Diagnóstico de roturas del manguito rotador por ecografía y resonancia magnética: ¿la morfología acromial influye en los resultados? / Ultrasound and magnetic resonance imaging diagnosis for rotator cuff tears: does acromial morphology affect the results?

INTRODUCCIÓN Actualmente no existen estudios que evalúen la concordancia entre la ecografía (ECO) y la resonancia magnética (RM) observando parámetros como el índice acromial (IA) y el ángulo crítico (AC) para roturas del manguito rotador (MR). Se considera que la mayor cobertura de la huella por un IA o AC incrementados podría afectar la adecuada visualización del MR en estudios de ECO al interponerse entre el complejo tendíneo y el transductor ecográfico. OBJETIVO Estimar la concordancia de la ECO y la RM en el diagnóstico de pacientes con roturas del MR confirmadas por artroscopia con IA y AC mayores al promedio normal (0.7 y 35°, respectivamente). Secundariamente, determinar si la concordancia diagnóstica es comparable entre tipos de rotura (espesor completo o parciales). MATERIALES Y MÉTODOS Estudio retrospectivo de una serie consecutiva de 100 pacientes con roturas totales o parciales del MR confirmadas por artroscopia. RESULTADOS La edad media del grupo de estudio fue de 55,7 ± 10,5 años. La media del IA fue de 0,77 ± 0,08, y la del AC, de 37,42° ± 5,88°. La concordancia entre la ECO y la RM y el IA fue > 0,7 de 56,7% (K = 0,27; p = 0,01); y < 0,7 de 35,7% (K = 0,01; p = 0,46), respectivamente. Y la concordancia entre la ECO y la RM y el AC fue > 35° de 61,5% (K = 0,32; p = 0,001); y < 35° de 33,3% (K = -0,00; p = 0,52), respectivamente. CONCLUSIÓN La concordancia diagnóstica de la ECO comparada con la de la RM, en pacientes con roturas del MR confirmada por artroscopia y con IA y AC mayores al promedio normal, fue justa. La concordancia diagnóstica de la ECO comparada con la RM, en pacientes con IA y AC menores al promedio normal, fue pobre. La capacidad diagnóstica fue similar entre la ECO y la RM para roturas parciales y totales.

INTRODUCTION Currently, there are no studies that evaluate the agreement between ultrasound (US) and magnetic resonance imaging (MRI) scans in rotator cuff (RC) tears by the observation of parameters such as the acromial index (AI) and critical shoulder angle (CSA). We hypothesize that the greater coverage of the footprint by increased AI or CSA could affect the proper visualization of the RC in US scans by its interposition between the tendinous complex and the US transducer. OBJETIVE To estimate the agreement between US and MRI in the diagnosis of patients with RC tears confirmed by arthroscopy and with AI and CSA greater than the normal average values (0.7 and 35° respectively). The secondary objective is to determine if the diagnostic agreement is comparable regarding different types of tear (partial and complete). MATERIALS AND METHODS A retrospective study of a consecutive case series of 100 patients with partial or complete RC tears confirmed by arthroscopy. RESULTS The mean age of the study group was of 55.7 10.5 years. The mean AI was of 0.77 0.08, and the mean CSA was of 37.42° 5.88°. The agreement regarding the US, the MRI and the AI was > 0.7 of 56.7% (K » 0.27; p » 0.01); and < 0.7 of 35.7% (K » 0.01; p » 0.46) respectively. And the agreement regarding the US, the MRI and the CSA was > 35° of 61.5% (K » 0.32; p » 0.001); and < 35° of 33.3% (K »-0.00; p » 0.52) respectively. CONCLUSION The diagnostic agreement of the US compared with the MRI, in patients with RC tears confirmed by arthroscopy and with AI and CSA greater than the normal average values was fair. The diagnostic agreement of the US compared with the MRI, in patients with AI and CSA lower than the normal average values was poor. The diagnostic performance of the IS and MRI was similar for partial and complete tears.

Anatomic classification of the acromial angle and its clinical significance / 解剖学报

Objective To study the acromial angle morphologic type and measurement analysis based on CT 3D reconstruction. Methods Totally 278 cases of adult CT three-dimensional reconstruction of the shoulder morphological data were collected, and the measurement data of the different types was analyzed, its statistical significance was clarified, and the morphological characteristics to division the type of acromial angle were summarized, its diagnosis and treatment under the acromion impingement of guiding significance were discussed. Results The acromial angle was divided into three types (C shaped acromial angle, L shaped acromial angle, and double angle shaped acromial angle). Among them, L type was the most, accounting for 48. 56%, followed by C type, and double angle type was the least. In comparison of the breadth of the acromion and the length of the acromion, L type was significantly longer than C type (P<0. 05). The thickness of acromion at a point of the double angle shaped acromial angle was greater than that of the other two type (P<0. 05). In the comparison of ∠a, the double-angle type was greater than the C type（P＜0.05）, and the C type was greater than the L type（P＜0.05）. Conclusion There are significant differences in the classification and anatomical parameters of acromial angle, and the differences are statistically significant. It has certain guiding significance to the etiology and clinical diagnosis and treatment of subacromial impingement syndrome.

Reliability of Bigliani’s Classification using Magnetic Resonance Imaging for Determination of Acromial Morphology

@#Introduction: Bigliani classification is used for determination of acromial morphology, but poor interobserver reliability has been reported on conventional radiographs. This study aims to assess inter- and intraobserver reliability using magnetic resonance imaging (MRI). Materials and methods: Forty consecutive patients diagnosed with subacromial impingement syndrome were included to study. All subjects underwent standard shoulder MRI scan and acromial shape was evaluated by nine observers of different level of expertise (three attending surgeons, three senior orthopaedic residents and three radiologists). A second set of evaluation was performed in order to assess intra-observer reproducibility. Kappa (κ) coefficient analyses both for interobserver reliability and intra-observer reproducibility were then performed. Results: Overall inter-observer agreement among nine observers was fair (κ=0.323). κ values for all 4 individual types ranged from 0.234 to 0.720 with highest agreement for type 4 and lowest agreement for type 3. Second evaluation did not result with an increase of inter-observer agreement (κ=0.338, fair). The κ coefficients for intra-observer reproducibility of nine observers ranged from 0.496 to 0.867. Overall intra-observer reproducibility was substantial. Comparison of inter- and intra-observer reliability among three groups showed no significant difference (p=0.92 and 0.22, respectively). Conclusion: Results showed that MRI did not show superior reliability compared to conventional radiographs. Moreover, inter- and intra-observer agreement did not differ between observers of different level of expertise. Findings of present study suggest that despite a sophisticated imaging modality like MRI, Bigliani’s classification apparently lacks accuracy and additional criteria, or different assessment methods are required to assess acromial morphology for clinical guidance.

Effect of the acromial inferolateral tilt on subacromial impingement syndrome: a retrospective magnetic resonance imaging assessment / A contribuição da inclinação inferolateral do acrômio na síndrome do impacto subacromial: uma avaliação retrospectiva por ressonância magnética

Abstract Objective: To evaluate the effect of acromial inferolateral tilt on subacromial impingement syndrome. Materials and Methods: The acromial inferolateral tilt was retrospectively quantified by two researchers on 346 shoulder magnetic resonance images using the glenoacromial (between the inferior proximal acromial surface and the glenoidal face) and acromioclavicular (between the axis of the proximal acromion and distal clavicle) angles. Results: The glenoacromial angle was associated with subacromial impingement syndrome (p < 0.001) and complete supraspinatus tendon rupture (p < 0.001), and the acromioclavicular angle was associated with partial or complete supraspinatus tendon rupture (p = 0.003). The area under the receiver operating characteristic curve (AUC), best cut-off angle, and odds ratio (OR) of the glenoacromial angle for impingement syndrome were 0.579 (95% confidence interval [CI]: 0.508-0.649; p = 0.032), 72°, and 2.1 (95% CI: 1.136-4.053), respectively. For complete supraspinatus tendon rupture, the AUC, best cut-off angle, and OR of the glenoacromial angle were 0.731 (95% CI: 0.626-0.837; p = 0.001), 69°, and 8.496 (95% CI: 2.883-28.33), respectively. For partial or complete supraspinatus tendon rupture, the AUC, best cut-off angle and OR of the acromioclavicular angle were 0.617 (95% CI: 0.539-0.694; p = 0.002), 17°, and 3.288 (95% CI: 1.886-5.768), respectively. Interobserver agreement found for the glenoacromial and acromioclavicular angles were 0.737 (95% CI: 0.676-0.787; p < 0.001) and 0.507 (95% CI: 0.391-0.601; p = 0.001), respectively. Conclusion: Inferolateral acromial tilt may have some impact on subacromial impingement syndrome; however, the best quantification method identified (glenoacromial angle) showed a moderate interobserver agreement and a fair performance to assess the risk of complete supraspinatus tendon rupture.

Resumo Objetivo: Avaliar a contribuição da inclinação inferolateral do acrômio na síndrome do impacto subacromial. Materiais e Métodos: A inclinação inferolateral do acrômio foi quantificada retrospectivamente por dois pesquisadores em 346 ressonâncias magnéticas de ombro por meio dos ângulos glenoacromial (entre a superfície inferior proximal do acrômio e a face glenoidal no plano coronal) e acromioclavicular (entre o eixo do acrômio proximal e o eixo da clavícula distal no plano coronal). Resultados: Houve associação entre ângulo glenoacromial e síndrome do impacto subacromial (p < 0,001) e ruptura completa do tendão supraespinal (p < 0,001). Ângulo acromioclavicular associou-se a ruptura parcial ou completa do tendão supraespinal (p = 0,003). A área sob a curva (area under the curve - AUC) característica de operação do receptor, o melhor ângulo de corte e a razão de chances (odds ratio - OR) do ângulo glenoacromial para a síndrome do impacto foram, respectivamente: 0,579 (intervalo de confiança [IC] 95%: 0,508-0,649; p = 0,032), 72° e 2,1 (IC 95%: 1,136-4,053). Para ruptura completa do tendão supraespinal, a AUC, o melhor ângulo de corte e a OR do ângulo glenoacromial foram, respectivamente: 0,731 (IC 95%: 0,626-0,837; p = 0.001), 69° e 8,496 (IC 95%: 2,883-28,33). Para ruptura parcial ou completa do tendão supraespinal, a AUC, o melhor ângulo de corte e a OR do ângulo acromioclavicular foram, respectivamente: 0,617 (IC 95%: 0,539-0,694; p = 0,002), 17° e 3,288 (IC 95%: 1,886-5,768). As concordâncias interobservador encontradas para os ângulos glenoacromial e acromioclavicular foram, respectivamente: 0,737 (IC 95%: 0,676-0,787; p < 0,001) e 0,507 (IC 95%: 0,391-0,601; p = 0,001). Conclusão: Inclinação inferolateral do acrômio pode determinar alguma influência sobre a síndrome do impacto subacromial, entretanto, o melhor método de quantificação identificado (o ângulo glenoacromial) apresentou moderada concordância interobservador e desempenho moderado para estratificar o risco de ruptura completa do tendão supraespinal.

Meta-analysis of intramedullary nail and locking plate in the treatment of proximal humeral fractures / 中国组织工程研究

BACKGROUND: Proximal humeral fractures are one of the most common types of upper limb fractures In adults. With the aging of the population, the Incidence of proximal humeral fractures has been increasing in recent years, and its treatment is still controversial. OBJECTIVE: To compare the clinical efficacy of locking plate and intramedullary nail in the treatment of proximal humeral fractures using meta-analysis. METHODS: We retrieved PubMed, the Cochrane Library, Embase, CNKI, Wanfang, and VIP database to collect studies on intramedullary nail and locking plate in the treatment of proximal humeral fractures. In accordance with the inclusion and exclusion criteria, studies were included. Data were extracted from the included studies. Continuous variables (Constant score, operation time, blood loss) and binary classification variables (total complications, postoperative infection, screw cutout and internal fixation failure, humerus head necrosis, secondary surgery, and acromial impact) were analyzed, and considered as evaluation indexes for the meta-analysis. Statistical software Stata12.0 was used to analyze the data. RESULTS AND CONCLUSION: (1) A total of 8 articles and 891 patients were included, and 9 data were analyzed. (2) The amount of blood loss (SMD=-1.82, 95%C/: -2.77—0.87, P 0.05). (3) These results confirmed that intramedullary nailing is superior to locking plate in operation time and intraoperative blood loss in the treatment of proximal humeral fractures. The results were similar in total complication rate, common complication rate and postoperative recovery of shoulder joint function between the two groups.

Os Acromiale-unusual Manifestation as Superior Spur and Bursitis-A Case Report

An Os acromiale is a condition that results from the failure of fusion of the anterior acromial apophysis. It can be asymptomatic. It can also result in subacromial impingement and rotator cuff tear. In this case report of a 39year-old lady we would like to present the management of the painful bursitis and spur formation on the superior surface of a meso-type of os acromiale. Conservative management in the form of rest, anti-inflammatory drugs and physiotherapy did not provide symptomatic relief. Patient then underwent surgical excision of the superior spur. Open reduction and internal fixation was not carried out. Patient had resolution of pain and no recurrence of symptoms or features of impingement at 6 months follow up. To the best of our knowledge there are limited reportsin English literature about this rare subset of patients with symptomatic os acromiale with superior spur formation and with no features of impingement or cuff pathology.

Thoraco-Acromial Artery : A Cadaveric Study Of Its Pedicle And Branches

Background of study- A detailed knowledge of variations in the origin and branching pattern of Thoraco-acromial artery(TAA) is important during various reconstructive and microvascular surgeries. Materials and methods- Hundred formalin xed specimens were studied at Government Medical College, Kozhikode, Kerala, India over a period of four years. Results- Normal quadrifurcation pattern was observed in majority of specimens (84%). The division of TAA into two trunks was seen in 9% followed by ramication into multiple branches in 4% specimens. Some specimens showed trifurcation (3%). Conclusion- In this scenario of increasing reconstructive surgeries, a thorough knowledge on the anatomical variations of TAA will be helpful to surgeons as this artery provides vascular supply to Pectoralis Major Myo-Cutaneous ap.

Crossbar Technique for the Failed Clavicular Hook Plate Fixation in an Acute Acromioclavicular Joint Dislocation: Salvage for Acromial Fracture after Clavicular Hook Plate

We experienced acromial erosion and subsequent fracture after the treatment of Rockwood type V acromioclavicular dislocation with hook plate and coracoclavicular ligament augmentation. It was treated by using a surgical technique to address an acromial fracture and subsequent losses of reduction in acromioclavicular joint with two trans-acromial cortical screws (crossbar technique). The reduction state of acromioclavicular joint could be maintained by these two screws. Our crossbar technique could be considered as a good salvage procedure for the reduction loss caused by cutout or significant erosion of acromion after insertion of clavicular hook plate.

Morphological Variations Of The Coraco-acromial Ligament: A Cadaveric Study

Introduction: The coraco-acromial ligament forms coraco-acromial arch along with acromion and coracoidprocess of scapula which prevent the superior humeral head displacement. It plays a key role in the pathoetiology of sub-acromial impingement syndrome when there are no significant bony abnormalities.Material and Methods: In the present study we have studied 120 formalin preserved upper limbs (right: 60; left:60) of unknown age and sex. Each shoulder was dissected carefully to see coraco-acromial ligament. The CALwas identified with careful blunt dissection to prevent overlooking any thinner bands. We observed the numberof bands present and shape of the ligament. Photographs were taken.Results: Different morphological subtypes of coraco-acromial ligament were observed and classified accordingto Kesmezacar et al. Type II (28.33 %) was the most common then type I (25 %), type IV (17.5 %), type V (15 %), typeIII (11.66%). Anterolateral band of ligament extended antero-laterally to form coracoacromial falx in 51%.Discussion: Coraco-acromial ligament shows different morphological variations in Indian population. Knowledgeof morphological variations of coraco-acromial ligament will be helpful for orthopedic surgeon for clinical andintraoperative decision while dealing with sub-acromial impingement syndrome.

Unilateral Variation In Branching Pattern Of Third Part Of Left Axillary Artery: A Case Report

The Axillary artery is the continuation of the subclavian artery and is a major artery of the upper limb. During theroutine dissection for undergraduate Ayurvedic medical students of SDM Trust’s Ayurvedic Medical College,Terdal, Bagalkot, Karnataka, India, in the department of anatomy we come across a variation in branchingpattern of third part of left axillary artery in male cadaver approximately 55 years of age. The first part and thesecond part of left axillary artery branches were found to be normal but third part of left axillary artery presentingonly one common trunk. This common trunk running posteriorly and dividing into subscapular artery, Anteriorcircumflex Humeral Artery, Posterior circumflex Humeral Artery and profunda brachii artery.

Predictors of shoulder degeneration in the Kwazulu-Natal population of South Africa / Indicadores de la degeneración del hombro en la poblacion Kwazulu/Natal de Sudáfrica

SUMMARY: The critical shoulder angle and acromion index are conventional radiological tools employed as predictors of shoulder degeneration. As they represent the static components of glenohumeral stability, the scapulo-humeral geometry and underlying subacromial tissue appear as the resultant cause-effect factors. Consequently, the purpose of this study was to investigate the critical shoulder angle and acromion index as interrelated parameters within the South African population. The measurement of both biomechanical parameters was conducted on two-hundred and sixty (n = 260) true AP radiographs. This was a cross-sectional study that also incorporated the demographic representation of the population group which was analysed accordingly. The mean values recorded for both the critical shoulder angle (36.31±5.84º) and acromion index (0.74±0.13) suggested rotator cuff arthropathy. The results confirmed the theories of Nyffeler et al. (2006) and Moor et al. (2012) who alluded to glenoid inclination and the acromial coverage over the humeral head. A significant proportionality correlation, verified by a P value of 0.000, was established between the acromion index and critical shoulder angle which may assist to differentiate between normal asymptomatic shoulders and those with cuff disease. Furthermore, these predictors of shoulder degeneration may present as a preventative tool against tear progression.

RESUMEN: El ángulo crítico del hombro y el índice acromial son herramientas radiológicas convencionales empleadas como indicadores de la degeneración del hombro. Debido a que representan los componentes estáticos de la estabilidad glenohumeral, la geometría escápulo-humeral y el tejido subacromial subyacente aparecen como los factores causa-efecto resultantes. En consecuencia, el propósito de este estudio fue investigar el ángulo crítico del hombro y el índice acromial como parámetros interrelacionados dentro de la población sudafricana. La medición de ambos parámetros biomecánicos se realizó en 260 radiografías antero-posteriores (AP). Se realizó un estudio transversal que también incorporó la representación demográfica del grupo de la población que fue analizada. Los valores medios registrados tanto para el ángulo crítico del hombro (36,31 ± 5,84º) como para el índice del acromión (0,74 ± 0,13) sugirieron una artropatía del manguito rotador. Los resultados confirmaron las teorías de Nyffeler et al. (2006) y Moor et al. (2012) que aludían a la inclinación glenoide y a la cobertura acromial sobre la cabeza humeral. Se estableció una correlación de proporcionalidad significativa, verificada por un valor de P de 0,000, entre el índice acromial y el ángulo crítico del hombro, lo que puede ayudar a diferenciar entre los hombros asintomáticos normales y aquellos con enfermedad del manguito rotador. Además, estos predictores de degeneración del hombro pueden ser útiles como una herramienta preventiva contra la progresión del desgarro.

Evaluation of the elbow carrying angle in healthy individuals / Evaluación del ángulo de desplazamiento del codo en individuos sanos

SUMMARY: Carrying angle, or cubital angle defined as the acute angle formed by the median axis of the arm when forearm is in fully extended and supinated position. This angle changes with skelatal growth and maturity. This study was aimed to investigate the correlation of carrying angle with bi-acromial diameter and bi-acromial diameter/bi-trochanteric diameter in our healthy young adult population. This was a cross-sectional study that included 400 (204 male, 196 female) young adult students selected from Çukurova University aged between 18-25 years (mean±standard deviation of females: 20.11±2.05 years; mean±standard deviation of males: 20.45±1.82 years) which originated from different cities in Turkey. After recording demographic data, carrying angle, forearm length, arm length, bi-trochanteric diameter and bi-acromial diameter were measured by using nonelastic tape measure, pelvimeter and manuel goniometer. In addition, body mass index and bi-acromial diameter/bi-trochanteric diameter were calculated for each participants. The mean values of body height and weight were in following respectively for both genders: 178.53±6.40 cm (male), 163.88±5.73 cm (female); 74.89±10.81 kg (male), 57.56±8.61 kg (female). Whereas on dominant arm this angle was as in males 9.77°±2.82° and 13.94°±3.97° in females. The mean value of the carrying angle on nondominant arm in males was 9.85°±2.95° and 14.03°±4.08° in females. The mean carrying angle was 9.81°±2.82° in males and 13.99°±3.97° in females. There are linear relationship between the carrying angle and height (r=-0.474, p<0.001, bi-acromial diameter (r=-0.490, p<0.001), bi-acromial diameter/bi-trochanteric diameter (r=-0.449, p<0.001), forearm length (r=-0.366, p<0.001) and arm length (r=-0.273, p<0.001). We believe that the reference values of carrying angle will help the clinician in the management of elbow displacements, fractures, prosthetic design and diagnosis of epicondylar diseases.

RESUMEN: Se estudió el ángulo de sustentación o ángulo cubital definido como el ángulo agudo formado por el eje mediano del brazo al estar en posición completamente extendido y supinado el antebrazo. Este ángulo cambia con el crecimiento esquelético y la madurez. El objetivo de este estudio fue investigar la correlación del ángulo con el diámetro biacromial y el diámetro bi-acromial / diámetro bi-trocantérico en una población adulta joven y sana. Se realizó un estudio transversal que incluyó 400 (204 hombres, 196 mujeres) estudiantes adultos jóvenes seleccionados de la Universidad de Çukurova con edades comprendidas entre 18-25 años (media ± desviación estándar de las mujeres: 20,11 ± 2,05 años; media ± desviación estándar de los hombres: 20,45 ± 1,82 años) que se originaron en diferentes ciudades de Turquía. Después de registrar los datos demográficos, el ángulo de desplazamiento, la longitud del antebrazo, la longitud del brazo, el diámetro bi-trocantérico y el diámetro biacromial se midieron utilizando cinta métrica no elástica, pelvímetro y goniómetro manual. Además, se calcularon el índice de masa corporal y el diámetro bi-acromial / diámetro bi-trocantérico para cada participante. Los valores medios de la altura y el peso corporal fueron respectivamente para ambos sexos: 178,53 ± 6,40 cm (masculino), 163,88 ± 5,73 cm (femenino); 74,89 ± 10,81 kg (masculino), 57,56 ± 8,61 kg (femenino). Mientras que en el brazo dominante este ángulo fue como en los hombres 9,77° ± 2,82° y 13,94° ± 3,97° en las mujeres. El valor medio del ángulo de transporte en el brazo no dominante en los hombres fue de 9,85° ± 2,95° y de 14,03° ± 4,08° en las mujeres. El ángulo medio de desplazamiento fue de 9,81° ± 2,82° en hombres y 13,99 ° ± 3,97 ° en mujeres. Hay una relación lineal entre el ángulo de desplazamiento y la altura (r = -0,474, p <0,001, diámetro bi-acromial (r = -0,490, p <0,001), diámetro biacromial / diámetro bi-trocantérico (r = -0,449, p <0,001), longitud del antebrazo (r = -0,366, p <0,001) y longitud del brazo (r = -0,273, p <0,001). Creemos que los valores de referencia del ángulo de carga ayudarán al clínico en el manejo de los desplazamientos del codo, las fracturas, el diseño protésico y el diagnóstico de enfermedades epicondilares.

Severe Sub-Acromial Bursitis with Rice Bodies in a Patient with Rheumatoid Arthritis: A Case Report and Review of Literature

@#sub-acromial bursitis secondary to extensive underlyingrheumatoid arthritis, sero-negative inflammatory arthritis ortuberculous joints. Although there is usually anaccompanying inflammatory arthropathy, it can occur in theabsence of any underlying systemic disorder. We report acase of five years old neglected rice body deposition inshoulder in a 54-years old lady diagnosed to be havingrheumatoid arthritis. After initial investigations, arthroscopicremoval of rice bodies with bursa excision relieved thesymptoms. The underlying rheumatic condition continued itscourse, generally sparing the involved shoulder joint. Wesuggest thorough examination for systemic rheumatologicdisease in patients diagnosed with such lesions.

Acromio-Clavicular Joint Dislocation Types IV to VI: Does the Outcome with the modified Weaver-Dunn Procedure Justify the Treatment?

@#clavicular joint (ACJ) injuries remains controversial. Themodified Weaver-Dunn (WD) procedure is one of thefrequently used techniques. Recently when it was comparedwith anatomical autogenous tendon graft reconstructionprocedures, the results were inferior. However, theseanatomical procedures are technically more demanding withsmall margin of error and they have tendency forpostoperative pain because of extra donor site incision.Materials and Methods: Forty patients with type IV to VIACJ dislocations were treated by modified WD procedureusing non-absorbable synthetic suture passed through thebase of coracoid process for augmentation of transferredcoraco-acromial (CA) ligament. Functional outcome wasassessed using the Oxford Shoulder Score, NottinghamClavicular Score and Visual Analog Score (VAS) at the finalfollow-up after surgery.Results: The mean pre-operative Oxford Shoulder Scoreimproved from 25.22±2.64 (range 20 to 30) to 44.75±1.99(range 40 to 48) and mean pre-operative NottinghamShoulder Score improved from 49.25±4.91 (range 39 to 58)to 87.27±4.39 (range 79 to 96) at last follow-up after surgerywith p-value <0.001. Thirty-five (87.5%) patients hadexcellent outcomes, four (10%) patients had good outcomesand one (2.5%) patient had fair outcome. Thirty-eight (95%)patients had no pain while two (5%) had moderate painbased on VAS score.Conclusion: Modified Weaver-Dunn is a simple wellestablished technique for grade IV to VI ACJ dislocation.We cannot consider this procedure as old and outdated on theargument that the long term functional outcomes are notsubopti

MRI in assessment of relationship between acromial morphology and rotator cuff tear / 中国医学影像技术

Objective To analyze the relationship between the morphological characteristics and rotator cuff tear (RCT) by MR.Methods The data of clinic and shoulder MRI of 37 patients with RCT (patients group) were analyzed retrospectively,and 19 healthy volunteers were collected in control group.The acromial shapes were classified into type Ⅰ (flat),type Ⅱ (curved),type Ⅲ (hooked) and type Ⅳ (convex).Additional measurements about pathogenesis of RCT including acromio-humeral distance (AHD),acromial index (AI),lateral acromial angle (LAA) and acromial thickness were performed for further assessment.Results Type Ⅱ was the most commonly encountered acromial shape in patients group (16/37,43.24 ％) and control group (11/19,57.89 ％).There was no statistically significant difference in the incidence of each acromial shape between two groups (P＞0.05).However,the AHD,AI,LAA and acromial thickness showed statistically significant difference between the patients group and control group (all P＜0.05).The type Ⅲ acromion was signifi candy different from the other types in patients group (P＜0.05).Conclusion MRI can clearly display RCT.The AHD and LAA are smaller,the AI and acromial thickness are bigger in RCT patients.Type Ⅲ acromion may increase risks for RCT.

A Histological Study of Postnatal Development of Clavicle Articular Ends / Estudio histológico del desarrollo posnatal de los extremos articulares de la clavícula / Um estudo histológico do desenvolvimento pós-natal das extremidades articulares da clavícula

The clavicle is the first bone to begin the process of ossification and the last one to complete it. Whilst histological studies of the clavicle have been focused mainly on embryonic events, our study focused on postnatal clavicle development. The objective of this study was to perform a qualitative description of the clavicle's epiphyseal growth to further shed light on the postnatal ossification process. Histological studies performed on clavicles obtained from cadavers confirmed medial and lateral extremities as true physes. Unlike the development of other long bones, no secondary ossification centre was present at the acromial end. Furthermore, appearance of the sternal end was observed after the age of 18, as evidenced in clavicles from a 19-year old individual. The articular surface of the clavicle's acromial end was fibrocartilage. Thus far no histological studies have been performed before describing postnatal development of clavicular ends. Our data confirm the absence of an acromial secondary ossification centre, the late development of a secondary ossification centre at the sternal end, and the presence of fibrocartilage at the acromial end.

La clavícula es el primer hueso que comienza el proceso de osificación y el último en completarlo. Mientras los estudios histológicos de la clavícula se han enfocado principalmente en los eventos embrionarios, nuestro estudio se enfoca en su desarrollo posnatal. El objetivo de este estudio fue llevar a cabo una descripción cualitativa del crecimiento epifisario de la clavícula, que pueda arrojar luz sobre el proceso de osificación posnatal. Los estudios histológicos llevados a cabo en clavículas procedentes de cadáveres confirman que las extremidades mediales y laterales son verdaderas fisis. A diferencia del desarrollo de otros huesos largos, no se encuentra otro centro de osificación secundaria en la extremidad acromial. Por otra parte, la aparición de la extremidad esternal ocurre a la edad de 18 años, como se evidenció en clavículas del individuo de 19 años de edad. La superficie articular del extremo acromial de la clavícula era fibrocartilago. No se han realizado hasta ahora estudios histológicos que describan el crecimiento posnatal de las extremidades claviculares. Nuestros datos confirman la ausencia de un centro de osificación secundaria acromial, el desarrollo tardío de un centro de osificación secundaria en la extremidad esternal y la presencia de fibrocartílago en la extremidad acromial.

A clavícula é o primeiro osso a iniciar o processo de ossificação e o último em completar. Enquanto estudos histológicos da clavícula tém sido focados principalmente em eventos embrionarios, nosso estudo enfoca no desenvolvimento pós-natal da clavícula. O objetivo de esse estudo foi realizar uma descreo qualitativa do crescimento epifisário da clavícula para aclarar o processo de ossificação pós-natal. Estudos histológicos realizados em clavículas obtidas de cadáveres confirmaram as extremidades mediais e laterais como fises reais. Diferente do desenvolvimento de outros ossos longos, nenhum centro de ossificação secundário estava presente na extremidade acromial. Além disso, o aparecimiento da extremidade esternal foi observado após os 18 anos, sendo evidenciado em clavículas de indivíduos de 19 anos. A superficie articular da extremidade acromial da clavícula era fibrocartilaginosa. Nenhum estudo histológico havia sido realizado previamente descrevendo o desenvolvimento pós-natal das extremidades claviculares. Nossos dados confirmam a ausencia de um centro de ossificação secundária acromial, o desenvolvimento tardio de centro de ossificação secundário na extremidade esternal, e a presenca de fibrocartilagem na extremidade acromial.

Correlación entre la anatomía acromial y roturas del manguito rotador: estudio caso-control / Relationship between acromial anatomy and rotator cuff tears: a case control-study

Determinar si existe correlación entre la anatomía acromial documentada por radiología y la presencia de roturas del manguito rotador (MR) evaluadas en forma artroscópica. Hipótesis: Existe correlación positiva entre la morfología acromial y las roturas del MR. Métodos: Serie retrospectiva caso-control de 279 casos consecutivos tratados mediante cirugía artroscópica. Se analizaron 2 cohortes; un grupo con roturas completas del MR (N = 155) y un grupo control, tratados por inestabilidad glenohumeral (N = 124) a los que se documentó indemnidad del MR durante la artroscopia. Se documentó la anatomía acromial preoperatoria mediante radiografías de hombro anteroposterior verdadera y axial subacromial y se midieron la pendiente acromial según Bigliani (B), la inclinación acromial según Kitay (K) y el índice acromial según Nyffeler (AI). Resultados: Las diferencias entre los valores promedios de B y K entre grupos no fueron significativas (p = 0,6 y p = 0,3). No existió correlación entre B y AI (r = 0,054; p = 0,377). Evidenciamos una correlación positiva en ambos grupos entre la inclinación acromial (r = 0,2; p = 0,008) y la pendiente acromial (r = 0,1; p = 0,03). Encontramos diferencias significativas en el IA entre grupos, que fue mayor para los casos (p = 0,01). Conclusión: En los resultados de las mediciones radiológicas de la anatomía acromial en nuestra población, documentamos una correlación significativa entre extensión del AI y roturas del MR confirmadas durante artroscopia...

To study the anatomical relationship between acromial morphology documented on X- rays and rotator cuff (RC) tears evaluated using arthroscopy. Hypothesis: There is a positive correlation as regards acromial morphology and RC tears. Methods:A retrospective, case control series of 279 consecutives cases, who underwent arthroscopic surgery were included in this study; cases were separated into 2 cohorts; one group with complete RC tears (N=155) and a control group treated for glenohumeral instability (N=124) with indemnity of the RC confirmed during arthroscopy. Pre-operative acromial anatomy was documented with X- rays – true anteroposterior and sub-acromial outlet views – measuring the acromial slope according to Bigliani (B), acromial tilt according to Kitay (K), and acromial index according to Nyffeler (AI). Results: The differences in the mean values of B and K between groups were not significant (P=.6 and P=.3). There was no correlation between B and AI (r= 0.05; P=.3). A positive correlation was observed between the acromial tilt (r= 0.2; P=.008) and acromial slope (r= 0.1; P=.03). A significant difference was found regarding AI, with greater values in the case group (P=.01). Conclusion:In this study, the acromial slope according to Bigliani, and acromial tilt according to Kitay, does not correlate with RC tears. A positive correlation of the AI with RC tears was observed...

Minimally invasive treatment via anterolateral acromial approach for severely impacted valgus fractures of proximal humerus / 第二军医大学学报

Objective To evaluate the feasibility and clinical outcomes of minimally invasive treatment via anterolateral acromial approach (ALA) for severely impeded vaigu fractures of the proximal part of the humerus. Methods From June 2011 to may 2013 a total of 20 patient’s with severly impacted valgus proximal humeral fracture were treated through ALA in a minimally invasive manner. Direct reduction, bone grafting, reconstruction of the rotator cuff insertion and Proximal Humerus Internal Locking System (PHILOS) Planting were well carried out. Systematic rehabilitation exercise of the shoulder joint was performed postoperatively. Results All the patients were followed-up for at least one year. with an average of (15 ± 3) months (range 12~36 months). No axillary neurapraxia occurred that could be attributed to the surgical approach. All fractures healed within 6 months. and tHaverage Constant-Murley score at 1 year was (83.0 ± 1.5) (range 79.0 to 89.5) during a 12-month follow-up. There was no internal fixation failure or avascular necrosis (AVN) of humeral head during follow-up. Conclusion Treatment of severely impacted valgus proximal humeral fractures with minimally invasive ALA through percutaneous plating PHILOS can avoid the injury of nerve and vascular. reduce the dissection of sott tissue. avoid damage to the residual blood supply of the humeral head and achieve stab! fixation, benefiting early function recovery.

An anthropometry study of the shoulder region in a chinese population and its correlation with shoulder disease / Estudio antropométrico de la región del hombro en una población china y su relación con enfermedad del hombro

Purpose: There is a paucity of data which reflected the relationship between morphology and incidence of shoulder disorders with respect to the ethnic Chinese population. We used anteroposterior radiographs to measure the Acromion Index (AI) and Acromioglenoid Angle (AA) of Chinese patients. The baseline was defined as the line that connected the superior and inferior osseous margins of the glenoid cavity. In order to calculate the AI, the distance from the baseline to the lateral margin of the acromion was measured and then divided by the distance from the baseline to the lateral aspect of the humeral head. The AA was defined as the angle formed by the intersecting line drawn tangent to the sclerotic line of the acromion undersurface and the baseline point. The AI and AA were determined in three groups: 165 patients (average age, 60.2 years) with chronic shoulder symptoms; in an age and gender-matched acute injury group of 61 patients (average age, 44.3 years); and in an age and gender-matched control group of 63 volunteers (average age, 37.3 years).The average AI and standard deviation was 0.72 +/- 0.06 in shoulders with subacromial impingement syndrome, 0.59 +/- 0.06 in those with acute injury, and 0.66 ± 0.06 in normal shoulders. The average AA and standard deviation was 76.8°+/-7.02 in shoulders with subacromial impingement syndrome, 84.2°+/-7.81 in those with acute injury, and 80.0°+/- 7.33 in normal shoulders. The AI and AA varied between patients with acute and chronic shoulder problems.

Hay escasez de datos que reflejen la relación entre la morfología y la incidencia de los trastornos de hombro con respecto a la población de origen chino. Se utilizó radiografías anteroposteriores para medir el índice acromial (IA) y ángulo acromioglenoido (AA) de los pacientes chinos. La línea de base se define como la que conecta los márgenes óseos superior e inferior de la cavidad glenoidea. Con el fin de calcular el IA, se midió la distancia desde la línea base hasta el margen lateral del acromion y luego se dividió por la distancia desde la línea base hasta la cara lateral de la cabeza humeral. El AA se define como el ángulo formado por la línea de intersección dibujada tangente a la línea esclerótica de la superficie inferior del acromion y el punto de línea base. El AI y AA se determinaron en tres grupos: 165 pacientes (edad media, 60,2 años) con síntomas crónicos en el hombro; en un grupo de 61 pacientes (edad media, 44,3 años) con herida aguda, y en un grupo control de 63 voluntarios (edad media, 37,3 años). La IA promedio fue de 0,72 +/- 0,06 en los hombros con el síndrome de pinzamiento subacromial, 0,59 +/- 0,06 en los pacientes con lesión aguda, y 0,66 +/- 0,06 en los hombros normales. El AA promedio fue de 76,8 ° +/- 7,02 en los hombros con el síndrome de pinzamiento subacromial, 84,2 ° +/- 7,81 en los pacientes con lesión aguda, y 80,0 ° +/- 7,33 en los hombros normales. La IA y AA variaron entre los pacientes con problemas en el hombro agudos y crónicos.

Acromial morphometric analysis using imaging software / Análisis morfométrico del acromion usando software de imágenes

The aim of this study was to accurately measure acromial morphology in order to describe the anatomical patterns of its subtypes and to conduct a survey of the literature regarding the relationships between morphological subtypes and their related diseases. We photographed scapulae from the Institute of Anatomy, University Severino Sombra, and analyzed the images using Image-J Software®. The average acromial angle was 139.23° ± 2.781, with no significant difference between the right and left sides. There was a positive correlation between the acromial angle and the angle of the spine of the scapula. The correlation mentioned above plays an important role in disorders of the shoulder-particularly impingement syndrome-which reinforces the importance of acromial morphology studies.

El objetivo de este estudio fue medir con precisión la morfología acromial para describir los patrones anatómicos de sus subtipos y llevar a cabo un estudio de la literatura sobre las relaciones entre los subtipos morfológicos y las enfermedades relacionadas. Tomamos fotografías de la escápula del Instituto de Anatomía de la Universidad Sombra Severino, y se analizaron las imágenes con el Software Image-J®. El ángulo acromial medio fue de 139,23 ± 2,781°, no habiendo diferencias significativas entre los lados derecho e izquierdo. De observó una correlación positiva entre el ángulo acromial y el ángulo de la columna vertebral de la escápula. La correlación mencionada anteriormente, juega un papel importante en los trastornos de la inflamación del hombro, especialmente el síndrome, lo cual refuerza la importancia de los estudios de la morfología acromial.