Do partial thickness, bursal side cuff tears affect outcome following arthroscopic subacromial decompression? A prospective comparative cohort study.

BACKGROUND: The present study aimed to compare medium-term clinical outcomes of patients following arthroscopic subacromial decompression (ASAD): those with intact rotator cuff with two groups of increasing size of partial thickness bursal-side tears. METHODS: Patients undergoing shoulder arthroscopy by a single surgeon had pre- and postoperative Constant scores prospectively recorded. Arthroscopic surgery included the assessment of any supraspinatus tears using the Ellman criteria, as well as ASAD and cuff debridement. Groups were created based on the status of rotator cuff and size of bursal tear. Outcome in these patient groups was then compared and analyzed. RESULTS: Seventy-four patients were suitable for inclusion in the study: 32 patients without a cuff tear; 21 patients with a cuff tear of 9 mm or less in length; and 21 patients with a cuff tear of 10 mm or more in length. Baseline characteristics of the three groups were similar. All three groups showed a significant improvement in their Constant scores following surgery. There was, however, no significant difference in Constant scores between the three groups. CONCLUSIONS: The results of the present study show that patients with varying sizes of bursal-side tears respond to ASAD as well as those with no rotator cuff tear.

Which measure should be used to assess the patient's functional outcome after distal radius fracture?

The Disability of the Arm, Shoulder and Hand (DASH) and the Patient-Rated Wrist Evaluation (PRWE) scores appear most frequently in the literature when assessing functional outcome after distal radius fracture. We aimed to evaluate if the two questionnaires correlate. We reviewed 258 cases of adults who sustained a distal radius fracture over a one year period. At mean follow-up of 17 months the disability of the arm, shoulder and hand (DASH) and the patient-rated wrist evaluation (PRWE) scores were recorded. The outcome scores for each group were not statistically different (DASH p = 0.86, PRWE p = 0.80). The results of both questionnaires correlated strongly (Spearman's coefficient = 0.90). As the DASH score is potentially influenced by concomitant upper limb problems we suggest that the specific patient rated wrist evaluation (PRWE) be the sole instrument for assessing the functional outcome of distal radius fractures. This will reduce questionnaire fatigue and standardise the literature.

Factors predictive of frank intrabiliary rupture in patients with hepatic hydatid cysts.

BACKGROUND/AIMS: Frank intrabiliary rupture (IBR) is a serious complication that occurs in 3-17% of patients. The aim of this study was to identify independent predictors of frank IBR of hepatic hydatid cysts (HHC). METHODOLOGY: Some 741 patients with HHC underwent surgery for HHC between 1965 and 2000. Patient and cyst characteristics were subjected to univariate and multivariate analysis to identify independent predictors of frank IBR. RESULTS: Frank IBR was associated with significantly older age (median, 41 vs. 37 years,p =0.025), more male subjects (40% vs. 32%, p = 0.024), longer duration of symptoms (16 vs. 6 months, p < 0.001), larger cysts (median, 12 vs. 9cm, p < 0.001) and higher incidence of solitary (86% vs. 62%, p < 0.001), multivesicular (89% vs. 39%, p < 0.001), left lobar (38% vs. 13%, p < 0.001) and infected cysts (78% vs. 24%, p < 0.001). Multivariate analysis identified cyst size (> or =10 cm), cyst infection, multivesicular content, solitary cysts and location in the left lobe of liver as well as long duration of symptoms as independent predictors of frank IBR. CONCLUSIONS: Patients with large (> or =10 cm), multivesicular, solitary, left lobar or infected HHC as well as those with prolonged history are at increased risk of frank IBR and should be offered early surgery.

The low anterior cervical approach to the upper thoracic vertebrae: a decision by preoperative MR imaging.

PURPOSE: Surgical approaches to the upper thoracic spine are fraught with many problems as they involve thoracotomy or sternotomy. We analyzed 102 midsagittal MRI scans to evaluate the level of the sternal notch in relation to the upper thoracic spine, so that if the tangential line through the upper part of the sternal notch passed below the level of the involved vertebra, we could surgically access the involved vertebra by the low anterior cervical approach, which is familiar to most spinal surgeons. MATERIALS AND METHODS: Between January and June 2002, 102 consecutive mid-sagittal T2 weighted MRI scans were evaluated. The line as described above was then drawn on each MRI to assess the level of the involved vertebra. RESULTS: In 68.7% of the cases, the level of the sternal notch corresponded to T2 and T3. This method of assessing accessibility was used in a patient with a fractured T3 that yielded excellent surgical exposure. It was found that routine use of saturation bands is not needed in upper thoracic spine pathology as it obscured the visualization of the sternal notch in 20% of the cases. CONCLUSION: In patients with high thoracic fractures who require surgical decompression and stabilization, pre-operative MR scan and assessing the level of the vertebra in relation to the sternal notch can allow a low anterior cervical approach to be used thus decreasing the patient morbidity related to the surgical approach.