Relation between narrowed coracohumeral distance and subscapularis tears

Purpose: The Purpose of this study is to detect differences between the values of dynamic coracohumeral distance [CHD] measured using ultrasonography [USG] in different shoulder rotations and to investigate its correlation with subscapularis tear

Methods:We prospectively enrolled consecutive patients [n = 84] who were scheduled to have arthroscopic rotator cuff repair. Patients with a history of previous shoulder surgery or shoulder fracture and patients with external rotation less than 30 were excluded from the study. Dynamic coracohumeral distance was measured utilizing ultrasonography in 3 different shoulder positions: external rotation, neutral and internal rotation. We assessed the intrarater reliability with 3 times repetition of measurement. Patients were divided into one of 3 groups according to arthroscopic findings: intact subscapularis, partial-thickness tear, and full-thickness tear of the subscapularis. The control group [n = 12] included patients without rotator cuff tears from the outpatient clinic. Subgroup analysis according to the presence of dynamic subcoracoid stenosis, defined as a coracohumeral distance less than 6 mm measured in internal rotation was performed to find the clinical effect of dynamic subcoracoid stenosis

Results: A partial-thickness tear of the subscapularis tendon was present in 30 patients [35.7%] and a full-thickness tear in 13 patients [15.5%] among 84 patients. The CHD was maximum in external rotation and the narrowest in internal rotation. There were no statistical differences in the CHDs between groups with different subscapularis tear status. According to the presence of dynamic subcoracoid stenosis, patients with dynamic subcoracoid stenosis had a significantly higher incidence of partial-thickness subscapularis tear than those without stenosis [P = 0.018]

Conclusions: The coracohumeral distance values were narrowest in shoulder internal rotation, which is thought to be the pathogenic position. We could not confirm the correlation between coracohumeral distance and subscapularis tear. However, patients who have dynamic subcoracoid stenosis had significantly higher incidence of subscapularis tear than others without dynamic stenosis

study to evaluate KM/propofol versus KM alone for procedural sedation in children

Background: the co-administration of ketamine and propofol [CoKP] is thought to maximize the beneficial profile of each medication, while minimizing the respective adverse effects of each medication

Objective: our objective was to compare adverse events between ketamine monotherapy [KM] and CoKP for procedural sedation and analgesia [PSA] in a pediatric emergency department [ED]

Methods: this was a prospective, randomized, single-blinded, controlled trial of KM vs. CoKP in patients between 3 and 21 years of age. The attending physician administered either ketamine 1 mg/kg i.v. or ketamine 0.5 mg/kg and propofol 0.5 mg/kg i.v. The physician could administer up to three additional doses of ketamine [0.5 mg/kg/dose] or ketamine/propofol [0.25 mg/kg/dose of each]. Adverse events [e.g., respiratory events, cardiovascular events, unpleasant emergence reactions] were recorded. Secondary outcomes included efficacy, recovery time, and satisfaction scores

Results: thirty-two patients were randomized to KM and 29 patients were randomized to CoKP. There was no difference in adverse events or type of adverse event, except nausea was more common in the KM group. Efficacy of PSA was higher in the KM group [99%] compared to the CoKP group [90%]. Median recovery time was the same

Conclusions: we found no significant differences in adverse events between the KM and CoKP groups. While CoKP is a reasonable choice for pediatric PSA, our study did not demonstrate an advantage of this combination over KM

occurrence of hip fractures among Old patients in KSA

Background: associated with the increase in the aging population, there is an increase in the occurrence of hip fractures worldwide. Result following such fractures is influenced by age of the patient

Purpose: this study purposes to evaluate the incidence and early outcome of hip fractures, comparing between different age groups

Materials and Methods: data of hip fractures collected over a period of five years was analyzed. Patients were divided into three groups, group A [patients under the age of 64], group B [patients between 65 and 84 years of age], and group C [patients over the age of 85]

Results: of the 588 patients included in the study, there were 45 patients in group A, 351 patients in group B and 192 patients in group C. There was a female preponderance across all age groups, and this increased as age advanced [p < 0.0001]. A significantly larger number of older patients lived alone and needed aids to walk before the injury [p < 0.0001]. There was no significant difference in the type of fracture across the three groups [p = 0.13]. A higher proportion of the elderly with intracapsular fractures were treated by replacement arthroplasty. Older patients who had internal fixation of intracapsular fractures had a better walking ability at 4 months. The overall deterioration in mobility was greater in older patients [p < 0.0001]. Mortality was higher in older patients

Conclusions: hip fractures are more common among females irrespective of age group. Older patients have a higher mortality and a greater deterioration of walking ability after such injuries. Internal fixation of intracapsular fractures have demonstrated satisfactory early outcome in the immediate period. This might be attributed to retention of native bone, better proprioception and shorter operation time