BACKGROUND:Preoperative planning software enables virtual implantation of reverse total shoulder arthroplasty (rTSA) and assessment of impingement-free range of motion (ROM). Recent studies have shown that scapular resting position varies significantly among individuals and impacts impingement-free ROM. The resting position of the arm also varies between individuals, yet its impact on simulated outcomes and whether this parameter should be integrated into planning programs remains unclear. The objective of this study was to assess the effect of the resting arm position in the coronal plane on simulated impingement-free ROM and on implant positioning metrics, specifically the lateralization shoulder angle (LSA) and distalization shoulder angle (DSA) in rTSA planning. METHODS:A prospective computational modeling study was conducted using a commercially available three-dimensional planning software (Imascap, Plouzané, France). Thirty computed tomography scans of patients with primary osteoarthritis or cuff tear arthropathy were planned independently by 9 experienced surgeons. The resting abduction angle (RAA) was implemented as proxy for the resting arm position in the coronal plane and determined by the humeral diaphyseal axis and vertical scapular axis. Each plan was simulated with 10 distinct resting arm positions (between -5° and 40° of abduction), resulting in 2,700 virtual cases. Impingement-free ROM, LSA, and DSA were evaluated for each resting arm position. One-way analysis of variance and Pearson correlation analyses were conducted to determine the relationship between RAA and key planning outcomes. RESULTS:RAA significantly influenced simulated ROM parameters across all tested arm positions (P < .0001). Increasing RAA, resulted in greater adduction (R2 = 0.72, P < .0001), internal (R2 = 0.23, P < .0001), and external rotation (R2 = 0.23, P < .0001), while inversely affecting abduction (R2 = 0.44, P < .0001), forward flexion (R2 = 0.26, P < .0001), and extension (R2 = 0.31, P < .0001). Significant differences were found in LSA and DSA values across the different simulated resting arm positions (P < .0001). LSA showed a weak positive correlation with RAA (R2 = 0.34, P < .0001), whereas DSA exhibited a strong inverse relationship (R2 = 0.63, P < .0001), indicating that a more abducted resting arm position led to higher LSA and lower DSA values without altering implant position. CONCLUSION:The resting arm position significantly affects virtual impingement-free ROM in Imascap planning software, highlighting the importance of incorporating humeral position into rTSA preoperative planning. Additionally, because LSA and DSA measurements are substantially influenced by the arm position despite an unchanged implant configuration, consideration of humeral orientation may be necessary when interpreting these metrics.
BACKGROUND:The endovascular clip system (eCLIPs), a unique extra-saccular device for treatment of wide necked bifurcation aneurysms (WNBAs), was evaluated in the French eCLIPs efficacy and safety study (EESIS-FR). This paper summarizes the patient demographics, procedural characteristics, and 30 day adverse event (AE) data. METHODS:The EESIS-FR trial was a prospective study from 18 centers, enrolling 123 adults with WNBAs at the carotid (CT) and basilar (BT) termini. The study protocol was approved by a central ethics committee, had independent adjudication of AEs by a Clinical Events Committee, and had independent core laboratory adjudication of effectiveness outcomes. RESULTS:Mean age was 55.0±1.2 years (19-78 years); 73% were women. 43% and 57% of the aneurysms were located at BT and CT, respectively. Mean neck length was 4.8 mm, neck depth 4.2 mm, dome height 5.4 mm, and dome width 6.3 mm. Successful implantation was achieved in 115 cases (93%). Implant time averaged 36 min. Three primary safety events (2.4%) occurred within the first 30 days, all at the index procedure: subarachnoid hemorrhage (SAH) due to a distal guidewire perforation, death from SAH due to rupture of the aneurysm, and spinal cord infarction caused by an occlusive access catheter. Five minor strokes (4.1%) and three transient ischemic attacks (2.4%) occurred, all of which were procedurals. None of these patients had a modified Rankin Scale score of >2 at 30 days. No patient had further ischemic or hemorrhagic events beyond the periprocedural period to 30 days. CONCLUSION:eCLIPs treated WNBAs at BT and CT, with procedural safety and technical success similar to those with intrasaccular devices.
To evaluate the feasibility and short-term outcomes of postoperative bladder drainage using a temporary prostatic urethral stent following Rezūm™ therapy. This prospective bicentric pilot study included 32 consecutive patients undergoing Rezūm™ therapy between March 2025 and February 2026. Postoperative bladder drainage was performed using a temporary prostatic stent (CoreFlow™, ProstaLund AB, Sweden). The primary endpoint was overall strategy success, defined as successful device insertion, maintenance until planned removal without conversion to standard urethral catheterisation, and no secondary re-catheterisation. Overall strategy success was achieved in 26 of 32 patients (81
Summary Direct penicillin challenge without skin testing was evaluated in adults with childhood reactions. Only a few patients had mild reactions, with no anaphylaxis or severe cutaneous adverse events.
The aim of this study was to define the variability of the scapulohumeral position during preoperative Computed Tomography (CT) acquisition and to evaluate its influence on angular lateralization and distalization measurements. We hypothesized that the preoperative resting arm position, in terms of humeral abduction, flexion and internal rotation, would vary significantly between patients and that this variability would influence the lateralization (LSA) and distalization shoulder angle (DSA). We analyzed a prospectively collected database of preoperative de-identified CT scans from a single Total Shoulder Arthroplasty (TSA) planning system (Equinoxe, Exactech GPS, Blue-Ortho), including all cases with scapular and humeral segmentation. Validated three-dimensional (3D) bone models were used to compute and automatically position scapular and humeral landmarks. These included: the superior glenoid tubercle; the most lateral border of the acromion and the most lateral border of the greater tuberosity. The position of the humerus relative to the scapula was automatically calculated, allowing the angles of abduction, flexion and internal rotation of the scapulohumeral joint to be assessed. Additionally, the potential relationship between the body mass index (BMI) and the resting arm position was assessed. Finally, LSA and DSA were calculated. A multiple linear regression analysis was performed to assess the relationship between the humeral position and the LSA and DSA. A total of 21,863 patients were included. Preoperative humeral positioning relative to the scapula showed a mean abduction of 10.3°±12.4 (-14.0°; 36.6°), mean flexion of 3.9°±8.9 (-16.0°; 26.1°) and mean internal rotation of 6.5°±18.9 (-41.4°; 48.9°). The preoperative median of LSA and DSA were 87.4°±14.3° and 43°±12.4, respectively. Among the independent variables, abduction showed the strongest negative correlation with LSA (β = -0.2998, p < 0.0001), followed by flexion (β = -0.04342, p < 0.0001). Internal rotation was positively correlated with LSA (β = 0.1229, p < 0.0001). For DSA, abduction had a weak positive influence (β = 0.04321, p < 0.0001), while flexion (β = −0.04302, p < 0.0001) and internal rotation (β = −0.04654, p < 0.0001) were negatively associated. Notably, a 10° variation in abduction, flexion or internal rotation led to a -3°, -0.4° and + 1.2° change in LSA, respectively, whereas DSA was minimally affected, with variations limited to + 0.4°, -0.4° and − 0.5°, respectively. The resting arm position during preoperative CT scans varies significantly, potentially affecting the preoperative planning of TSA. The main findings of this study suggest that there exists a weak correlation between the initial scapulohumeral position and the LSA/DSA measurements. Level IV. Case series with no comparison group.
