The influence of bone mineral density and cortical index on the complexity of fractures of the proximal humerus.

OBJECTIVES: The goal of this study is to investigate the relation between indicators of osteoporosis (i.e., bone mineral density (BMD), and Cortical Index (CI)) and the complexity of a fracture of the proximal humerus as a result of a low-energy trauma. METHODS: A retrospective chart review of 168 patients (mean age 67.2 years, range 51 to 88.7) with a fracture of the proximal humerus between 2007 and 2011, whose BMD was assessed at the Fracture Liaison Service with Dual Energy X-ray Absorptiometry (DXA) measurements of the hip, femoral neck (FN) and/or lumbar spine (LS), and whose CI and complexity of fracture were assessed on plain anteroposterior radiographs of the proximal humerus. RESULTS: No significant differences were found between simple and complex fractures of the proximal humerus in the BMD of the hip, FN or LS (all p > 0.3) or in the CI (p = 0.14). Only the body mass index was significantly higher in patients with a complex fracture compared with those with a simple fracture (26.9 vs 25.2; p = 0.05). CONCLUSION: There was no difference in BMD of the hip, FN, LS or CI of the proximal humerus in simple compared with complex fractures of the proximal humerus after a low-energy trauma. Factors other than the BMD and CI, for example body mass index, may play a more important role in the complexity of this fracture.Cite this article: J.W.A.M. den Teuling, B.S. Pauwels, L. Janssen, C.E. Wyers, H. M. J. Janzing, J.P.W. van den Bergh, J. W. Morrenhof. The Influence of bone mineral density and cortical index on the complexity of fractures of the proximal humerus. Bone Joint Res 2017;6:584-589. DOI: 10.1302/2046-3758.610.BJR-2017-0080.

High-energy versus low-energy extracorporeal shock wave therapy for calcifying tendinitis of the shoulder: which is superior? A meta-analysis.

BACKGROUND: There are several treatment options for calcifying tendinitis of the shoulder. The next step treatment after conservative treatment fails is still a matter of dispute. Extracorporeal shock wave therapy (ESWT) has been shown to be a good alternative to surgery, but the best treatment intensity remains unknown. High-energy ESWT is much more painful, more expensive, and usually is done in an inpatient setting, whereas low-energy ESWT can be performed in an outpatient setting by a physical therapist. QUESTIONS/PURPOSES: A systematic review and meta-analysis of randomized trials was performed to answer two clear research questions: (1) Is there a greater increase in the Constant-Murley score in patients treated with high-energy ESWT compared with those treated with low-energy ESWT by 3 months and by 6 months? (2) Is there a greater chance of complete resorption of the calcifications in patients treated with high-energy ESWT compared with those treated with low-energy ESWT by 3 months and by 6 months? METHODS: Five relevant electronic online databases, Medline (through PubMed), EMBASE (through OVID), Cinahl (through EBSCO), Web of Science, and the Cochrane Central Register of Controlled Trials, were systematically searched. We also crosschecked the reference lists of articles and reviews for possible relevant studies. Eligible for inclusion were all randomized controlled trials (RCTs) that compared high-energy ESWT (> 0.28 mJ/mm(2)) with low-energy ESWT (< 0.08 mJ/mm(2)). One author examined titles and abstracts of each identified study to assess study eligibility. Two reviewers independently extracted data and assessed the risk of bias and study quality. The primary outcome measure, the Constant-Murley score, was assessed by comparing mean functional outcome scores between the groups. Secondary outcomes were assessed using odds ratios, when appropriate data were pooled. Based on this process, five RCTs (359 participants) were included. RESULTS: All five RCTs showed greater improvement in functional outcome (Constant-Murley score) in patients treated with high-energy ESWT compared with patients treated with low-energy ESWT at 3 and 6 months. The 3-month mean difference was 9.88 (95% CI, 9.04-10.72, p < 0.001; 6-month data could not be pooled). Furthermore, high-energy ESWT more often resulted in complete resorption of the deposits at 3 months. The corresponding odds ratio was 3.40 (95% CI, 1.35-8.58) and p = 0.009 (6-month data could not be pooled). CONCLUSION: When shock wave therapy is chosen, high-energy shock wave therapy is more likely to result in improved Constant-Murley score and resorption of the deposits compared with low-energy therapy. LEVEL OF EVIDENCE: Level I, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

Surgical versus non-surgical interventions for treating humeral shaft fractures in adults.

BACKGROUND: Fractures of the shaft of the humerus account for 1% to 3% of all fractures in adults. The management of these fractures, including surgical intervention, varies widely. OBJECTIVES: To assess and compare the effects of surgical versus non-surgical intervention for non-pathological fractures of the humeral shaft in adults. SEARCH METHODS: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, trial registers, and bibliographies of trial reports. The full search was conducted in October 2011. SELECTION CRITERIA: Considered for inclusion were all randomised and quasi-randomised (method of allocating participants to a treatment which is not strictly random; e.g. by date of birth, hospital record number or alternation) controlled trials that compared surgical with non-surgical intervention for humeral shaft fractures in adults. DATA COLLECTION AND ANALYSIS: Two authors independently selected and assessed potential eligible studies for inclusion. MAIN RESULTS: We found six completed studies that appeared to meet our inclusion criteria. After scrutiny, we excluded all six studies: five were retrospective studies and one was a prospective study without randomisation. We identified three potentially eligible ongoing studies, two of which involve randomisation of treatment allocation and one, which we excluded, that does not. AUTHORS' CONCLUSIONS: There is no evidence available from randomised controlled trials to ascertain whether surgical intervention of humeral shaft fractures gives a better or worse outcome than no surgery. Sufficiently powered good quality multi-centre randomised controlled trials comparing surgical versus non-surgical interventions for treating humeral shaft fractures in adults are needed. It is likely that the results from the two ongoing randomised trials on this topic will help inform practice in due course.

Operative treatment of acute Achilles tendon rupture: Open end-to-end-reconstruction versus reconstruction with Mitek-anchors.

PURPOSE: To retrospectively compare the open end-to-end repair versus repair using the Mitek-anchor system in acute Achilles tendon rupture. METHOD: Forty-seven consecutive patients with Achilles tendon rupture, all operated on between 2004 and 2005, were included. Their medical records were reviewed and they were interviewed for surveillance of post-operative function at follow-up. Functional outcome was determined using an adapted VISA tendinopathy questionnaire and by testing the isometric ankle plantar flexion strength. Post-operative complications and recurrence rate of rupture were noted. RESULTS: Seven patients were lost to follow-up. From a total of 40 patients, twenty-eight (68% of total) underwent classic repair and 12 (32%) were treated by the Mitek-anchor system. Median age was 43 years (range 29-63). Median post-operative follow-up was 29 months (range 17-40). Median time to resume work was nine weeks in the classic group versus 12 weeks in the Mitek-group. Median time to resume sports was 19 versus 31 weeks respectively. Wound infections occurred in five percent of the total (one in each group) and rupture recurrence rate was three percent of the total (nil in classic group, one in Mitek-group). Loss of strength in the injured leg compared to the non-injured leg was greater in the Mitek-group than in the classic group. CONCLUSION: We conclude that in comparing classical end-to-end repair of acute Achilles tendon ruptures with repair using Mitek-anchors, it took patients in the Mitek-group longer to return to work and sport activities than in the classic group. Greater loss of strength in the injured leg was seen in the Mitek-group. Therefore we do not advocate the use of Mitek-anchors for the repair of acute ruptured Achilles tendons.