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Background: The MoPyc radial head arthroplasty (RHA) is a monopolar implant with a pyrocarbon head that obtains rigid fixation via controlled expansion of the titanium stem. The aim of this study was to evaluate the short-term to midterm outcomes of MoPyc RHA., Materials and Methods: Between 2002 and 2021, 139 MoPyc RHA were implanted in 139 patients with a RH fracture. The mean follow-up was 5.9 years ± 3.5 (range 1-16). Range of motion, mean Mayo Elbow Performance Score (MEPS), Quick Disabilities of the Arm, Shoulder and Hand score, visual analog scale (VAS), radiographic outcome, and reason for failure were recorded., Results: The mean MEP, Quick Disabilities of the Arm, Shoulder and Hand, and VAS scores were 89.1 ± 2.2 (range, 45-100), 17.5 ± 16.7 (range, 0-78), and 0.8 ± 1.6 (range, 0-50), respectively. Stress shielding (SS) and osteolysis around the stem were identified in 92 (66%) and 20 (14%) patients. A total of 47 (29%) patients experienced at least 1 complication and 29 (21%) of them required re-intervention. Persistent stiffness (n = 12; 9%) was the most common complication. No painful loosening was noted. Osteolysis around the stem, presence of an autoexpanding stem, and overstuffing were associated with a lower MEPS and an increase in VAS (P < .05). SS was associated with an increase in MEPS (adjusted beta coefficients= 6.92; P < .001) and lower VAS (adjusted beta coefficients= -0.69; P = .016). The autoexpending stem increased the likelihood of SS after RHA (adjusted odds ratio = 1.49; P = .001)., Conclusions: A well-fixed MoPyc RHA provided satisfactory short to midterm outcomes, without painful loosening. However, the autoexpanding stem system was associated with poorer functional outcomes and increased the likelihood of SS., (Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: We sought to assess if the medullary diameter to cortical width ratio (MD:CW), canal flair index (CFI), and canal fill (CF) of the proximal radius were associated with the presence of stress shielding (SS) after a MoPyC radial head arthroplasty., Materials and Methods: We conducted a retrospective, international, multicenter (4 centers) study. A total of 100 radial head arthroplasties in 64 women and 36 men with a mean age of 58.40 years ± 14.90 (range, 25.00-91.00) were included. Radiographic measurements, including MD:CW, CFI, CF, and postoperative SS were captured at a mean follow-up of 3.9 years ± 2.8 (range, 0.5-11)., Results: SS was identified in 60 patients. Mean preoperative MD:CW, CFI, and CF were 0.55 ± 0.09, 1.05 ± 0.18, and 0.79 ± 0.11, respectively. The presence of SS was significantly associated with MD:CW (adjusted odds ratio = 13.66; P = .001), and expansion of the stem (adjusted odds ratio = 3.78; P = .001). The amount of the SS was significantly correlated with expansion of the stem (aβ 4.58; P < .001)., Conclusions: Our study found that MD:CW was an independent risk factor of SS after MoPyc radial head arthroplasty. Autoexpansion of the MoPyc stem significantly increased the risk of SS and its extent. Further studies involving multiple implants designs are needed to confirm the preliminary observations presented in the current study., (Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

HAND ACCIDENT PREVENTION. Advances in surgical techniques and a better organization with SOS mains structures have improved the management of hand injuries. However, there are still too many accidents, which can lead to functional and aesthetic after-effects, as well as their socio-professional consequences. The prevention of hand injuries is therefore mandatory. It is organized with three levels: primary prevention, that aims to prevent the occurrence of the accident itself; secondary prevention, to guide and provide the best emergency care for the patient; and tertiary prevention, to avoid deprofessionalization and provide support for any physical and psychological after-effects., Competing Interests: A. Kilinc déclare n’avoir aucun lien d’intérêts. G. Ciais déclare avoir participé à des interventions ponctuelles pour les entreprises FH Ortho, Smith Nephew et avoir été pris en charge, à l’occasion de déplacement pour congrès, par FH Ortho.

Purpose: The purpose of the study is to report the results of reverse shoulder arthroplasty (RSA) after three types of initial treatment performed for complex proximal humeral fracture (PHF): conservative, reduction and internal fixation (RIF), or hemiarthroplasty., Methods: This is a retrospective study of 63 patients separated into three groups with a minimum follow-up of two years. Group I included 25 patients with an initial conservative fracture treatment, group II included 25 patients treated by RIF, and group III included 13 patients initially treated by hemiarthroplasty. Patients were assessed using the absolute Constant-Murley score, functional parameters, complications rate, and radiological follow-up., Results: One patient died and five were lost to follow-up. All functional outcomes improved significantly post-operatively for the three groups (p < 0.005). The mean Constant-Murley score increased from 13.7 to 54.1 (group I); 16.6 to 48.5 (group II); and 22.6 to 48.2 (group III) (p < 0.001). The gain of Constant-Murley and SST scores was better for group I (p = 0.049 and 0.028, respectively), while post-operative pain was better in group III (p = 0.033). The complication rate was 38% in group III, 30% in group II, and 14.3% in group I., Conclusions: Reverse shoulder arthroplasty represents a good surgical option in complex proximal humeral fracture sequelae. Whatever the initial treatment, function and motion of the shoulder are improved. The final result is better if the initial treatment was conservative. The group initially treated with hemiarthroplasty had the most complications.

Background: The prevalence of combined humeral and glenoid defects varies between 79 and 84 % in case of chronic posttraumatic anterior shoulder instability. The main goal of this study was to evaluate the relationship between humeral and glenoid defects based on quantitative radiological criteria., Methods: A retrospective study was performed between 2000 and 2011 including patients who underwent primary surgical shoulder stabilization for chronic posttraumatic anterior shoulder instability, with bone defects in both the glenoid and humerus and a healthy contralateral shoulder. The following measurements were taken: D/R ratio (Hill-Sachs lesion depth/humeral head radius) on an AP X-ray in internal rotation and the D1/D2 ratio [diameter of the involved glenoid articular surfaces (D1)/the healthy one (D2)] on a comparative Bernageau glenoid profile view. Measurements were taken by two observers. Correlations were determined by the Spearman correlation coefficients (r), Bland and Altman diagrams, and intra-class correlation coefficients (ICC). A sample size calculation was done., Results: Thirty patients were included, 25 men/5 women, mean age 29.8 ± 11.2 years. The mean D/R was 23 ± 12 % for observer 1 and 23 ± 10 % for observer 2. The mean D1/D2 was 95 ± 4 % for observer 1 and 94 ± 6 % for observer 2. No significant correlation was found between humeral and glenoid bone defects by observer 1 (r = 0.23, p = 0.22) or observer 2 (r = 0.05, p = 0.78). Agreement of the observers for the D/R ratio was excellent (ICC = 0.89 ± 0.04, p < 0.00001) and good for the D1/D2 ratio (ICC = 0.54 ± 0.14, p = 0.006)., Conclusion: Humeral and glenoid bone defects were not correlated. Inter-observer reliability was excellent for the D/R ratio and good for the D1/D2 ratio., Level of Evidence: Nonconsecutive Patients, Diagnostic Study, Level III.

The ideal dorsal wrist approach has to provide the best exposure while preserving sensitive dorsal nerve branches, dorsal veins, and skin integrity. Longitudinal incision is mostly used in the wrist surgery. Few anatomic or clinical studies have described transverse dorsal approach following Langer's lines. We present a universal transversal skin incision, the design of which meets the requirements of a dorsal wrist approach. It is adjustable with the radial and ulnar extension and respects Langer's lines, nerves, and veins. We conducted both an anatomic, clinical, and a retrospective study. For the anatomic part, we performed a cadaveric study on the wrist. For the clinical part of the study, we analyzed clinical results for 10 consecutive patients who underwent a universal dorsal wrist approach for various surgical procedures by the same surgeon. For the last part, we reviewed the patients operated during the past 5 years with this approach for different procedures in the wrist.

Purpose: The transfer of the pectoralis major in cases of irreparable rupture of the subscapularis has been described through different techniques. The aim of this prospective study was to compare the clinical results of transferring the clavicular or the sternal head of the pectoralis major tendon underneath the conjoint tendon., Methods: Fifteen patients underwent the procedure, including eight clavicular head of the pectoralis major tendon transfers and seven sternal head transfers. The mean age at the time of surgery was 57 years (range, 37-66). Each patient had pre-operative MRI and CT scan. The criteria for an irreparable subscapularis tear were retraction at the level of the glenoid and fatty infiltration of the muscle graded III or IV. Pre-operative and postoperative functions were assessed by the Constant score. Patients were finally asked if they were very satisfied, satisfied or unhappy with the functional outcome., Results: The average follow-up was 24 months (range, 12-50). The mean absolute Constant score of the entire series increased significantly from 36 preoperatively to 69 at the latest follow up (p < 0.01); it improved significantly and similarly in both types of tendon harvested. Nine patients were very satisfied, three were satisfied and three were dissatisfied with the clinical outcome., Conclusion: A clavicular or a sternocostal head transfer of the pectoralis major under the coracoid process reduced pain, and improved the strength and function of the shoulder.

Acute mucositis is the main intensity-limiting toxicity in the management of head and neck (H&N) and digestive track carcinomas with radiotherapy. New radiation modalities (hyperfractionation and/or acceleration) as well as combined modality regimens in this situation induce higher rates of acute toxicity. Hyperfractionation for example allows higher control rates, with few late toxicities, but it slightly increases acute mucositis. The addition of chemotherapy introduces systemic toxicity and can exacerbate local tissue reactions when used concurrently with radiation. Mucositis is recognized as the principal limiting factor to further treatment intensification. As local-regional control and overall survival are related to dose-intensity in this case, further research into the assessment, analysis, prevention and treatment of mucosal toxicity is not only crucial to the improvement in quality of life, but certainly to improved rates of disease control as well. Several topical and systemic treatments are directed to the decrease and the acceptance of this acute toxicity, but few have shown significant preventive effect. Improvement of technical aspects of H&N radiotherapy (3D conformal radiation, intensity-modulated radiotherapy) should have a major impact in the prevention of mucositis. The efficacy of low level laser therapy in the management of such a toxicity could hence yield important development of this method in the field of oncology. MASCC/ISOO mucositis group's recommendations for the management of acute radiation-induced mucositis are here summarized.

Purpose: To evaluate the feasibility of in vivo measurements with metal oxide semiconductor field effect transistor (MOSFET) dosimeters for oropharynx and nasopharynx intensity-modulated radiation therapy (IMRT)., Methods and Materials: During a 1-year period, in vivo measurements of the dose delivered to one or two points of the oral cavity by IMRT were obtained with MOSFET dosimeters. Measurements were obtained during each session of 48 treatment plans for 21 patients, all of whom were fitted with a custom-made mouth plate. Calculated and measured values were compared., Results: A total of 344 and 452 measurements were performed for the right and left sides, respectively, of the oral cavity. Seventy percent of the discrepancies between calculated and measured values were within +/-5%. Uncertainties were due to interfraction patient positions, intrafraction patient movements, and interfraction MOSFET positions. Nevertheless, the discrepancies between the measured and calculated means were within +/-5% for 92% and 95% of the right and left sides, respectively. Comparison of these discrepancies and the discrepancies between calculated values and measurements made on a phantom revealed that all differences were within +/-5%., Conclusion: Our experience demonstrates the feasibility of in vivo measurements with MOSFET dosimeters for oropharynx and nasopharynx IMRT.

The appearance of mucositis is a frequent and painful secondary effect of anticancer chemotherapy. Patients who develop oral toxicity during the first course of treatment will almost assuredly show identical side effects during each subsequent course unless the drugs are changed or the doses are lowered. In the absence of an efficacious antidote or preventive prophylaxis for such lesions to date, this report presents the results of a preliminary retrospective non-randomized study of the effect of soft-laser treatments on mucositis in cancer patients receiving combination chemotherapy, including 5-fluorouracil. Iatrogenic mucositis was observed during 43% of 53 chemotherapy cycles in the case control population. Curative laser therapy reduced the time to repair lesions and the rate of therapeutic modifications. For patients who received soft-laser therapy as a preventive measure, the incidence of oral complications was reduced to 6% during 101 cycles of chemotherapy. All of these patients, even those who have encountered mucositis before receiving preventive laser therapy, terminated their cancer therapy as originally scheduled. Well designed and carefully controlled trials will be necessary to define the place of helium-neon laser therapy in the repair and prevention of oral complications due to cancer chemotherapy.