SUMMARYBackground. The aim of treatment of frozen shoulder is to regain a painless and functional shoulder range of shoulder motion. In this study we evaluated the results of using the arthroscopic technique for the release of the shoulder joint capsule in patients with a diagnosis of frozen shoulder.Material and methods. The study included 40 patients with frozen shoulder. They were operated upon with the use of electrocautery for the release of the shoulder joint capsule. The group consisted of 29 women and 11 men with a mean age of 48.2 years (range 38-62).Results. Preoperatively, the mean Constant and Murly shoulder score was 36.35 (range 21-51). At the end of the follow up period, the mean score was 85.8 (range 62 to 98). The difference between the means of preand postoperative total score was statistically significant (t =10.85 and p=0.0001). 22 patients (55%) had excellent results, 14 patients (35%) had good results, 4 patients (10%) had fair results and none had poor results. The 4 cases with fair results were all female, all had insulin-dependent diabetes mellitus and were > 50 years old.Conclusions. 1. Arthroscopic capsular release is an effective and safe method for the treatment of refractory frozen shoulder. 2. It achieves dramatic pain and motion improvement post-operatively, allowing very early postoperative rehabilitation.
Cervical facet dislocation is a serious injury that carries risks of short- and long-term morbidity. The optimal management of these injuries remains controversial with the ongoing debate regarding indications and requirements for closed reduction, timing, type of surgical approach and method of fixation. This review gives an update on the relevant anatomy, classification systems for sub-axial cervical facet dislocation and an overview of the current concepts regarding their management, including surgical approaches and the choice of implants.
Background and objectives The mortality after hip, proximal femur, fractures in elderly patients has steadily declined in the last decade in the United Kingdom as a result of implementing of multiple protocols focusing on prompt multidisciplinary pre- and post-operative optimization and reducing time to surgery. The pinnacle of these protocols is the development of the best practice tariff as an incentive program for hospitals that meet set criteria by the National Health Service (NHS) England in managing these injuries. Until the time of writing this paper, there was no parallel program for the management of fractures involving distal femur in the elderly. The aim of this study is to evaluate the outcomes of distal femur fractures in elderly patients against proximal femur fractures regarding post-injury mortality, the prevalence of surgical treatment and time delay till surgery. Methods A retrospective study of all patients above the age of 60 admitted to Queens Hospital Burton between 2010 and 2014 with fractures involving distal end of the femur. Patient data were assessed for demographic criteria, co-morbidities as per Charleston Comorbidities Index, type of management, time-lapse before surgery and 30-day, six-month and one-year mortality. Results were compared to an age-matched control group of patients with proximal femur fractures randomly selected during the same time window. Results The main demographic criteria such as age, gender, and Charleston Comorbidities Index were similar in both groups. There were more patients treated non-operatively in the distal femur group than in the proximal femur group (15% vs 4%). Time to surgery was statistically significantly longer in distal femur group compared to the proximal femur (49.130 hours vs 34.075 hours, P = 0.041). The mortality in distal femur group was higher at all times (9.68% at 30 days, 20.32% at six months and 34.41% at one year) when compared to that in the proximal femur group (6.99% at 30 days, 14.52% at six months, 21.51% at one year). Conclusion The distal femoral fractures showed higher mortality at 30 days, six months and one year compared to the proximal femur group. This could be partly influenced by the implementation of best practice tariff in the proximal femur fracture group reflected in less time to surgery, pre- and post-operative multidisciplinary approach and more frequent operative management.
Background. Fractures of the hand are the most common fractures in the skeletal system and phalangeal fractures constitute about 46% of all hand fractures. Operative treatment of unstable phalangeal fractures should aim at anatomic fracture reduction and stable fixation that allows early mobilization of the affected finger’s joints . This study evaluates the results of fixation of unstable shaft fractures of finger proximal or middle phalanges using a non-spanning external minifixator. Material and methods. 32 men and 8 women aged 17 to 60 (median, 31.25) years suffering from fractures of 44 phalanges in 40 hands were included in the study. Four of the fractured phalanges were middle phalanges and 40 were proximal phalanges .All fractures were fixed using a mini external fixator. All procedures were done under regional anaesthetic block. The fixator was applied after closed reduction of fractures. Additional procedures included wound debridement in open fractures, and tendon repair was needed in 4 cases. We excluded fractures where intraarticular fracture extension mandates open reduction and internal fixation. Results. At the end of the follow-up period (mean follow-up 11.5 months), patients were assessed clinically and radiologically. 26 fingers (59.1 %) had “excellent” results , 14 fingers (31.8 %) had “good” results and 4 fingers (9.1%) had “poor” results as their P.I.P. flexion ranges were < 80˚. Conclusion. External fixation of displaced phalangeal shaft fractures is an effective method of treatment in terms of a minimally invasive technique with rigid fracture fixation allowing early mobilization after surgery.
Background and objectives There is a growing use of functional rehabilitation programs for the treatment of Achilles tendon rupture. Factors such as patient age and level of activity have been used to guide the decision. One of the debated indications is the gap size between the ruptured ends of the tendon. This study aims to define any correlation between the amount of the initial gap between tendon ends and patients outcome treated with the functional rehabilitation program. Method A prospective case series study of all patients with acute Achilles tendon rupture treated nonsurgically with the functional rehabilitation program between 2016 and 2018. The tendon gap was measured with an ultrasound scan on the initial presentation. Patients were followed for a minimum of 12 months and assessed for Achilles Tendon Rupture Score (ATRS), plantarflexion strength, and re-rupture rate. Results A total of 56 patients completed one-year follow-up, and 2 patients had re-ruptures. The mean plantar flexion gap was 13.7 mm. The mean ATRS at 12 months was 85.12. There was no statistically significant correlation between the final ATRS and the mean rupture gap. Conclusion The outcome following non-operative functional rehabilitation treatment of rupture Achilles tendon did not correlate with the size of the tendon gap, and authors recommend that decision on functional rehabilitation should not be based on these criteria.
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