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Aim: Proximal humerus fractures are common injuries in the elderly population. This study hypothesizes that arthroplasty is not superior to conservative treatment in the management of multi-part proximal humerus fractures in elderly patients. Material and Method: Patients aged 65 and above with 3-4-part proximal humerus fractures, treated either conservatively or with arthroplasty, were included in the study. The minimum follow-up period was set at 12 months. Functional evaluations of the patients were performed using the Quick Disabilities of Arm, Shoulder and Hand (Q-DASH) scoring system. Statistical analysis comparing the two groups was conducted using the SPSS software. The mean values of numerical data were analyzed using the Mann-Whitney U test, while categorical data were compared using the Chi-square test. A significant level of 0.05 was considered. Results: A total of 67 patients who received adequate clinical follow-up were included in the study (50 conservative 17 arthroplasty). The average age of the patients was 76.12 years, with 9 male and 58 female patients. The average follow-up period was 22.61 months (range: 12-82). There were no statistically significant differences in age, gender, side, follow-up period, and fracture type distribution between the two groups. However, a significant difference in Q-DASH scores was observed (p<0.05). Conclusion: In the treatment of proximal humerus fractures, even when they are multi-part fractures, conservative treatment should may be the first choice. We think that the early results of conservative treatment are better than arthroplasty. [ABSTRACT FROM AUTHOR]

Aim: Videos related to avascular necrosis of the femoral head are no exception, and so the aim of this study is to evaluate the educational quality of YouTube videos on this topic. Material and Method: A standardized video search was performed on YouTube using the terms "avascular necrosis of the hip", "osteonecrosis of the hip" and "avascular necrosis of the femoral head". The top 50 videos were then analyzed, and the characteristics and content of the videos were recorded. The Journal of American Medical Association criteria, The DISCERN score, The Global Quality Score and the new YouTube 'Avascular Necrosis of the Femoral Head Score" were all used to assess the reliability and accuracy of the videos. Results: The median video duration of the 50 videos was 10.85±19.17 minutes. The median number of views was 10,866 (range 221 to 278,174). According to the video content, 60% of the videos contained information about the disease, 10% were about patient experience, and the remaining 30% related to surgical technique or approach. Physicians were the primary uploader on YouTube for this topic. The rate of low-quality videos was determined as following according to the different evaluative systems: 68% according to the newly defined YouTube Avascular Necrosis of the Femoral Head Score, 60% according to the DISCERN score, and 56% according to The Global Quality Score. The Journal of the American Medical Association, The Global Quality Score, and DISCERN score were significantly correlated with video duration, while the New YouTube Avascular Necrosis of the Femoral Head Score was significantly correlated with video duration, time since upload, number of views, and like rate. Conclusion: Most of the popular YouTube videos about avascular necrosis are of a low quality. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the performance of the bear hug (BH) and belly press (BP) tests in diagnosing tears of the subscapularis (SSC)., Methods: A retrospective review was conducted on prospectively maintained data on patients who underwent arthroscopic rotator cuff repair (ARCR) of SSC tears between 2011 and 2021. A control group also was obtained of ARCRs with an intact SSC tendon. All examinations and ARCRs were performed by one high-volume shoulder surgeon. The BH test and BP test results were compared with arthroscopic findings as the gold-standard diagnostic modality. Tear type was classified based on the Lafosse classification. Sensitivity, specificity, positive and negative predictive values, false-positive and false-negative rates, and accuracy were calculated for both tests., Results: A total of 1,122 patients were included for analysis, 866 with intraoperatively confirmed SSC tears (77%) and 256 without (23%). The BH test diagnosed SSC tears with a sensitivity of 46.1% and a specificity of 83.2%, whereas the BP test diagnosed tears with a sensitivity of 23.3% and a specificity of 93.4%. Overall, both tests missed SSC tears in 42.3% (n = 475) of cases. The BH test had accuracy rates of 25.9% for SSC type I tear, 48.7% for type II tear, 65% for type III tear, and 81.7% for type IV-V tear. In contrast, the BP test had accuracy rates of 7.6% for type I tear, 14.7% for type II tear, 42% for type III tear, and 68.7% for type IV-V tear., Conclusions: The BH test had greater sensitivity than the BP test in identifying SSC tears. Both tests showed low accuracy in identifying SSC tears as tear size decreased. Combining both tests did not provide any additional benefits over using the BH test alone., Level of Evidence: Level III, diagnostic study., Competing Interests: The authors report the following potential conflicts of interest or sources of funding: M.E.M. is a consultant for 10.13039/100007307Arthrex. P.J.D is a consultant for 10.13039/100007307Arthrex. All other authors (A.I.K., J.A., T.P.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Full ICMJE author disclosure forms are available for this article online, as supplementary material., (© 2023 Published by Elsevier Inc. on behalf of the Arthroscopy Association of North America.)

Purpose: To compare radiologist and surgeon magnetic resonance imaging (MRI) interpretations of subscapularis (SSC) tears against intraoperative arthroscopic examination., Methods: We conducted a retrospective review of prospectively maintained data on patients who underwent arthroscopic rotator cuff repair with and without SSC tears between 2011 and 2022. The radiologists' assessments of SSC integrity were extracted from the MRI reports. One high-volume fellowship-trained shoulder surgeon assessed all MRI scans for the presence or absence of SSC tears. Radiologist and surgeon MRI-based assessments were compared against the diagnostic gold standard (intraoperative arthroscopic examination) and classified according to the Lafosse classification. Sensitivity, specificity, positive and negative predictive values, and accuracy were calculated., Results: A total of 1,090 patients were included for analysis, 839 with intraoperatively confirmed SSC tears (77%) and 251 without such tears (23%). Radiologists diagnosed SSC tears with a sensitivity of 56.0% (470 of 839 patients) and specificity of 67.3% (169 of 251 patients) via MRI, whereas the surgeon diagnosed SSC tears with a sensitivity of 71.4% (599 of 839 patients) and specificity of 78.1% (196 of 251 patients). Overall, radiologists only correctly identified 56% of SSC tears whereas the shoulder surgeon correctly identified approximately 71.4% of tears. When considering arthroscopically confirmed tear size, that is, intact, partial, full thickness [upper border], and complete, the radiologists' diagnosis rates with MRI were 67.3%, 40.4%, 64.6%, and 78.3%, respectively, and the surgeon's diagnosis rates were 78.1%, 52.7%, 81.9%, and 97.5%, respectively., Conclusions: In a community practice, radiologists miss approximately 50% of SSC tears on MRI examination. A shoulder surgeon with the benefit of clinical examination misses 28.6% of tears on MRI. Accuracy increases as tear size increases, with radiologists detecting 40.4% of partial tears and 78.3% of complete tears and a surgeon detecting 52.7% and 97.5%, respectively., Level of Evidence: Level III, diagnostic study (nonconsecutive patients)., Competing Interests: The authors report the following potential conflicts of interest or sources of funding: M.E.M. is a consultant for Arthrex, outside the submitted work. P.J.D. is a consultant for Arthrex, outside the submitted work. All other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Full ICMJE author disclosure forms are available for this article online, as supplementary material., (© 2023 Published by Elsevier Inc. on behalf of the Arthroscopy Association of North America.)