The aim of our retrospective study is to compare infraspinatus strength and functional outcomes in patients treated with Classic Judet versus Modified Judet approach for scapular fractures. Surgical treatment of scapular fracture with posterior approach is frequently associated with infraspinatus postoperative hypotrophy. The Classic Judet approach (CJ) require the infraspinatus muscle lateral reflection. The Modified Judet approach (MJ) consists in a blunt dissection through the interval between infraspinatus and teres minor. We enrolled 20 patients with scapular neck and body fracture treated with posterior approach for lateral border plate fixation. In 11 of 20 cases we used MJ Approach and in 9 cases we used CJ approach. All fractures were classified according to AO Classification system. At the follow-up examinations patients had X-Ray assessment with Acromion Humeral Distance (AHD) measurement, clinic evaluation, active ROM examination, Constant Shoulder Score, DASH Score. Infraspinatus strength assessment was measured using a dynamometer during Infraspinatus strength test (IST) and Infraspinatus Scapular Retraction Test (ISRT). Demographic data did not significantly differ between CJ Group and MJ Group. All X-ray examinations showed fracture healing. The AHD was significantly decreased in CJ Group (p=0.006). We did not find significant differences in active ROM between MJ and CJ (p<0.05). The Constant Score and DASH score were not statistically different (p> 0.05). The IST and ISRT tests showed a mean strength statistically higher in MJ group (p=0.002). Infraspinatus ipotrophy was detected in 6 patients, 5 of CJ group and 1 of MJ group and it was strictly related to infraspinatus strength weakness in IST and ISRT (p<0.001). Infraspinatus sparing surgical approach for scapular fractures avoids infraspinatus hypotrophy and external-rotation strength weakness. We suggest to use mainly Modified Judet approach for scapular fracture and to restrict as much as possible Classic Judet approach to scapular fractures extending to medial border
Objectives:Post-operative retear is the most common surgical complication following rotator cuff repair with reported rates ranging from 11% to 94%. There have been a number of advancements in the technology and management of rotator cuff repair which may have improved retear rates. The aim of this study was to determine if there has been any improvements in rotator cuff repair integrity in our centre and, to identify any changes in the management of rotator cuff tears that may have impacted post-operative re tear rate. Methods:This observational single cohort study used running average analysis to examine 1600 consecutive patients who underwent primary arthroscopic rotator cuff repair by a single surgeon, and had cuff integrity assessed by ultrasound six months post operation. Exclusion criteria included revision rotator cuff repairs, isolated subscapularis repairs, and irreparable tears. Results:Retear rates over the course of our study ranged from 3% to 34%, with the mean retear rate being 15%. The retear rate at the commencement of our study was 18% and decreased to 5% by the end. Reductions in retear were associated with; more passive rehabilitation, more attention to post-operative abduction sling use, increased surgical team experience. Increases in retear rates were associated with; increased false positives with a more sensitive ultrasound machine and, learning curves with new equipment for surgeon and sonographer. Conclusion:A significant decrease in retear rate following arthroscopic rotator cuff repair was observed over the course of our study with the re-tear rate at the end of the study being 5%. While the study design does not allow us to directly attribute changes in retear rate to changes in management, our results suggest that less aggressive rehabilitation, abduction sling use and increased surgeon experience decrease postoperative retear.
We aimed to detect Cutibacterium acnes with histologic methods from intra-articular shoulder tissue specimen and to analyse whether it can be found intracellularly when taken from patients having first time shoulder surgery. Cutibacterium acnes is a mysterious member of the shoulder microbiome. It has been multiply associated with chronic postoperative complications and low-grade infections in orthopedic surgery. Still, it is unclear whether it should be either linked to skin contamination or to true deep infections. Some authors hypothesized C. acnes to be a commensal of deep, intraarticular tissues and linked it to osteoarthritis. Further, C. acnes is reported to persist in macrophages as a niche for its survival and spread. In 23 consecutive, otherwise healthy patients (17 m, 6 f; 58y), who had first time shoulder surgery and no previous shoulder injections, specimen were taken from intraarticular tissue during arthroscopic (n=11) and open (n=12) surgery. The samples were microbiologically cultivated and histologically processed using immunohistochemical staining with C. acnes specific antibodies, CD163 macrophage and ß-actin markers to identify the position of C. acnes within the cell cytoskeleton. Positional analyses were conducted with a 3D confocal laser microscopy scanner at a maximal resolution of 310nm. In 10 patients (43%) C. acnes growth was observed in microbiological culture (7 subcutanenous, 7 deep). C. acnes was detected in all tissue samples at histological analysis. In 5 tissue samples (22%, all arthroscopic), C. acnes was detected intracellularly in stroma cells and in macrophages. C. acnes can be detected intracellularly in macrophages and within stroma cells of intraarticular tissues of patients who never experienced a previous penetration of their shoulder joint. These data indicate C. acnes to be a commensal of the human shoulder joint where it persists within macrophages and stroma cells.
BACKGROUND:Although venous thromboembolism (VTE) has been studied in lower-extremity arthroplasty, there are few guidelines regarding established risk factors for VTE in total shoulder arthroplasty (TSA). With literature suggesting the VTE rate may be as high as 13%, VTE prevention and risk factors should be considered in preoperative planning. METHODS:All TSAs from 2011 through 2016 were queried from the National Surgical Quality Improvement Program database. Age, sex, body mass index, American Society of Anesthesiologists class, ethnicity, functional status, comorbidities, discharge destination, surgical indication, length of stay, and operative time were compared between patients with and without 30-day postoperative VTE. Pearson χ2 and t tests were used to assess baseline categorical and continuous variables, respectively. Multivariate logistic regression analysis was conducted to determine associated independent risk factors for VTE. RESULTS:The analysis included 13,299 patients; VTE developed in 83 patients (0.62%). Patients with VTE were older (72 years vs. 69 years) and had a longer hospital stay (3.5 days vs. 1.9 days). Compared with patients with no VTE, patients with VTE were more likely to undergo TSA for proximal humeral fractures, to be discharged to a rehabilitative center, to have a preoperative albumin level lower than 3.5 g/dL, to undergo non-elective surgery, to have an American Society of Anesthesiologists class of 3 or greater, to have a surgical-site infection develop, and ultimately to need a shoulder reoperation (all P < .05). Multivariate logistic regression analysis revealed that hypoalbuminemia (albumin level < 3.5 g/dL), an increased length of stay, and African American ethnicity were independent risk factors for VTE development. CONCLUSION:Patients with hypoalbuminemia, an increased length of stay, and African American ethnicity are at an increased risk of VTE after shoulder arthroplasty. A high index of suspicion is warranted for elderly patients with fractures who may need preoperative medical optimization.
