Evaluation of the results of management of frozen shoulder using the arthroscopic capsular release.

BACKGROUND: 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 pre- and 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.

Treatment of subtalar calcanean fractures using trans-osseous limited lateral approach.

BACKGROUND: Calcaneal fractures are the most common fractures of the tarsal bones. The majority of these fractures are produced by axial force like a fall from a height. Controversy still exists on the best line of treatment. This study is to evaluate the results of trans-osseous limited lateral approach as a minimally invasive surgical treatment of the displaced intra-articular calcaneal fractures. MATERIAL AND METHODS: The study included forty two patients (46 feet) with displaced intra-articular calcaneal fractures admitted to El-Hadra University Hospital. They were treated by trans-osseous open reduction of subtalar joint and internal fixation by k-wires consuming the trans-osseous limited lateral approach. Out of 42 patients, 36 pateints (85.7%) were males. RESULTS: Using calcaneal fracture scoring system, the mean score was 67.55+17.35. Satisfactory results were found in 26 patients (61.9%), while 16 patients (38.1%) had unsatisfactory results. There was significant relationship between classification of the fracture and the final results (the more the grade of the fracture, the worse the final score) (x 2 =5.914, p=0.05). The value of calcaneal angles were significantly improved after surgery including bohler angle (p=0.0001), gissane angle (p=0.0001), calcaneal pitch angle (p=0.001) and calcaneofibular space (p=0.0021). CONCLUSIONS: 1. Trans-osseous limited lateral approach is an effective method for management of intra articular calcaneal fractures. 2. Anatomical reduction for intra articular calcaneal fractures is essential. 3. Functional outcome of intra articular calcaneal fractures depends upon the initial damage of the articular cartilage. 4. There is a need for multi-center prospective randomized study for accurate assessment of the results of operative management of intra articular calcaneal fractures involving pre and post-operative CT for assessment of reduction and using a rational scoring system and a long period of follow up.