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PURPOSE: During the last few years, the number of electric scooter (e-scooter) users has risen to an all-time high. This study aimed to analyze e-scooter related accidents and trauma prevention measures in a large European city (Vienna, Austria). METHODS: This retrospective study comprises a thorough data assessment and analysis of all e-scooter related accidents between 2018 and 2021 at a large level 1 trauma center in Vienna. Based on the data analysis, risk factors were identified, and possible prevention strategies were proposed. RESULTS: During the observed period, 1337 patients sustained an injury from an e-scooter. Of these, 1230 were injured directly while driving (92%). The remaining 107 patients (8%) were classified as non-driving injuries. 927 injuries involved males (69.3%). The mean age was 32.1 years (range 4-86 years). Of all injured patients, 429 (32.1%) sustained at least one serious injury. The most common injuries included radial head fractures and concussions. Among the accidents treated, the use of protective equipment was sporadic. For example, helmets were worn in only 13.7% of cases. Wearing a helmet reduced the number of head injuries (24% versus 46.8%). In just three years, the number of patients increased 19-fold with a focus in the summer months. CONCLUSION: This study shows a substantial and sustained increase in e-scooter accidents with potentially serious injuries. Helmet use was found to be an effective form of head injury prevention. Further options for using protective equipment should be evaluated to improve the safety aspects of riding e-scooters.
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BACKGROUND: Loss of shoulder range of motion (ROM) is common after surgical management of anterior shoulder instability; however, it remains unclear to what degree this is related to their injury. AIM: The purpose of this study was to compare passive shoulder ROM in patients with ASI to a normal contralateral shoulder. METHODS: A total of 121 patients undergoing stabilization surgery were prospectively enrolled. Preoperative advanced imaging was used to assess for glenoid bone loss and the presence of off-track Hill-Sachs lesions. Passive ROM was measured in both shoulders while under anaesthesia prior to surgery. RESULTS: In all directions, there was a significant loss of ROM in shoulders with instability. Regression analysis showed that neither a glenoid bone defect nor greater glenoid bone loss were associated with a loss of ROM in any plane. The presence of a Hill-Sachs lesion was significantly associated with a loss of external rotation, while off-track lesions were associated with a loss of ROM in all planes (p < 0.05). CONCLUSION: Patients with anterior shoulder instability lost motion in all directions, with a profound loss of external rotation. The presence of a glenoid bone defect nor greater bone loss did not reliably predict a loss of range of motion. A Hill-Sachs lesion was predictive of a loss of external rotation, while an off-track lesion was predictive of a loss of range in all directions.
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Background: Arthroscopic superior capsule reconstruction (SCR), arthroscopic partial repair (PR), and arthroscopic debridement (DB) are valid treatment options for irreparable rotator cuff (RC) tears. Purpose/Hypothesis: The purpose of this study was to compare clinical, functional, and radiological outcomes of arthroscopic SCR with arthroscopic PR and arthroscopic DB in patients with irreparable posterosuperior RC tears. It was hypothesized that SCR would lead to superior clinical and functional outcomes compared with PR or DB. Study Design: Cohort study; Level of evidence, 3. Methods: Clinical and functional outcomes of this single-center retrospective study included range of motion, strength, and the age- and sex-adjusted Constant-Murley score. Patient-reported outcome measures (PROMs) involved the quick Disabilities of the Arm, Shoulder and Hand score, the Subjective Shoulder Value, and the visual analog scale for pain. Graft and repaired tendon integrity was evaluated by magnetic resonance imaging (MRI) at 12 months of follow-up. Results: In total, 57 patients treated with SCR (n = 20), PR (n = 17), and DB (n = 20) were included. The mean clinical follow-up was 33.8 ± 17.9 months. Preoperative clinical and functional characteristics were comparable among the 3 groups. The range of motion and clinical and functional scores of all 3 groups significantly improved from pre- to postoperatively. Postoperative PROMs showed no differences among all 3 study groups. SCR revealed significantly higher postoperative strength compared with PR (P = .001) and DB (P = .004). Postoperative MRI revealed a rerupture in 4 patients with SCR (20%). Postoperative MRI showed a rerupture in 9 patients with PR ( 53%). Fatty muscle infiltration of the supraspinatus and infraspinatus significantly progressed within all 3 study groups in postoperative MRI scans. No clinical and functional differences were observed between intact and reruptured PR. Conclusion: Patients who underwent SCR had better postoperative strength recovery than patients who underwent PR or DB.
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PURPOSE OF REVIEW: The purpose of this review is to summarize recent literature regarding the latest design modifications and biomechanical evolutions of reverse total shoulder arthroplasty and their impact on postoperative outcomes. RECENT FINDINGS: Over the past decade, worldwide implantation rates of reverse total shoulder arthroplasty have drastically increased for various shoulder pathologies. While Paul Grammont's design principles first published in 1985 for reverse total shoulder arthroplasty remained unchanged, several adjustments were made to address postoperative clinical and biomechanical challenges such as implant glenoid loosening, scapular notching, or limited range of motion in order to maximize functional outcomes and increase the longevity of reverse total shoulder arthroplasty. However, the adequate and stable fixation of prosthetic components can be challenging, especially in massive osteoarthritis with concomitant bone loss. To overcome such issues, surgical navigation and patient-specific instruments may be a viable tool to improve accurate prosthetic component positioning. Nevertheless, larger clinical series on the accuracy and possible complications of this novel technique are still missing.
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PURPOSE: To review clinical and subjective outcomes in patients with deep infections after arthroscopic rotator cuff repair. METHODS: All patients in whom deep infections developed after arthroscopic rotator cuff repair at a single center between 2002 and 2016 were retrospectively reviewed. Demographic data, clinical and microbiological findings, and treatment were analyzed. Clinical and subjective outcomes included the Constant score, visual analog scale score for pain, American Shoulder and Elbow Surgeons score, and Simple Shoulder Test score. RESULTS: Thirty patients could be identified and included in the study. The most commonly isolated pathogens were Staphylococcus epidermidis (36.7%) and Cutibacterium acnes (30.0%). In 26 of 30 patients (86.7%), the infection was treated initially with an open surgical approach, whereas 4 patients (13.3%) underwent arthroscopic revision. A transosseous rotator cuff repair could be performed in 20.0% of patients. A single reoperation was sufficient in 80% of patients, whereas 13.3% required 2 revisions and 6.7% required 3. At the final follow-up of 8.3 years (range, 4-14 years), 26 patients (1 woman and 25 men) were available for outcome evaluation. Significant improvement from the initial surgical procedure to final follow-up was detected in the Constant score (25.7 vs 65.7, P < .001), visual analog scale score for pain (7.0 vs 1.7, P < .001), American Shoulder and Elbow Surgeons score (38.0 vs 76.7, P < .001), and Simple Shoulder Test score (4.0 vs 8.3, P < .001). CONCLUSIONS: Patients with deep infections after arthroscopic rotator cuff repair showed moderate mid- to long-term outcomes. LEVEL OF EVIDENCE: Level IV, therapeutic case series.
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PURPOSE: To report mid- to long-term clinical and radiological outcomes after microfracturing for symptomatic chondral defects of the glenohumeral joint. METHODS: All patients who underwent glenohumeral arthroscopic microfracturing between 2002 and 2012 at a single center were considered for inclusion in this retrospective study. Clinical outcome was evaluated using the Constant Score, Oxford Shoulder Score, and Subjective Shoulder Value. Progression of joint space narrowing, sclerosis, marginal osteophytes, and presence of cysts over time were assessed using 4 different radiological grading systems. RESULTS: A total of 16 patients (n = 9 female, n = 7 male) with a mean age of 51.8 ± 12.6 years at the time of surgery and a mean follow-up of 122 ± 51.2 months (range, 61-204 months) were included in this retrospective study. Nine patients (56.3%) showed an isolated chondral defect, while 7 patients (43.8%) had concomitant pathologies. Constant Score (60.3 ± 12.7 vs. 85.9 ± 9.3; P < .001), Oxford Shoulder Score (29.0 ± 5.8 vs. 42.4 ± 4.5; P < .001), and Subjective Shoulder Value (23.9 ± 7.4 vs. 84.3 ± 10.9; P < .001) changed significantly from pre- to postoperative. The majority of patients (88%) were able to return to their preoperative level of activity. Three patients (19.8%) developed radiological signs of progressive glenohumeral degeneration during the study period. However, only 1 patient (6.25%) showed a progression of arthritic changes of more than 1 grade according to radiographic classifications. Two patients (12.5%) underwent revision surgery to a hemi shoulder arthroplasty during the study period at 12 and 36 months after the initial procedure. CONCLUSIONS: Glenohumeral microfracturing is commonly performed together with other procedures, but seems to be a feasible treatment option for contained cartilage lesions in active patients reproducibly yielding good mid- to long-term outcome. LEVEL OF EVIDENCE: Level IV, therapeutic case series.
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Increasing numbers of arthroplasties are also accompanied by postoperative infections. The main purpose was to evaluate preoperative serum bilirubin levels between patients with and without infections after shoulder and knee arthroplasties. For this retrospective case-control single-center study, a total of 108 patients were extracted from a prospectively collected database. Eighteen patients with infections after shoulder (n = 8) and knee (n = 10) arthroplasty were matched by age, gender, and implant type in a 1:5-scenario to 90 patients (40 shoulders and 50 knees) without postoperative infection. Demographic data, preoperative blood parameters, and postoperative infection-related outcomes were evaluated. Total bilirubin was the only preoperative parameter significantly different between the infection (8.21 ± 3.25 µmol/L or 0.48 ± 0.19 mg/dL) and noninfection (10.78 ± 4.62 µmol/L or 0.63 ± 0.27 mg/dL; P = .014) group, while C-reactive protein and other liver parameters were similar between the groups. Significantly more controls (92.1%) had preoperative bilirubin levels above 8.72 µmol/L or 0.51 mg/dL than cases (7.9%; P = .007). The 5-year infection survival-rate was 65.6% for patients with preoperative bilirubin levels < 8.72 µmol/L or < 0.51 mg/dL and 91.2% with ≥ 8.72 µmol/L or ≥ 0.51 mg/dL. Mildly decreased preoperative bilirubin levels with a cutoff at 8.72 µmol/L or 0.51 mg/dL were significantly associated to patients with infections after shoulder and knee arthroplasty. There were no differences in other blood parameters or comorbidities between patients with infections and their matched-controls.
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Artrite Infecciosa/sangue , Artroplastia do Joelho , Artroplastia do Ombro , Bilirrubina/sangue , Infecções Relacionadas à Prótese/sangue , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Estudos RetrospectivosRESUMO
BACKGROUND: The purpose of this study was to compare restoration of mechanical limb alignment and three-dimensional component-positioning between conventional and patient-specific instrumentation in total knee arthroplasty. METHODS: Radiographic data of patients undergoing mobile-bearing total knee arthroplasty (n = 1257), using either conventional (n = 442) or patient-specific instrumentation (n = 812), were analyzed. To evaluate accuracy of axis restoration and 3D-component-positioning between conventional and patient-specific instrumentation, absolute deviations from the targeted neutral mechanical limb alignment and planned implant positions were determined. Measurements were performed on standardized coronal long-leg and sagittal knee radiographs. CT-scans were evaluated for accuracy of axial femoral implant rotation. Outliers were defined as deviations from the targeted neutral mechanical axis of > ± 3° or from the intraoperative component-positioning goals of > ± 2°. Deviations greater than ± 5° from set targets were considered to be severe outliers. RESULTS: Deviations from a neutral mechanical axis (conventional instrumentation: 2.3°± 1.7° vs. patient-specific instrumentation: 1.7°± 1.2°; p < 0.001) and numbers of outliers (conventional instrumentation: 25.8% vs. patient-specific instrumentation: 10.1%; p < 0.001) were significantly lower in the patient-specific instrumentation group. Significantly lower mean deviations and less outliers were detected regarding 3D-component-positioning in the patient-specific instrumentation compared to the conventional instrumentation group (all p < 0.05). CONCLUSIONS: Patient-specific instrumentation prevented from severe limb malalignment and component-positioning outliers (> ± 5° deviation). Use of patient-specific instrumentation proved to be superior to conventional instrumentation in achieving more accurate limb alignment and 3D-component positioning, particularly regarding femoral component rotation. Furthermore, the use of patient-specific instrumentation successfully prevented severe (> 5° deviation) outliers.
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Artroplastia do Joelho/métodos , Mau Alinhamento Ósseo/prevenção & controle , Osteoartrite do Joelho/cirurgia , Posicionamento do Paciente/métodos , Idoso , Artroplastia do Joelho/efeitos adversos , Mau Alinhamento Ósseo/diagnóstico por imagem , Feminino , Humanos , Imageamento Tridimensional/métodos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/patologia , Prótese do Joelho , Perna (Membro)/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Modelos Anatômicos , Osteoartrite do Joelho/diagnóstico por imagem , Medicina de Precisão/métodos , Cuidados Pré-Operatórios/métodos , Radiografia , Tomografia Computadorizada por Raios X/métodosRESUMO
Most older adults prefer to age in place and it is therefore vital to support them in maintaining a high quality of life in their place of residence. Many Naturally Occurring Retirement Communities (NORCs) have implemented services to fulfill a range of needs of their residents. Community Partners (CP) provided 58 NORC residents in six apartment buildings within two suburban neighborhoods in Maryland with health and social work services, activities and transportation services. Participants were compared with 70 residents who did not receive these services. Residents were assessed prior to initiation of services (e.g. transportation, social work and recreation) and after service usage through a membership program. Members had significantly increased satisfaction with recreational activities and social life in the community as well as significant decreases in depressed affect. Members' self-reports showed that they were more likely to get out of the house, felt less isolated, and were happier since joining CP activities. This study is unique in examining the impact of utilization of a variety of services for older persons, while comparing these individuals to a local group of community-dwelling older persons who are without NORC services.
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Características de Residência , Aposentadoria , Serviço Social , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Maryland , Pessoa de Meia-Idade , Qualidade de Vida , Recreação , Inquéritos e QuestionáriosRESUMO
The objective of this study was to describe the development, utilization and utility of an ongoing evaluation of a system of coordinated services to persons living in two naturally occurring retirement communities (NORCs). The evaluation system includes service provision, service utilization and client satisfaction. It identifies trends in provided services and determines how services are utilized. A continuous monitoring system for reporting and quality improvement was developed with the four service agencies associated with the service provision system. The monthly data from each agency are compiled and distributed in the form of a report. The evaluation project was successful in tailoring the reporting system to each agency. Multiple issues arose with staff compliance in utilization of the system, but, overall, the system evaluation presents detailed feedback on the services provided and helps with continuing development, testing of new delivery models, planning, maximizing resource utilization, customer service, and attaining and sustaining funding. A system evaluation of an organization that provides services to a community is vital to optimizing frequency and quality of services. There are many ways to implement system evaluations. However, the use of electronic-based records increases the likelihood of maintaining and utilizing the system.