Effect of affective temperament on outcome of rotator cuff surgery

Introduction: Although numerous risk factors have been described, the effects of temperament, which is defined as a risk factor for certain disorders, on the outcome of patients undergoing rotator cuff surgery have not been investigated. Hypothesis: We investigated whether a relationship exists between affective temperament and the outcome of patients undergoing rotator cuff surgery. Material and methods: The outcomes of 176 patients undergoing rotator cuff surgery were examined using the Oxford and Constant questionnaires as well as visual analog scale values preoperatively and postoperatively. Inclusion criteria were defined as 1) dissatisfaction with pain despite 6 months of non-operative treatment; 2) rotator cuff defects with full-thickness, small-to large-sized defects; 3) presence of a single dominant temperament or nondominant temperament; 4) no history of a diagnosed psychiatric disorder; and 5) a minimum of greater than 1 year of follow-up after surgery. Exclusion criteria were 1) other comorbid shoulder pathology; 2) irreparable or partial rotator cuff rupture; 3) grade 3 retractions; 4) grade 3-4 fatty infiltration; 5) other comorbid diseases such as diabetes, thyroid disorders, or inflammatory diseases; 6) history of shoulder surgery; 7) infection of the shoulder joint; 8) neurologic deficit in muscles around the shoulder; 9) two or more dominant temperaments; and 10) history of acromioclavicular joint resection and/or biceps tenodesis with cuff repair. All patient temperaments were evaluated according to the Temperament Evaluation of Memphis, Pisa, Paris and San Diego auto questionnaire version. Results: The mean follow-up time was 45.5 months. The outcomes of patients with depressive temperament were worse than of patients with a nondominant temperament. This situation was observed both preoperatively and postoperatively. However, a similar relationship between nondominant and anxious temperament groups was observed only postoperatively.Conclusion: We noticed that depressive and anxious temperaments had a negative effect on patient outcomes after rotator cuff surgery; however, nondominant temperaments had a positive effect on patient outcomes. (C) 2019 Elsevier Masson SAS. All rights reserved

Arthroscopic stabilization of anterior shoulder instability using a single anterior portal

Objective: The aim of this study was to compare the effects of the use of a single anterior portal in the arthroscopic surgery treatment of traumatic anterior shoulder instability with those in the literature. Methods: The study included 72 patients (60 males, 12 females; mean age: 23.9 years) who underwent surgery using a single arthroscopic anterior portal for the treatment of traumatic anterior shoulder instability between 2002 and 2011. Clinical outcomes were assessed using the Rowe and Oxford scales, forward flexion range and external rotation limitation. Redislocation was considered failure. Results: Mean follow-up was 49.3 months. Bankart lesion was determined in 38 patients and Bankart and SLAP lesions in 34. An average of 3.7 (range: 2 to 5) anchors were used. Redislocation was observed in 4 (5.6%) patients in the postoperative period. Postoperative Rowe and Oxford scores were 93.4 and 42.6, respectively. Conclusion: Instability surgery performed using a single arthroscopic anterior portal provided findings comparable with the literature regarding clinical outcomes, postoperative shoulder movements and low recurrence rates, emphasizing the importance of appropriate patient selection rather than the number of the portals. The use of a single portal is less invasive and reduces the surgical period

Clinical evaluation of an antero-medial approach for plate fixation of the proximal humeral shaft

Objective Surgical approach of fractures of the proximal humeral shaft should protect the muscular insertions and the vascularisation of fragments, improving bone union and functional recovery. The aim of this study is to review cases operated with an original anteromedial approach, in cases of specific fractures of the proximal humeral shaft. Materials and methods Prior to clinical application, a cadaveric study was accomplished. Based on the results, six clinical cases had surgery using an approach medial to the biceps and brachialis. The osteosynthesis was performed with locked plates and 4.5 screws. The approach was indicated in fractures presenting with a large lateral wedge including the deltoid muscle insertion. Stable osteosynthesis achieved with this approach allowed early postoperative mobilization of the arm in all cases. Results The case-series consisted of three women and three men with a mean age of 52.1 years (range 38–68). The minimal follow-up was 1 year. Bone union was observed at an average time of 11.2 weeks. There were no intra- or postoperative complications. Discussion Open reduction and internal fixation with compression plating is a standardized and successful procedure in the treatment of humeral fractures. Internal fixation with lateral plating is difficult in the proximal third of the humeral shaft, where the positioning of the implant may hurt the long biceps tendon and the deltoid insertion. This approach was successful and safe in the presented cases. Conclusion The antero-medial approach with metaphyseal locking plate protects the muscular insertions and the vascularisation of the wedge fragment, leading to good results in all the cases in this series

Arthroscopic release of the subscapularis for shoulder contracture of obstetric palsy

Objective Retrospective study of one surgeon’s experience with arthroscopic release in obstetrical brachial plexus palsy. Methods Over a four-year period, 6 patients who presented with a shoulder contracture secondary to obstetric palsy before the age of 8 years were treated arthroscopically. Small arthroscopy instruments, small shaver blades, including a 2.7-mm, 30° angled scope, and 90° radiofrequency probe, were used for this surgery. Patient selection for this approach was based on the lack of bone deformity and targeted soft tissue release. Postoperative brace immobilization for 6 weeks was used in all patients. Functional status of the patients was evaluated pre- and postoperatively with the assessment of external rotation. Results The case series consisted of 2 girls and 4 boys with a mean age of 5.1 years (range, 3–8 years). No patient was lost to follow-up, and all patients completed a minimum 1 year of clinical and radiographic follow-up. Increases in external rotation were observed in all patients. There was no intra- or postoperative complications. Conclusion Arthroscopic treatment of the shoulder contracture in obstetric palsy was found to be a safe and eVective procedure in patients who are likely to undergo future tendon transfer or bone surgery

An observational, multicenter, registry-based cohort study of Turkish Neonatal Society in neonates with Hypoxic ischemic encephalopathy

BACKGROUND: Hypoxic ischemic encephalopathy (HIE) is a significant cause of mortality and short- and long-term morbidities. Therapeutic hypothermia (TH) has been shown to be the standard care for HIE of infants ≥36 weeks gestational age (GA), as it has been demonstrated to reduce the rates of mortality, and adverse neurodevelopmental outcomes. This study aims to determine the incidence of HIE in our country, to assess the TH management in infants with HIE, and present short-term outcomes of these infants. METHODS: The Turkish Hypoxic Ischemic Encephalopathy Online Registry database was established for this multicenter, prospective, observational, nationally-based cohort study to evaluate the data of infants born at ≥34 weeks GA who displayed evidence of neonatal encephalopathy (NE) between March, 2020 and April 2022. RESULTS: The incidence of HIE among infants born at ≥36 weeks GA (n = 965) was 2.13 per 1000 live births (517:242440), and accounting for 1.55% (965:62062) of all neonatal intensive care unit admissions. The rates of mild, moderate and severe HİE were 25.5% (n = 246), 58.9% (n = 568), and 15.6% (n = 151), respectively. Infants with severe HIE had higher rates of abnormal magnetic resonance imaging (MRI) findings, and mortality (p0.05). TH was administered to 85 (34.5%) infants with mild HIE, and of those born of 34-35 weeks of GA, 67.4% (n = 31) received TH. A total of 58 (6%) deaths were reported with a higher mortality rate in infants born at 34-35 weeks of GA (OR 3.941, 95% Cl 1.446-10.7422, p = 0.007). CONCLUSION: The incidence of HIE remained similar over time with a reduction in mortality rate. The timing of TH initiation, whether [removed

A Population Model of Time-Dependent Changes in Serum Creatinine in (Near)term Neonates with Hypoxic-Ischemic Encephalopathy During and After Therapeutic Hypothermia

The objective was to apply a population model to describe the time course and variability of serum creatinine (sCr) in (near)term neonates with moderate to severe encephalopathy during and after therapeutic hypothermia (TH). The data consisted of sCr observations up to 10 days of postnatal age in neonates who underwent TH during the first 3 days after birth. Available covariates were birth weight (BWT), gestational age (GA), survival, and acute kidney injury (AKI). A previously published population model of sCr kinetics in neonates served as the base model. This model predicted not only sCr but also the glomerular filtration rate normalized by its value at birth (GFR/GFR0). The model was used to compare the TH neonates with a reference full term non-asphyxiated population of neonates. The estimates of the model parameters had good precision and showed high between subject variability. AKI influenced most of the estimated parameters denoting a strong impact on sCr kinetics and GFR. BWT and GA were not significant covariates. TH transiently increased sCr in TH neonates over the first days compared to the reference group. Asphyxia impacted not only GFR, but also the sCr synthesis rate. We also observed that AKI neonates exhibit a delayed onset of postnatal GFR increase and have a higher sCr synthesis rate compared to no-AKI patients. Our findings show that the use of sCr as marker of renal function in asphyxiated neonates treated with TH to guide dose selection for renally cleared drugs is challenging, while we captured the postnatal sCr patterns in this specific population. Graphical Abstract: [Figure not available: see fulltext.].</p

The Effect of Acromial Morphology on the Functional Outcomes of Degenerative Rotator Cuff Tear Surgery

Purpose: The aim of this study was to investigate how the critical shoulder angle (CSA) and acromion index (AI) affect the outcome of arthroscopic rotator cuff tear (RCT) repair. Methods: A total of 287 patients, who underwent arthroscopic surgery due to degenerative rotator cuff tear, were evaluated. The Constant Shoulder Score (CSS), Oxford Shoulder Score (OSS) and Visual Analogue Scale (VAS) were evaluated preoperatively and postoperatively. The AI and CSA were measured on true anteroposterior shoulder radiographs. The patients were separated into two groups according to their CSA and AI values (control group ≤ 38°, increased CSA > 38°, and control group ≤ 0.7, increased AI > 0.7). The relationship between CSS, OSS and VAS was examined in all the groups. Result: The evaluation was made of a total of 287 patients with a mean age of 60.29 ± 8.55 years. The mean duration of follow-up of the patients was 34.00 ± 18.97 months (range 12–80 months). There was a statistically significant difference between the preoperative and postoperative clinical scores of the patients (p 0.05). The interobserver ICC for CSA and AI were determined to be 0.962 and 0.967, respectively (95% CI) indicating a high correlation (p < 0.001). Conclusion: CSA and AI do not affect functional outcomes in the postoperative period, so they are not significant at the time of degenerative arthroscopic rotator cuff repair decisions. © 2021, Indian Orthopaedics Association

L5-S1 spondilopitozisin tedavisi: olgu sunumu

Spondiloptozis veya grade 5 spondilolistezis ise L5 vertebra cisminin S1 üzerinde ileri derecede kayması sonrası oluşur. İleri derece spondilolisteziste redukiyon hala tartışılırken füzyonun daha güvenilir bir tedavi yöntemi olduğu üzerinde görüş birliği vardır. Başlangıç korreksiyonu idame ettirebilmek için posterior füzyona anterior füzyonun da eklenmesi önerilmektedir. L5 in S1 üzerinde redüksiyonu ve L5-S1 füzyonu tedavi şekli olarak kabul görse de majör komplikasyonların redüksiyon yapılsın veya yapılmasın görülebileceği unutulmamalıdır. Gains? in tariflediği metod da ise L5 vertebrektomi, redüksiyonun sağlanması ve L4-S1 füzyonunu içermesi ile spinal kanalı kısaltılır, sinir kökleri ve periferal sinirlerin doğrultusu sağlanmış olur ve buda nörolojik hasar oluşumunu azaltır. Bu olgu sunumunda ise iki spondilopitozisli vakanınGaines prosedürü ile tedavi edilmesi ve sonrasında 6 ve 12 yıllık takipleri sunulmuştur.Spondyloptosis or grade 5 spondylolisthesis is defined as the forward slippage of the entire L5 vertebral body of S1. Reduction of severe spondylolisthesis continues to be a subject of debate; most authors agree that fusion insitu is a safe and reliable procedure for treatment of high grade spondylolisthesis. Reduction and fixation of L5 on to S1 as described before is a treatment option but it has been noted that the rate of major complications is an acceptably high after reduction or even non reduction procedures. L5 reduction procedures appear to have a distinct instance of L5 root deficits. A method described by Gaines including L5 vertebrectomy, reduction and fusion of L4 on to S1 seems to be more logical because it shortens the spinal canal and nerve roots and peripheral nerves can be re aligned avoiding neurologic deficit. In this case report, two cases of spondyloptosis treated by Gaines procedure were presented with follow-up six years and twelve years