Radiological outcomes following surgical fixation with wires versus moulded cast for patients with a dorsally displaced fracture of the distal radius: a radiographic analysis from the DRAFFT2 trial.

Aims: The primary aim of this study was to report the radiological outcomes of patients with a dorsally displaced distal radius fracture who were randomized to a moulded cast or surgical fixation with wires following manipulation and closed reduction of their fracture. The secondary aim was to correlate radiological outcomes with patient-reported outcome measures (PROMs) in the year following injury. Methods: Participants were recruited as part of DRAFFT2, a UK multicentre clinical trial. Participants were aged 16 years or over with a dorsally displaced distal radius fracture, and were eligible for the trial if they needed a manipulation of their fracture, as recommended by their treating surgeon. Participants were randomly allocated on a 1:1 ratio to moulded cast or Kirschner wires after manipulation of the fracture in the operating theatre. Standard posteroanterior and lateral radiographs were performed in the radiology department of participating centres at the time of the patient's initial assessment in the emergency department and six weeks postoperatively. Intraoperative fluoroscopic images taken at the time of fracture reduction were also assessed. Results: Patients treated with surgical fixation with wires had less dorsal angulation of the radius versus those treated in a moulded cast at six weeks after manipulation of the fracture; the mean difference of -4.13° was statistically significant (95% confidence interval 5.82 to -2.45). There was no evidence of a difference in radial shortening. However, there was no correlation between these radiological measurements and PROMs at any timepoint in the 12 months post-injury. Conclusion: For patients with a dorsally displaced distal radius fracture treated with a closed manipulation, surgical fixation with wires leads to less dorsal angulation on radiographs at six weeks compared with patients treated in a moulded plaster cast alone. However, the difference in dorsal angulation was small and did not correlate with patient-reported pain and function.

Scoping review: Evidence for long-term follow-up and monitoring in shoulder and elbow arthroplasty.

Aims: Long-term follow-up and monitoring of asymptomatic shoulder and elbow arthroplasty remains contentious, with a wide spectrum of non-evidence-based mechanisms used. This scoping review aims to outline related evidence, thereby informing research requirements. Methods: Studies relevant to shoulder and elbow arthroplasty follow-up, surveillance and time-related failure were included. The review included randomised controlled trials, systematic reviews and economic studies indexed in MEDLINE, Embase, Cochrane CDSR and Cochrane CENTRAL since 1 January 2012. In addition, all registry studies, follow-up studies, cohort studies and case reports indexed in MEDLINE since 1 January 2020 were included. The screening was undertaken by two reviewers. Key characteristics of each study were described, alongside a narrative review. Results: Twenty-one articles were included. We were unable to identify evidence that long-term follow-up and monitoring of asymptomatic shoulder and elbow arthroplasty identifies failure or leads to a revision that is of reduced patient morbidity and cost. In addition, no evidence was apparent to inform whether patients will self-present with a failing implant. Several surveillance mechanisms were identified. Conclusion: This scoping review highlights the paucity of evidence related to long-term follow-up and monitoring of shoulder and elbow arthroplasty, and the need for high-quality data to inform the development of evidence-based care pathways.

Shoulder Pain Diagnosis, Treatment and Referral Guidelines for Primary, Community and Intermediate Care.

These care pathway guidelines for the shoulder have been written in collaboration with the NHS Evidence Based Interventions (EBI) programme. The EBI programme is a partnership between the Academy of Medical Royal Colleges, NHS Clinical Commissioners, the National Institute for Health and Care Excellence, as well as NHS England and Improvement.

The Neviaser portal for superior glenoid anchor insertion: an anatomic study.

PURPOSE: To measure the angular relationship between the Neviaser portal and the superior glenoid labrum in 60 cadaveric specimens to determine whether this portal can be used for reliable anchor placement. METHODS: The Neviaser portal of 30 left and 30 right unpaired dry cadaveric scapulae with clavicles were measured by a single observer using an analogue vernier caliper. The angular relationship between the Neviaser portal and the 12 o'clock position of the glenoid labrum was calculated. RESULTS: 13 of the 60 scapulae were excluded from analysis, because the Neviaser portal was medial to the glenoid rim making safe anchor insertion unfeasible. For the remaining 47 scapulae, the mean angles α and ß were 58.2º and 57.9º, respectively. Compared with the ideal angles α and ß of 30º and 0º, respectively, all the 47 Neviaser portals were more posterior (relative to the 12 o'clock position) and closer to the transverse plane, making insertion of suture anchors in the optimum position unfeasible, except for one that was within 10º of the ideal angles in both planes. CONCLUSION: Reliable insertion of suture anchors at the 12 o'clock position of the glenoid labrum through the Neviaser portal is unfeasible in most patients.

An unusual complication of the Mackenzie approach for a Copeland hemiarthroplasty.

We report the case of a patient with end-stage osteoarthritis who received a successful Copeland resurfacing hemiarthroplasty through a Mackenzie anterosuperior approach, which involves taking the anterior portion of the deltoid attachment from the acromion along with an osteo-periosteal sleeve. The patient went on to develop severe subacromial impingement symptoms 4 months postoperatively. X-rays revealed a large anteroinferior acromial osteophyte that had not been present preoperatively and was deemed to represent a malunited osteo-periosteal sleeve from the Mackenzie approach.

Venous thromboembolic events are rare after shoulder surgery: analysis of a national database.

BACKGROUND: Data on venous thromboembolic (VTE) events after different types of shoulder surgery have not previously been available in large numbers in the United Kingdom. We aimed to determine baseline postoperative complication rates with reference to national thromboembolic prophylaxis guidelines. METHODS: Diagnostic and operative codes are routinely collected on every patient admitted to the hospital in the English NHS. Data for a 42-month period were analyzed for planned shoulder surgery (total replacement, hemiarthroplasty, or arthroscopy) and proximal humeral fracture surgery (internal fixation or replacement). In addition, complications during the two 6-month periods before and after the implementation of national thromboprophylaxis guidelines were compared. Rates of symptomatic deep venous thrombosis, pulmonary embolism, and mortality within 90 days were extracted. RESULTS: For total shoulder replacement (4,061 patients), deep venous thrombosis, pulmonary embolism, and mortality rates were 0%, 0.20%, and 0.22%, respectively. For arthroscopic procedures (65,302 patients), the rates were less than 0.01%, 0.01%, and 0.03%, respectively. For proximal humeral fracture surgery (internal fixation or replacement, 4,696 patients), the rates were 0.19%, 0.40%, and 3.02%, respectively. There was no significant difference in the VTE event or mortality rates before and after the introduction of the 2007 National Institute for Health and Clinical Excellence guidelines after arthroscopy or proximal humeral fracture surgery. A statistically significant decrease in total shoulder replacement-related mortality was found, from 0.72% (5 patients) to 0%. DISCUSSION: VTE disease is not a significant problem after shoulder surgery, and thromboprophylaxis may not be required, even in high-risk patients. National thromboprophylaxis guidelines did not affect VTE event rates.

Occult Monteggia fracture in an adult: a case report.

Injuries with the Monteggia fracture-dislocation pattern necessitate operative fixation of the ulna fracture in an adult. It is important to identify this by taking radiographs of the elbow and wrist joints in all cases of ulna fracture. We present a case of an occult Monteggia fracture-dislocation in an adult, which was not apparent on the initial radiographs. A thorough clinical examination along with an examination under anaesthesia in view of the high index of suspicion helped us to achieve the diagnosis.