Functional Performance Tests Reveal Promising Results at 6 Months After Shoulder Stabilization Surgery.

BACKGROUND: Although athletes are mostly allowed to return to play 6 months after shoulder stabilization surgery, there are inadequate data about their functional status during this period. HYPOTHESES: Performance tests would reveal insufficiency in the functional capacity of shoulder 6 months after stabilization surgery. STUDY DESIGN: Prospective cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: A total of 32 male athletes with arthroscopic anterior capsulolabral repair (AACR) were included in the study. Shoulder internal and external rotator (IR-ER) strength was assessed using isokinetic dynamometer at 60°/s and 180°/s angular velocities preoperatively and 6 months postoperatively. Shoulder function was assessed with closed kinetic chain upper extremity stability (CKCUES) test, Y balance test-upper quarter (YBT-UQ), and unilateral seated shot-put test (USSPT) at 6 months postoperation. Western Ontario shoulder instability index (WOSI) and Tampa scale of kinesiophobia (TSK) were used for the self-assessment of the shoulder. Mixed-model ANOVA was used to analyze the changes in the IR-ER strength on both shoulders. Limb symmetry index (LSI) was calculated for the IR-ER strength, YBT-UQ, and USSPT scores. RESULTS: Shoulder IR strength was higher at 6 months postoperatively compared with preoperatively. The LSI was 76.4% and 76.6% for ER strength, and 94.2% and 94% for IR strength at 60°/s and 180°/s angular velocities, respectively, at the postoperative 6 month timepoint. The mean CKCUES test score was 21.8 ± 2.6 touches and the LSI was 94.7% for the YBT-UQ and 102.5% for the USSPT. WOSI (P < 0.001) and TSK (P = 0.001) scores were significantly lower at 6 months postoperatively. CONCLUSION: Functional status of the patients with shoulder stabilization surgery improved considerably 6 months after surgery, yet they did not fully recover function. CLINICAL RELEVANCE: Exercise programs focusing on shoulder ER strength and shoulder performance should be emphasized after stabilization surgery.

The comparison of single plate and double plate fixation methods for treatment of humeral shaft nonunions.

OBJECTIVES: This study aims to evaluate the early- and mid-term shoulder and elbow functions and compare the union rates after the application of single plate and double plate for the treatment of humerus shaft nonunions. PATIENTS AND METHODS: This retrospective study included 56 patients (36 males, 20 females; mean age 53.8±9.5; range, 28 to 68 years) treated with double plate (n=25) and single plate (n=31) osteosynthesis between October 2012 and January 2016. Surgical treatment of the nonunion was applied in the fourth month after the fracture at the earliest. Autograft taken from the iliac bone was applied during the surgery in all patients. Evaluation was performed using The University of California at Los Angeles (UCLA) Shoulder Score, Mayo Elbow Performance Score (MEPS), Visual Analog Scale (VAS), Constant Shoulder Score, and Disabilities of the Arm Shoulder and Hand (DASH) questionnaire. RESULTS: The mean postoperative follow-up time was 40.7±9.6 (range, 25 to 58) months. No statistically significant difference was determined in respect of time to union, follow-up time, DASH questionnaire score, UCLA Shoulder Score, VAS, MEPS and Constant Shoulder Score after union in the comparison of the two groups (p>0.05). In the examination of postoperative early (three months) recovery phase of shoulder and elbow functions, statistically significant superior scores were obtained in the double plate group for MEPS (double plate median=85 [min 75-max 90], single plate median=75 [min 70-max 85]) and Constant Shoulder Score (double plate median=89 [min 85-max 92], single plate median=81 [min 75-max 90]) (p<0.001). CONCLUSION: There was no statistically significant difference in terms of time to union and union rates between single plate and double plate fixations for surgical treatment of humeral shaft nonunions. However, superior clinical results were obtained in the early recovery phase of shoulder and elbow functions with double plate fixation.

Does Malrotation After Minimally Invasive Plate Osteosynthesis Treatment of Distal Tibia Metaphyseal Fractures Effect the Functional Results of the Ankle and Knee Joints?

OBJECTIVES: To investigate whether rotational malalignment of tibia, after fracture management with minimally invasive plate osteosynthesis technique (MIPO), leads to impaired results in knee and ankle joint functional scores. DESIGN: Prospectively collected data were retrospectively analyzed for this study. SETTING: Level III academic trauma center. PATIENTS/PARTICIPANTS: Sixty-five consecutive patients who applied between October 2010 and January 2014 with a unilateral distal tibia fracture and had full bone union at their last visit were analyzed. Patients were excluded if they had a pathologic fracture, Gustilo-Anderson type II or III open fracture, additional ligamentous trauma, were pregnant, or had any deformity. A total of 27 patients were accepted into the study. INTERVENTION: All patients were treated with a MIPO technique after a mean of 2.8 days. The fibular fracture, when present, was fixed first. MAIN OUTCOME MEASUREMENTS: The main outcome of this study was the relation between tibial malrotation after a MIPO procedure, and Lower Extremity Functional Scale, American Orthopedic Foot and Ankle Society, KOOS scores, and range of motions of adjacent joints. RESULTS: Fourteen patients (51.8%) had a rotation higher than 10 degrees. The mean malrotation angle was 14.6 degrees. Concomitant fibular fractures were present in 13 patients, which did not seem to have a significant influence on malrotation. There was no significant difference between groups regarding functional scores and range of motions of the knee and ankle joints. CONCLUSIONS: Despite high rates of malrotation after tibial metaphyseal-diaphyseal fractures treated with MIPO technique, this finding does not seem to have a significantly negative effect on knee and ankle joint functions. Meticulous intraoperative evaluation, through a range of different techniques, should be performed to avoid malrotation. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.