Browser's Notes
- PDF / 101,596 Bytes
- 2 Pages / 595.276 x 790.866 pts Page_size
- 29 Downloads / 175 Views
BROWSER'S NOTES
Browser's Notes
# ISS 2020
Acromial and scapular fractures after reverse total shoulder arthroplasty with a medialized glenoid and lateralized humeral implant Routman HD, et al. J Bone Joint Surg Am. (2020); 102(19):1724–33. A retrospective review of 4125 primary reverse total shoulder arthroplasty (rTSA) surgeries in 3995 patients (mean age 72 years, 64% female) found 61 (1.5%) developed postoperative scapular fractures based on radiographs. Within a subset of 1869 rTSAs (1797 patients) with at least 2 years of post-operative follow up data, there were 33 (1.8%) scapular fractures. All rTSA surgeries used a single type of prosthesis featuring a medialized glenoid and lateralized humeral design. Operative indications included osteoarthritis, osteonecrosis, rheumatoid arthritis, rotator cuff tear and rotator cuff arthropathy. Patients with pre-operative fracture, os acromiale, revision rTSA, and infection were excluded from this study. Shoulder range of motion was measured and 5 clinical outcomes scores were collected pre-operatively and at the last follow-up examination; in addition, patient demographics and co-morbidities were recorded. Scapular fracture location was determined by the Levy classification depicted diagrammatically as: Type 1 (n = 10)- mid/lateral aspect of the acromion, Type 2 (n = 32)- medial acromion to spinoglenoid notch, Type 3 (n = 18)- scapular spine; one fracture “could not be classified.” All fractures were treated non-operatively. All clinical scores and range of motion assessments were poorer for patients experiencing scapular fractures. The mean time from surgery to radiographic fracture identification was 12.9 months (range 1 day – 6.5 years) with nearly a quarter of the fractures associated with trauma. Women were more likely to fracture (1.9% vs. 0.7%), and no men had Type 1 fractures. Mean time to fracture for Type 1 (16 months) and Type 3 (26 months) fractures was significantly longer than for Type 2 fractures (4.5 months). Patients with Type 3 fractures were more likely to have had previous shoulder surgery than those with Type 2 fractures. Risk factors for post-rTSA
scapular fracture included: female gender (odds ratio, OR = 2.75), rheumatoid arthritis (OR = 3.14), and rotator cuff arthropathy (OR = 2.07). Approximately 18% of patients were lost to 2 year follow-up. There may be limited generalizability of the results since only a single type of rTSA was used. Preoperative meniscal extrusion predicts unsatisfactory clinical outcomes and progression of osteoarthritis after isolated partial medial meniscectomy: A 5-year follow-up study. Novaretti JV, et al. J Knee Surg. (2020); EPub ahead of print PMID 32838459. Pre-operative medial meniscal extrusion for 95 patients (mean age 31 years, 70 males) who underwent arthroscopic isolated partial medial meniscectomy for meniscal tear was compared to clinical and radiographic outcomes at least 5 years post-operatively. Pre-operative meniscal extrusions were measured independently by 2 musculoskeletal radiologists on mid-
Data Loading...
