Clinical and Radiological Results after Arthroscopic Superior Capsular Reconstruction in Patients with Massive Irreparable Rotator Cuff Tears

BACKGROUND: Massive, irreparable rotator cuff tears (RCTs) are a challenging clinical problem in young patients. In recent years, arthroscopic superior capsular reconstruction (ASCR) is a popular treatment in the massive, irreparable RCTs. However, studies reporting clinical results of ASCR are rare in the literature. METHODS: Between 2013 and 2015, six patients underwent ASCR. One patient treated with dermal allograft, while five patients with autogenous fascia lata graft. Demographic data, as well as preoperative and last follow-up clinical data including pain, range of motion (ROM), strength, American Shoulder and Elbow Surgeons system, the Constant system, the University of California at Los Angeles system, the Simple Shoulder Test, and the Shoulder Pain and Disability Index system were obtained. Acromiohumeral distances and Hamada classification were measured on standard anteroposterior x-ray. RESULTS: All patients were men, and the average age was 59.5 ± 4.18 years (range, 53–65 years).The minimum follow-up was 18 months with a mean follow-up was 27.33 ± 7.58 months (range, 18–36). All patients had postoperative improvement in pain scores and functional scores. The ROM and strength did not improve after surgery. The Hamada score progressed of radiographic stage in 2 patients. In the case of dermal allograft, there was graft failure 6 weeks after ASCR. CONCLUSIONS: Our results support the ASCR as a viable treatment for surgical salvage in massive, irreparable RCTs. This treatment option may provide patients with decreased pain and increased function. And studying our case of dermal allograft failure provides opportunities to decrease graft failure in ASCR using dermal allograft.

Mini-open Treatment Using Plate of Clavicle Mid-shaft Fractures

BACKGROUND: Increased frequency of comminuted clavicle mid-shaft fractures and importance of functional satisfaction through early joint exercise has resulted in higher emphasis on surgical treatments. This study aimed to evaluate the clinical radiological results of treatment of clavicle mid-shaft fractures by open reduction and internal fixation using a plate with a small incision. METHODS: The subjects of this study were 80 clavicle mid-shaft fracture cases treated with internal fixation using a plate from October 2010 to July 2014. Clavicle mid-shaft fractures were internally fixated using anatomical plates or locking compression plates. Achievement of bone union, union period, and clavicle length shortening were evaluated radiologically, and clinical assessment was done by using Constant and University of California at Los Angeles (UCLA) scores. RESULTS: All 80 cases were confirmed to have achieved bone union through radiographs with an average union period of 10.9 weeks (range: 7–18 weeks). The average clavicle length of shortening in the affected side was 1.8 mm (range: 0–17 mm). The average UCLA score and Constant score were 33.6 (range: 25–35) and 92.5 (range: 65–100), respectively. Regarding complications, four cases reported skin irritation by metal plates, and one case reported a screw insertion site fracture due to minor trauma history. CONCLUSIONS: We were able to induce successful bone union and obtain clinically satisfactory results in displaced mid-shaft fractures of the clavicle without major complications such as nonunion through treatment of internal fixation using a plate.

Mini-open Treatment Using Plate of Clavicle Mid-shaft Fractures

BACKGROUND: Increased frequency of comminuted clavicle mid-shaft fractures and importance of functional satisfaction through early joint exercise has resulted in higher emphasis on surgical treatments. This study aimed to evaluate the clinical radiological results of treatment of clavicle mid-shaft fractures by open reduction and internal fixation using a plate with a small incision. METHODS: The subjects of this study were 80 clavicle mid-shaft fracture cases treated with internal fixation using a plate from October 2010 to July 2014. Clavicle mid-shaft fractures were internally fixated using anatomical plates or locking compression plates. Achievement of bone union, union period, and clavicle length shortening were evaluated radiologically, and clinical assessment was done by using Constant and University of California at Los Angeles (UCLA) scores. RESULTS: All 80 cases were confirmed to have achieved bone union through radiographs with an average union period of 10.9 weeks (range: 7–18 weeks). The average clavicle length of shortening in the affected side was 1.8 mm (range: 0–17 mm). The average UCLA score and Constant score were 33.6 (range: 25–35) and 92.5 (range: 65–100), respectively. Regarding complications, four cases reported skin irritation by metal plates, and one case reported a screw insertion site fracture due to minor trauma history. CONCLUSIONS: We were able to induce successful bone union and obtain clinically satisfactory results in displaced mid-shaft fractures of the clavicle without major complications such as nonunion through treatment of internal fixation using a plate.