are still needed to further validate the results of this study to ensure the reliability of the results.
Topics: Animals; Humans; Rats; Disease Models, Animal; Mesenchymal Stem Cell Transplantation; Mesenchymal Stem Cells; Network Meta-Analysis; Spinal Cord Injuries
PubMed: 38910431
DOI: 10.1177/09636897241262992 -
Journal of ISAKOS : Joint Disorders &... Jun 2024The Subscapularis (SSC) muscle is a crucial anterior glenohumeral stabilizer and internal rotator of the shoulder joint. The partial tears of the SSC might result from... (Review)
Review
The Subscapularis (SSC) muscle is a crucial anterior glenohumeral stabilizer and internal rotator of the shoulder joint. The partial tears of the SSC might result from traumatic injury or intrinsic degeneration. Partial SSC tears can range in severity and be classified into different categories based on the location of the tear, size of the lesion, and associated pathology. The tear usually begins from the superolateral margin in the first facet and propagates downwards. It is frequently associated with biceps pathology or anterosuperior lesions. These tears are now increasingly recognized as distinct pathology that requires specific diagnostic and management approaches. The current management approaches are shifting towards operative, as partial SSC tears are increasing recognized as distinct pathology. At present, there is no consensus regarding the timing of repair, but the relative tendency of the SSC to retract much faster than other rotator cuff muscles, and difficulty in mobilization, advocates an early repair for SSC irrespective of the lesion size. An associated biceps pathology can be treated with either tenotomy (biceps delamination/erosion) or tenodesis. The techniques of partial SSC repair are constantly improving. There is no reported difference in use of 2-anchor-based conventional single-row (SR), a 3-anchor-based interconnected double-row technique, or a 2-anchor-based interconnected hybrid double-row construct in the repair construct. However, the 2-anchor-based interconnected double-row provides an advantage of better superolateral coverage with the leading-edge protection, as it helps in placing the superolateral anchor superior and lateral to the original footprint. A timely intervention and restoration of the footprint will help restore and rehabilitate the shoulder. Future directions should prioritise injury prevention, early diagnosis with clinic-radiological cues and targeted interventions to mitigate risk.
PubMed: 38909905
DOI: 10.1016/j.jisako.2024.06.009 -
Journal of Dairy Science Jun 2024The aim of this study was to evaluate the effect of hoof trimming on overall limb movements by comparing the changes in 8 limb joint angles before and after one week of...
The aim of this study was to evaluate the effect of hoof trimming on overall limb movements by comparing the changes in 8 limb joint angles before and after one week of hoof trimming. Seventeen Holstein-Friesian dairy cows that were able to move freely and had no history of hoof diseases were included in the study. The cows were walked on a rubber mat with a high friction coefficient (HFM) and a low friction coefficient by the spraying of sodium polyacrylate (LFM). A high-speed camera was set to 200 fps on the image analysis software, and the images of the cows that were given 15 reflective markers on their right side were captured while walking on the test mat. The tests were conducted before and after one week of hoof trimming, and the cows were trimmed by the functional hoof trimming method. With image analysis software, video clips of walking cows were confirmed visually and tracked during one gait cycle by each reflective marker attached to the hoof of the forelimb and hindlimb, after which the stance phase and swing phase were identified. The durations of the stance phase and swing phase of the forelimb and hindlimb, respectively, and the maximum, minimum, and range of motion (ROM) values of the 8 joint angles, shoulder joint, elbow joint, carpus joint, forelimb fetlock joint, hip joint, stifle joint, hock joint and hindlimb fetlock joint during one gait cycle were included in the analysis. The maximum and minimum angles of the hip and stifle joints were narrower after hoof trimming than before, although the ROM did not change and was clearer for HFM than for LFM. It was thought that the flexion of the proximal hindlimb would progress smoothly during walking after trimming.
PubMed: 38908688
DOI: 10.3168/jds.2023-24255 -
Scandinavian Journal of Pain Jan 2024Pain is still a neglected problem in mild traumatic brain injury (mTBI). In this cross-sectional study, we examined the frequency of musculoskeletal pain in a sample of...
OBJECTIVES
Pain is still a neglected problem in mild traumatic brain injury (mTBI). In this cross-sectional study, we examined the frequency of musculoskeletal pain in a sample of adult patients with persistent cognitive symptoms after mTBI and whether pain level affected cognition.
METHODS
The participants were 23 adult patients aged 18-50 referred to brain injury rehabilitation clinics for neuropsychological assessment after having sustained an mTBI. A non-injured control group ( = 29) was recruited through advertisements. The patients were, on average, assessed 22 months after trauma. All participants completed a comprehensive neuropsychological test battery and completed the Örebro Musculoskeletal Pain Screening Questionnaire, The Rivermead Post-Concussion Symptoms Questionnaire, and the State-Trait Anxiety Inventory.
RESULTS
Patients reported high levels of current pain and significantly more frequent neck and shoulder pain than the non-injured controls. Patients also reported high post-concussive symptoms and anxiety levels and performed less well on several neuropsychological tests. Pain level was associated with slower processing speed among the controls but not related to performance in the mTBI group.
CONCLUSION
We conclude that musculoskeletal pain is frequent in mTBI patients referred to rehabilitation settings. Furthermore, the results indicate that the interaction between pain and cognitive functioning differs in mTBI compared to controls. Our results implicate that pain screening should be an integrated part of neuropsychological rehabilitation after mTBI to identify conditions that run the risk of becoming chronic. The study was approved by the Regional Ethical Board in Stockholm, Sweden (04-415/2).
Topics: Humans; Male; Female; Adult; Cross-Sectional Studies; Brain Concussion; Middle Aged; Neuropsychological Tests; Young Adult; Musculoskeletal Pain; Cognition; Anxiety; Adolescent; Post-Concussion Syndrome
PubMed: 38907605
DOI: 10.1515/sjpain-2023-0124 -
Ugeskrift For Laeger Jun 2024Shoulder dystocia is a serious obstetric complication, where one or both shoulders of a child are trapped after the head is born during vaginal delivery. The situation...
Shoulder dystocia is a serious obstetric complication, where one or both shoulders of a child are trapped after the head is born during vaginal delivery. The situation is life-threatening for the child and requires quick management with obstetric manoeuveres for delivering the shoulders. Rarely, the abdominal approach called Zavanelli manoeuvre is used to achieve delivery after a replacement of the head back in the birth canal, prior to acute caesarean section. This is a case report of a 26-year-old woman with severe shoulder dystocia, failed Zavanelli manoeuvre and vaginal delivery of a lifeless child.
Topics: Humans; Female; Pregnancy; Adult; Stillbirth; Delivery, Obstetric; Shoulder Dystocia; Infant, Newborn
PubMed: 38904285
DOI: 10.61409/V02240095 -
Journal of Hand Surgery Global Online Mar 2024Surgical reconstruction of elbow extension can help restore function in patients with tetraplegia and triceps paralysis because of spinal cord injury. Both posterior...
PURPOSE
Surgical reconstruction of elbow extension can help restore function in patients with tetraplegia and triceps paralysis because of spinal cord injury. Both posterior deltoid-to-triceps tendon transfer and transfer of the branch of the axillary nerve to the triceps motor branch of the radial nerve have been described for triceps reanimation. This systematic review aimed at reviewing current evidence in the two schools of surgery in terms of their outcome and complication profile.
METHODS
A systematic review was conducted using MEDLINE (1974-2023) and EMBASE (1946-2023) databases. The keyword terms "elbow extension," "triceps," "deltoid," "nerve transfer," "spinal cord injury," "tetraplegia," "quadriplegia," and "tetraplegic" were used in the initial search, which was supplemented with manual searches of the bibliographies of retrieved articles.
RESULTS
Twenty studies met our inclusion criteria, with 14 studies (229 limbs) on posterior deltoid-to-triceps tendon transfer, 5 studies (23 limbs) on axillary to radial nerve transfer, and 1 study (1 limb) on combined transfer. For the tendon transfer group, the majority of studies reported a median triceps power of grade 3, with a wide range of failure percentage to reach antigravity (0% to 87.5%). Common complications included gradual stretching of the musculotendinous unit, rupture of the tendon transferred, elbow contracture, and infection. For the nerve transfer group, the majority of studies also reported a median triceps power reaching grade 3. There were no reported complications or loss of power in donor action of shoulder abduction or external rotation.
CONCLUSIONS
Transfer of the axillary nerve branch to the triceps motor branch of the radial nerve in tetraplegia shows promising results, with comparable triceps muscle power compared to traditional tendon transfer and a low incidence of complication.
TYPE OF STUDY/LEVEL OF EVIDENCE
Systematic Review III.
PubMed: 38903844
DOI: 10.1016/j.jhsg.2023.11.012 -
Journal of Hand Surgery Global Online Mar 2024Combined trapeziectomy and suture-button suspensionplasty (SBS) is a common and well-established surgical treatment for thumb carpometacarpal (CMC) osteoarthritis....
PURPOSE
Combined trapeziectomy and suture-button suspensionplasty (SBS) is a common and well-established surgical treatment for thumb carpometacarpal (CMC) osteoarthritis. Although short and mid-term follow-up studies have shown promising outcomes with patients retaining excellent range of motion and strength, long-term data are lacking. The aim of our study was to assess the long-term outcomes of patients who underwent SBS surgery for thumb CMC arthritis, with a minimum follow-up period of 10 years.
METHODS
We evaluated 17 patients, at least 10 years after undergoing SBS surgery for thumb CMC arthritis. We measured grip and pinch strength, range of motion, and trapezial space height and compared it with the respective values measured on the routine postoperative 3-month follow-up visit. All patients have additionally completed the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire.
RESULTS
The study included 11 women and 6 men with an average age of 60.3 ± 6.4 years and a mean follow-up of 137.4 ± 11.4 months after surgery. The mean Quick Disabilities of the Arm, Shoulder, and Hand score was 9 (range: 0-40.9) at the long-term follow-up, compared with 26.2 (range: 4.5-75) recorded 3 months after the surgery. Grip and pinch strengths were 116% and 111% of the 3-month postoperative value, respectively. Radial abduction and palmar abduction were 98% and 94% of the 3-month postoperative value, respectively. Kapandji scores were either equal or higher than the previously documented scores. Average height of the trapezial space was 69% of the previous postoperative measurement.
CONCLUSIONS
Our findings demonstrate that patients who underwent SBS surgery for thumb CMC osteoarthritis achieve excellent long-term outcomes by maintaining favorable subjective and objective results, despite some radiographic subsidence over time. These results indicate SBS to be an effective and durable technique for the long-term management of thumb CMC osteoarthritis.
TYPE OF STUDY/LEVEL OF EVIDENCE
Therapeutic IV.
PubMed: 38903836
DOI: 10.1016/j.jhsg.2023.12.002