Optimal time for manipulation of frozen shoulder may be between 6 and 9 months.

BACKGROUND AND AIMS: Idiopathic frozen shoulder can be successfully treated conservatively. Manipulation under anesthesia, in randomized controlled studies, has proven to bring no additional benefit to other treatments. However, manipulation under anesthesia still is a used method mainly among patients with unbearable pain or too longstanding restriction of shoulder motion. Manipulation under anesthesia may lead to significant improvement in shoulder motion and function. However, the best timing for manipulation under anesthesia is still unclear. We therefore investigated whether timing of manipulation under anesthesia has influence on the results of manipulation under anesthesia, concerning range of motion, pain, and function. MATERIAL AND METHODS: We followed 57 patients (65 shoulders; 31 in women) at 2-14 years after manipulation under anesthesia evaluating range of motion, pain, and function. Their mean age at manipulation under anesthesia was 54.0 years. A total of 10 patients had diabetes. The time between the onset of symptoms and manipulation averaged 8.8 months. We formed two groups, those mobilized between 6 and 9 months after the onset of symptoms (Group A, 25 shoulders), and the others (Group B, 40 shoulders). We recorded visual analog scale pain, range of motion, Simple Shoulder Test, and Constant-Murley scores. RESULTS: Patients manipulated between 6 and 9 months after the onset of symptoms had significantly better abduction and external rotation, less pain at rest and at night, and better Simple Shoulder Test than the others. CONCLUSIONS: It seems that timing has statistically significant influence on results of manipulation of the idiopathic frozen shoulder. The best time for manipulation under anesthesia, if non-operative treatment has failed to alleviate pain or limitation of shoulder motion is too cumbersome, might be between 6 and 9 months from the onset of the symptoms. However, the clinical importance of results can be questioned.

Problems associated with longitudinal fractures of the femoral shaft in adults. A comparison between intramedullary nailing, interlocking intramedullary nailing and plating.

The results of 64 operatively treated patients with longitudinal femoral shaft fracture are presented. Twenty-four fractures were treated with an intramedullary nail, six with an interlocking intramedullary nail and 34 with plating. The functional end results were good and the anatomical result satisfactory in all groups although treatment with plate caused several failures. We conclude that intramedullary nailing is a good and safe method to treat non-comminuted fractures of the femoral shaft.

Incidence of local complications after intramedullary nailing and after plate fixation of femoral shaft fractures.

A consecutive series of 378 patients with 381 acute adult femoral shaft fractures in previously intact femora admitted during a 10-year period was reviewed for the incidence of local complications including malunion. The majority, 282 fractures (74%), were caused by motor vehicle accidents. The median age of the patients was 28 years. The policy of management was internal fixation of the fracture on the day of admission. The method of treatment was intramedullary nailing (Küntscher or interlocking nailing) in 279 and plate fixation in 102 fractures. A local complication occurred in 90 patients (24%). Of these 90 cases 24 had malunion only while in the remaining 66 patients there was mechanical failure of fixation in 27, local infection in 20 (5.3% of the total), delayed union or nonunion in 15, and refracture in four patients. Concurrent injuries in the lower extremities were associated with a significantly increased frequency of delayed union, nonunion, and refracture. In 41 patients (11%) a total of 58 reoperations had to be undertaken because of local complications. There was an over-representation of plated fractures among those patients suffering a local complication classified as severe, 24 out of 37 (chi 2 = 30.3; p less than 0.001). Consequently, we now only exceptionally use plate fixation in the management of femoral shaft fractures.