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Current literature suggests a significant epidemiological association between traumatic brain injury (TBI) and proximal upper limb fractures in addition to major clinical consequences. A systematic review was conducted to assess how TBI is taken into consideration in interventional studies on shoulder fractures.The following data sources were used: MEDLINE, EMBASE, EBM Reviews, CINAHL, and OpenGrey databases. Study selection included interventional randomized clinical trials and prospective cohort studies on shoulder fractures published in English or French between 2008 and 2020. Studies on pathologic fractures, chronic fracture complications, nonhuman subjects, and biomechanics were excluded. Articles were reviewed by two independent authors according to the PRISMA guidelines. Baseline characteristics, exclusion criteria, and input relevant to TBI were recorded. Methodological quality was assessed with the Cochrane risk of bias tool for randomized clinical trials and the Newcastle-Ottawa Scale for cohort studies.One-hundred-thirteen studies met the inclusion criteria. None discussed the possible impact of TBI on their results. Only three (2.7%) studies considered TBI relevant and included these patients in their cohort. Furthermore, 43/113 (38.1%) excluded patients with injuries or mechanisms strongly related to traumatic brain injuries: head injuries (4); moderate and/or severe TBI (7); high energy traumas (3); Polytrauma subjects (33).TBI are ignored or discriminated in prospective clinical trials on shoulder fractures. The exclusion of these cases impacts generalizability as their prevalence is significant. Considering the major impact of TBI on important outcomes, its presence should always be assessed to ensure high quality evidence.Systematic Review, Therapeutic Level II.

The Western Ontario Shoulder Instability (WOSI) questionnaire is a 21-item questionnaire to evaluate quality of life in patients with shoulder instability. Completing the questionnaire is time-consuming because each item is evaluated on a visual analog scale. Telephone or email versions of the score are appealing alternatives to administering it during the standard in-person patient visit; however, their validity and reliability remain unknown.(1) Does the numerical scale (NS) version of the WOSI correlate with the original WOSI and Quick-DASH? (2) Do telephone and email administration of the NS-WOSI have good reliability and consistency? (3) Compared with the original WOSI form, does the NS form lead to faster completion for patients and quicker data extraction for researchers?Between 2014 and 2019, 50 patients with a documented history of shoulder dislocation with persistent symptomatic shoulder instability, whether anterior, posterior, or multidirectional; patients scheduled for surgery; and patients with traumatic or nontraumatic injuries were prospectively recruited from the outpatient clinic of two university hospitals acting as Level 1 trauma centers and sports traumatology tertiary referral centers. The median (IQR) age was 28 years (24 to 36), and 80% (40 of 50) were men. Most (52% [26 of 50]) patients had two to five lifetime shoulder dislocations. Validity of the NS-WOSI was assessed using the Pearson correlation coefficient during an in-person visit; the original WOSI questionnaire (or its previously validated French-language version), NS-WOSI, and Quick-DASH questionnaires were administered in a random order. After a minimum 7-day interval, 78% (39 of 50) of patients completed the phone interview, and 74% (37 of 50) of patients completed the email version of the NS-WOSI score to evaluate NS-WOSI's reliability using the intraclass correlation coefficient (ICC), which was interpreted as poor (0.5), moderate (0.50-0.75), strong (0.75-0.90), and very strong (0.90). The standard error of measurement (SEM) was used to evaluate variability around the true score, with a low value indicating a high reliability. The 95% minimal detectable change (MDC 95% ) was calculated to evaluate the minimal change in score that was not related to measurement errors. Lastly, the Cronbach alpha was used to assess internal consistency (intercorrelation strength), where a value0.70 was considered good. The time needed for the patient to complete the various versions and for researchers to extract data was recorded.The NS-WOSI score was very strongly correlated with the original WOSI score (r = 0.96 [95% confidence interval (CI) 0.93 to 0.98]; p0.001). Although telephone-acquired and email-acquired data for the NS-WOSI questionnaires were correlated with the NS-WOSI (telephone r = 0.91 [95% CI 0.83 to 0.95]; p0.001; email r = 0.84 [95% CI 0.71 to 0.91]; p0.001), the ICC was higher for telephone interviews (0.92 [95% CI 0.86 to 0.96] versus email 0.80 [95% CI 0.64 to 0.89]), indicating that although both had good reliability, the phone interview was more suitable. The phone interview was also preferable to email regarding SEM (3% [52 of 2100 points] versus 6% [132 of 2100 points]) and the MDC 95% (7% [144 of 2100 points] versus 17% [366 of 2100 points]). The 95% CI of the MDC acquired by email was superior to the reported minimum clinically important difference for the original WOSI (7% [152 of 2100 points]), meaning that an error of measurement could wrongly be interpreted as a clinically significant change in score. Internal consistency was deemed good, with a Cronbach alpha of 0.96 (95% CI 0.92 to 98) and 0.89 (95% CI 0.79 to 0.94) for NS-WOSI telephone and email, respectively. The time to complete the NS-WOSI was reduced compared with the original WOSI (221 ± 153 seconds versus 266 ± 146 seconds, mean difference -45 seconds [95% CI -72 to -12]; p = 0.009). Lastly, data extraction was faster (62 ± 15 seconds versus 209 ± 52 seconds, mean difference -147 seconds [95% CI -164 to -130]; p0.001) with the NS-WOSI than with the original WOSI.The NS-WOSI in person, by telephone, or by email is a valid, reliable, and timesaving alternative to the original WOSI questionnaire. However, the reliability of data acquisition by telephone interviews was superior to that of email.Given that there were no important differences in performance for the NS-WOSI, regardless of whether it was administered in person or by phone, we suggest that physicians use both interchangeably based on patient convenience. However, we do not recommend using the email version, especially for research purposes, since it was not as reliable when compared with in-person administration. The responsiveness of the modified NS-WOSI, as well as factors influencing response rates to phone interview, are questions that remain to be explored.

Background Total hip arthroplasty (THA) is one of the most successful procedures in orthopedic surgery. The most frequent THA indications are osteoarthritis and avascular necrosis, whereas symptomatic aseptic loosening is the most common indication to revision surgery. Chondrosarcoma (CS) is the most frequent bone sarcoma in adults, and proximal femur is the most prevalent location. Wide resection is the treatment of choice.We report 3 cases of unrecognized high-grade CS in the setting of primary or revision THA and reviewed the literature on this rare clinical presentation. Methods A systematic literature review on CS in the setting of THA, published between 1980 and 2020, was performed on PubMed, Embase, Medline, Ovid SP, and Web of Science, using the guidelines set in the Preferred Reporting Items for Systematic Reviews and Mata-analyses (PRISMA). Results Case series: Three patients were referred to our sarcoma center after failure of THA due to unrecognized high-grade CS. All 3 had rapid fatal outcome. Literature review: Fifty-nine articles were identified, of which 8 were included in the study. They confirmed that primary or revision THA failure due to unrecognized CS is extremely rare, with only few cases reported in the literature. Conclusions Before proceeding to primary or revision arthroplasty, diagnosis must be ascertained. Atypical presentation of a common pathology, such as osteoarthritis, avascular necrosis, or aseptic loosening of an endoprosthesis, should raise suspicion for another cause to symptoms, and additional workup be performed. As our cases demonstrated, unrecognized or inadequately managed bone sarcoma may lead to poor or even fatal outcome.

Background Chordoma is a rare malignant tumor of the axial skeleton. Percutaneous cryoablation (PCA) is a minimally invasive technique that allows freezing of tumors under imaging control. The purpose of our retrospective study was to investigate the outcome of PCA in a selected cohort of patients with sacrococcygeal chordoma, with a minimum of 5 years follow-up. Materials and methods Four patients were treated in 10 sessions. The mean follow-up was 57.3 months. We evaluated the feasibility, the procedure-related complications, the impact on pain control and oncological outcomes. Results Freezing of 100% of the tumor volume was possible in 60%. Pain control was not reliably evaluable. Local recurrence occurred in 90% of the treated lesions; the mean time to progression was 8.1 months (range 1.5-16). At last follow-up, one patient had died of the disease, one of another cause and one was receiving the best supportive care. The only patient alive without the disease had received additional carbon-ion radiotherapy. The 5-year survival rate after index PCA was 50%. Conclusion Complete freezing of the tumor was technically challenging, mainly due to the complex local anatomy. Recurrence occurred in 90% of the lesions treated. PCA should be considered with caution in the curative management of sacrococcygeal chordoma.

The stability of the glenohumeral joint depends on soft tissue stabilizers, bone morphology and dynamic stabilizers such as the rotator cuff and long head of the biceps tendon. Shoulder stabilization techniques include anatomic procedures such as repair of the labrum or restoration of bone loss, but also non-anatomic options such as remplissage or tendon transfers. Rotator cuff repair should restore the cuff anatomy, reattach the rotator cable and respect the coracoacromial arch whenever possible. Tendon transfer, superior capsular reconstruction or balloon implantation have been proposed for irreparable lesions. Shoulder rehabilitation should focus on restoring balanced glenohumeral and scapular force couples in order to avoid an upward migration of the humeral head and secondary cuff impingement. The primary goal of cuff repair is to be as anatomic as possible and to create a biomechanically favourable environment for tendon healing.Cite this article: EFORT Open Rev 2020;5:508-518. DOI: 10.1302/2058-5241.5.200006

Introduction: The olecranon Chevron osteotomy (OCO) is commonly used to approach complex intraarticular fractures of the distal humerus. Predrilled tension band wiring (TBW) has historically been used to fix OCO. However, clinical outcomes are burdened by secondary loss of reduction and up to 21.3% non-union rates. The biomechanical stability of anatomic locking compression plate (LCP) was reported to be superior to TBW in olecranon fracture fixation. We hypothesised that this implant may also be superior to TBW in the anatomic reconstruction of the articular surfaces of the ulnar greater sigmoid notch after OCO by predrilling the holes of the angular stable plate with the threaded drill guide prior to osteotomy., Materials and methods: Lateral standardised and calibrated radiographs of twenty synthetic ulnar bones were obtained using a custom-made holder prior to preparation by a senior orthopaedic trauma surgeon. Ten specimens were then predrilled using the threaded drill bit guide of an olecranon LCP, while the other ten samples were predrilled with two 1.6 mm Kirschner wires. A distal "V" OCO was performed using a 0.6 mm oscillating saw. After repositioning and fixation with the corresponding device, lateral radiographs were repeated. Two independent observers used the TraumaCad planning software to document the articular geometry of the ulnar greater sigmoid notch pre- and postoperatively. The diameter of the best-fitting circle (diameter), the distance between the tip of the coronoid and the olecranon processes (distance) and the maximum articular depth were measured., Results: With the TBW technique, after OCO and fixation, all three postoperative measurements were significantly (p = 0.13). Inter and intra-observer measurement reliability was strong to very strong (intraclass correlation coefficients >= 0.793) for all three variables., Conclusion: Our study reveals that the predrilled LCP technique is more accurate than the predrilled TBW in restoring the anatomic articular geometry of the ulnar greater sigmoid notch after OCO. (C) 2020 Elsevier Ltd. All rights reserved.

Resume Contexte Le taux d’echec apres arthroplastie totale anatomique de l’epaule (ATEa) est plus eleve en cas de perte osseuse asymetrique de la glene secondaire a une usure posterieure, ainsi qu’en cas de subluxation posterieure statique persistante de la tete humerale (SPH). Hypothese Nous avons teste l’hypothese selon laquelle l’utilisation combinee d’un implant glenoidien augmente posterieurement (GAP) avec une planification chirurgicale en 3D et des guides d’instrumentation specifiques au patient (ISP) permet de reduire a court terme la SPH apres une ATEa chez les patients avec des glenes de type B2 ou B3. Materiel et methodes Nous avons inclus neuf patients consecutifs atteints d’omarthrose primaire et presentant des glenes de type B2 ou B3, qui ont beneficie d’une ATEa avec implants GAP a quille cimentee (augmentation posterieure de 15, 25 ou 35 degres). Tous les patients ont eu une tomodensitometrie (TDM) de l’epaule preoperatoire combinee a une planification chirurgicale 3D couplee a un ISP. Des TDMs postoperatoires ont ete effectuees apres 14 semaines en moyenne (de 10 a 21 semaines). La subluxation scapulo-humerale ainsi que la version et l’inclinaison de la glene ont ete mesurees en 3D, a la fois sur des TDMs pre- et postoperatoires, avec la meme methode quantitative et fiable. Resultats Nous avons observe une diminution significative de la subluxation scapulo-humerale de 49 ± 12 % en preoperatoire, a 22 ± 17 % en postoperatoire (p = 0,0039), avec une taille d’effet importante (Cohen's d = 1,89). La version preoperatoire de la glene a ete corrigee de −17,3 ± 9,4 degres a −5,2 ± 7,5 degres en postoperatoire. La difference absolue entre la version et l’inclinaison postoperatoire et les mesures correspondantes planifiees chirurgicalement etait respectivement de 5,4 ± 3,6 degres et 3,3 ± 2,0 degres. Conclusion L’utilisation combinee d’implants GAP avec la planification preoperatoire 3D et une ISP entraine une diminution significative a court terme de la SPH et de la version glenoidienne chez les patients presentant une usure asymetrique posterieure de la glene. Nous suggerons que ces implants asymetriques ne devraient pas se limiter a l’augmentation posterieure, car les usures osseuses sont egalement observees dans d’autres secteurs de la glene. Niveau d’evidence scientifique IV, science de base.

Glenoid bony lesions play a role in approximately half of anterior shoulder instability cases. The purpose of this study is to see if the anatomy of the coracoid affects the location of glenoid rim defects. We hypothesized that a prominent coracoid (lower and lateral) would be more likely to cause an anterior–inferior glenoid lesion, and a less prominent coracoid more prone to cause an anterior lesion. The null hypothesis being the absence of correlation. Fifty-one shoulder CT-scans from a prospective database, with 3D reconstruction, were analyzed. The position of glenoid lesions was identified using the validated clock method, identifying the beginning and end time. The size of bony glenoid defects was calculated using the validated glenoid ratio method. The position of the coracoid tip was measured in three orthogonal planes. Analysis included 25 right shoulders and 26 left shoulders in seven females and 41 males. The vertical position of the coracoid tip relative to the top of the glenoid was highly correlated to the location of the glenoid defect on the profile view (r = −0.625; 95% CI 0.423–0.768; p = 0.001). Thus, higher coracoids were associated with anterior lesions, while lower coracoids were associated with anterior–inferior lesions. A more laterally prominent coracoid was also correlated with anterior–inferior lesions (r = 0.433; 95% CI 0.179–0.633; p = 0.002). This study shows that coracoid anatomy affects the location of bony Bankart defects in anterior shoulder instability. Lower and laterally prominent coracoids are associated with anterior–inferior lesions. This variation in anatomy should be considered during pre-op planning for surgeries involving bone graft. Level 4 basic science.

Despite recent improvements in surgical implants and techniques, distal humerus nonunion does occur between 8% and 25% of the time. Careful identification and improvement of any modifiable risk factors such as smoking, metabolic disorders, immunosuppressant medications, poor nutritional status and infection is mandatory. A recent computed tomography scan is paramount to determine the nonunion pattern, assess residual bone stock, identify previously placed hardware, and determine whether there is evidence of osteoarthritis or malunion of the articular surface. Internal fixation is the treatment of choice in the majority of patients presenting with reasonable bone stock and preserved articular cartilage; total elbow arthroplasty is an appealing alternative for elbows with severe destruction of the articular cartilage or severe bone loss at the articular segment, especially in older, female patients. Internal fixation requires not only achieving a stable fixation, but also releasing associated elbow contractures and the liberal use of bone graft or substitutes. Although reported union rates after internal fixation of distal humerus nonunions are excellent (over 95%), the complication rate remains very high, and unsatisfactory results do occur. Cite this article: EFORT Open Rev 2020;5:289-298. DOI: 10.1302/2058-5241.5.190050

Theobjective of this study was todetermine the normativebone mineral density (BMD) of cortical and trabecular bone regions in the adult glenoid and itsdependence on the subject's age andsex.We analyzed computed tomography (CT) scans of 450 shoulders (317 males, 18-69 years)withoutany signs of glenohumeral joint pathology. Glenoid BMD was automaticallyquantified in six volumes of interest (VOIs): cortical bone (CO), subchondral cortical plate (SC), subchondral trabecular bone (ST), and three adjacent layers of trabecular bone (T1, T2, T3).BMD was measuredin Hounsfield unit (HU).We evaluated the association between glenoid BMD and sex and age with the Student'st-test andPearson'scorrelation coefficient (r), respectively.The lambda-mu-sigma method was used to determineage- and sex-specific normative values ofglenoid BMDin cortical (CO, SC) and trabecular (ST, T1, T2,T3)bone.Glenoid BMD was higher in males than females, in most age groups and most VOIs. Before 40 years old, the effect of age on BMD was very weak inboth males and females.After40 years old, BMD declined over time in all VOIs.ThisBMD decline with age was greater in females (cortical: r = - 0.45, trabecular:r = - 0.41) than in males (cortical:r = - 0.30;trabecular: r = - 0.32). Thesenormativeglenoid BMD values couldproveclinically relevantin the diagnosis and management of patients with various shoulderdisorders,in particular glenohumeral osteoarthritis and shoulder arthroplasty or shoulder instability, as well as in related research. Keywords This article is protected by copyright. All rights reserved.

Objectives: Recurrent traumatic anterior shoulder instability occurs most commonly in young to middle-aged male athletes. The Latarjet procedure was reported to enable early return to sport compared to capsulolabral repair. Recent research has highlighted the negative effect of immobilization on shoulder rehabilitation. However, only few studies evaluated different rehabilitation programs after open Latarjet and their potential impact on complication rates, stiffness and time to return to sport. The reported immobilization periods ranged from zero to three weeks, and different types of mobilization protocols were used. The aim of this study was to evaluate the benefit of sling immobilization after open Latarjet procedure for anterior shoulder instability. The hypothesis was that immediate self-rehabilitation without sling immobilization would result in improved functional scores at 6 months compared to patient wearing a sling for 3 weeks postoperatively. Methods: We randomized 72 patients with anterior shoulder instability scheduled for open Latarjet procedure into sling and no-sling groups. Two partially 1 cm apart threaded 4.0-mm cancellous screws were used to secure the graft. Both groups started the same immediate self-rehabilitation protocol. Patients were evaluated clinically using Rowe score, the Single Assessment Numeric Evaluation (SANE) instability score as well as visual analogue pain scale (VAS) preoperatively and at 1.5, 3, and 6 months. A computed tomography was performed at 6 months to evaluate graft healing. Results: Both groups had similar preoperative patient characteristics. Both groups had a significant improvement in Rowe score (from 38.8 ± 20.4 to 81.6 ± 17.8, p < 0.001), SANE instability score (from 42.5 ± 20.5 to 84.7 ± 13.2, p < 0.001) and VAS (from 27.7 ± 21.8 to 13.9 ± 16.1, p < 0.001) at 6 months postoperative. There was no difference in functional outcomes between the two groups at 6 months. Mean Rowe score was respectively 80.7 ± 15.9 and 82.6 ± 19.6 in the sling and no-sling group (p = 0.64). Mean SANE instability score was 83.7 ± 13.0 and 85.7 ± 13.6 (p = 0.53) and mean VAS 15.6 ± 14.8 versus 12.2 ± 17.5 (p = 0.38), for sling and no-sling group respectively. Finally, computed tomography evaluation revealed no significant differences regarding bone graft healing between both groups (p = 0.35). Conclusions: Both treatment groups resulted in excellent early functional outcomes. Absence of sling immobilization did not increase complication rates after open Latarjet. Sling immobilization seems therefore optional after open Latarjet procedure.

Shoulder pain in the context of rotator cuff disorders is a frequent source of medical consultation. A wide range of therapeutic options is reported in the literature. Non- or minimally invasive treatments include physiotherapy, anti-inflammatory medication, and infiltration of corticosteroids or platelet-rich plasma. Surgical treatments include subacromial debridement, long head of the biceps tenotomy/tenodesis, rotator cuff repair, superior capsular reconstruction, and tendon transfers. Reverse shoulder arthroplasty completes the therapeutic arsenal. Guiding and advising the patient in the face of all these options can therefore be challenging. This article aims to summarize the clinical, demographic, and imaging characteristics useful in guiding and choosing the most appropriate treatment option for each patient.La pathologie de la coiffe des rotateurs est une source fréquente de consultation. Les options thérapeutiques proposées dans la littérature sont vastes. Les traitements conservateurs comprennent la physiothérapie, les anti-inflammatoires ainsi que l’infiltration de corticostéroïdes ou de plasma riche en plaquettes. Les traitements chirurgicaux incluent le débridement sous-acromial, les gestes sur le tendon du long chef du biceps, la réinsertion des tendons de la coiffe des rotateurs, la reconstruction capsulaire supérieure et les transferts tendineux. La prothèse d’épaule inversée vient compléter l’arsenal thérapeutique. Conseiller le patient face à toutes ces options peut donc s’avérer complexe. Cet article vise à résumer les caractéristiques cliniques, démographiques et radiologiques permettant d’orienter au mieux chaque patient.

The biomechanics of the shoulder relies on careful balancing between stability and mobility. A thorough understanding of normal and degenerative shoulder anatomy is necessary, as the goal of anatomic total shoulder arthroplasty is to reproduce premorbid shoulder kinematics. With reported joint reaction forces up to 2.4 times bodyweight, failure to restore anatomy and therefore provide a stable fulcrum will result in early implant failure secondary to glenoid loosening. The high variability of proximal humeral anatomy can be addressed with modular stems or stemless humeral components. The development of three-dimensional planning has led to a better understanding of the complex nature of glenoid bone deformity in eccentric osteoarthritis. The treatment of cuff tear arthropathy patients was revolutionized by the arrival of Grammont’s reverse shoulder arthroplasty. The initial design medialized the centre of rotation and distalized the humerus, allowing up to a 42% increase in the deltoid moment arm. More modern reverse designs have maintained the element of restored stability but sought a more anatomic postoperative position to minimize complications and maximize rotational range of motion. Cite this article: EFORT Open Rev 2021;6:918-931. DOI: 10.1302/2058-5241.6.210014

Introduction: Knee arthrodesis is an established procedure for limb salvage after failed total knee arthroplasty (TKA) in cases of recurrent infection, soft tissue damage, reduced bone stock or with a deficient extensor mechanism. Walking with an arthrodesis is more efficient and less costly in terms of energy expenditure than above-knee amputation. Surgical options include an arthrodesis nail, external fixator or compression plate. We present our results of knee arthrodesis using the modular Wichita Fusion Nail® in patients after infected TKA. Methods: Fifteen patients with irretrievably failed TKA, due to infection, who underwent arthrodesis with the Wichita Fusion Nail® from 2004 to 2012 were retrospectively reviewed to assess fusion rate, time to fusion, complication rate, including new infections, and ambulatory status. Results: Three patients were lost to follow-up. Mean follow-up was 33months (6-132months). At their most recent follow-up, all patients were walking with full weight bearing on a fused arthrodesis. Mean time to union was 9months (3-29months). Three patients necessitated a revision arthrodesis to achieve union after a mean of 5months after the last procedure. Conclusion: Arthrodesis with the Wichita Fusion Nail® provides satisfactory results in patients with failure after infected TKA, with 75% primary union rate and no new or persistent infection at last follow-up visit. Although burdened with a high complication rate, it represents an acceptable option for limb salvage in this particular pathology.

Background Bone metastases are frequently painful and may lead to various complications that can affect quality of life. While external beam radiation therapy is the standard first-line treatment, 20-30% of patients do not experience sufficient pain relief. Cryoablation is increasingly being used for the treatment of musculoskeletal metastases. The purpose of our retrospective study was to analyze pain relief and local disease control after percutaneous image-guided cryoablation (PCA) therapy of painful bone metastases. Materials and methods Sixteen patients treated with PCA for painful bone metastases (n = 18) over a 5-year period (from June 2011 to June 2016) were retrospectively reviewed. Five patients also benefited from long bone fixation because of an impending fracture. We analyzed the impact of treatment on pain relief, using a numerical rating scale (NRS), and local disease control. Results The mean follow-up period was 12 months (range, 1.5–39 months). At last oncological outpatient consultation, 75% (12/16) of patients had good pain relief, while 63% (10/16) had locally stable disease or no local recurrence of the treated bone metastases. The mean NRS score decreased significantly from 3.3 to 1.2 after PCA (p = 0.0024). The five patients with concomitant long bone fixation all had satisfactory pain relief at the last follow-up visit. Conclusion PCA is a safe and valid treatment option for pain and local disease control in cases of painful bone metastases after failed standard first-line therapy. This technique can also be effectively associated to prophylactic long bone fixation and may allow for easier rehabilitation protocols when treating weight-bearing bones. Level of evidence IV, Retrospective case series.

Resume Contexte Les metastases osseuses sont frequemment douloureuses et peuvent mener a des complications qui ont une incidence sur la qualite de vie. Bien que la radiotherapie soit le traitement standard de premiere ligne, 20–30 % des patients ne sont pas soulages de leurs douleurs de facon satisfaisante. La cryoablation est utilisee de facon croissante pour le traitement des metastases musculosquelettiques. Le but de notre etude retrospective est d’analyser le soulagement de la douleur ainsi que le controle local de la maladie apres cryoablation percutanee (CP) guidee par imagerie de metastases osseuses douloureuses. Materiel et methodes Seize patients traites par CP pour des metastases osseuses douloureuses (n = 18) sur une periode de 5 ans (de juin 2011 a juin 2016) ont ete revu de facon retrospective. Cinq d’entre eux ont egalement beneficie d’une osteosynthese prophylactique en raison d’une menace de fracture. Nous avons analyse l’impact de ce traitement sur le soulagement de la douleur, en utilisant un « numerical rating scale » (NRS), ainsi que sur le controle local de la maladie. Resultats La duree de suivi moyenne etait de 12 mois (de 1,5 a 39 mois). Lors de la derniere consultation oncologique ambulatoire, 75 % (12/16) des patients etaient bien controles sur le plan de la douleur, tandis que 63 % (10/16) avaient une maladie oncologique localement stable ou pas de recidive locale des metastases osseuses traitees. Le score NRS moyen a diminue significativement de 3,3 a 1,2 apres la CP (p = 0,0024). Les cinq patients ayant beneficie d’une osteosynthese concomitante presentaient tous un soulagement satisfaisant de la douleur lors du dernier controle. Conclusion La CP est une option therapeutique sure et valide pour le traitement de la douleur et le controle local de la maladie en cas de metastases osseuses douloureuses apres echec des therapies standards de premiere ligne. Cette technique peut egalement etre efficace en association avec une osteosynthese prophylactique et pourrait permettre une rehabilitation facilitee lors du traitement d’un membre portant. Niveau de preuve IV, serie de cas retrospective.

Objectives: Recurrent glenohumeral instability is frequently associated with glenoid and humeral bone loss. It is predictive of capsulolabral repair failure. However, the best way to quantify these shortcomings remains controversial. The aim of our study is to determine the best predictor of recurrent instability after arthroscopic shoulder stabilization. Methods: Over the past 10 years, all the patients recruited for shoulder stabilization surgery in 4 academic centers have been included in the prospective cohort called "LUXE". The ISIS score is used to stratify patients for surgery (Bankart, Bankart + Remplissage, Latarjet). Only patients with a preoperative CT scan with 3D reconstruction and clinical follow-up ≥1 year were included. Of a total of 262 patients included in the “LUXE” cohort, 103 met the inclusion criteria. The majority of patients were male (79%) with an average age of 28 years. The median number of dislocations before stabilization surgery was six. Bone deficits were measured on the 3D reconstructions using the Glenoid Clock and Ratio, the Humeral Clock and Ratio and the Glenoid Track methods and the angle of engagement of the Hill-Sachs lesion in the axial plane. Results: Seventy patients had arthroscopic stabilization and 33 a Latarjet procedure. The ISIS scores for the two groups were 2.7 and 4.8 (pConclusion: Despite a lower ISIS score, arthroscopic management with Bankart +/- Remplissage is correlated with a significantly higher recurrence rate compared to the Latarjet procedure. Failure was related to humeral bone loss and to the morphology/orientation of the Hill-Sachs lesion rather than the volume of bone loss.

Cryoablation (CA) has gained popularity in the treatment of benign and malignant musculoskeletal tumors. While extra-abdominal desmoid (EAD) tumors are not malignant, they remain challenging to treat because of their high local recurrence rate. We reviewed all EAD tumors treated with CA at our institution between November 2012 and March 2020. Fourteen procedures were performed on nine females and one male (mean age, 33 ± 18 years) as either first-line (n = 4) or salvage therapy (n = 6) with curative intent (n = 8) or tumor debulking (n = 2). Mean tumor size was 63.6 cm3 (range, 3.4–169 cm3). Contrast-enhanced MRI was performed before treatment and at 3-, 6-, and 12-month follow-up. Treatment outcome was based on the change in enhanced tumor volume (ET-V). For curatively treated patients, the mean ET-V change was −97 ± 7%, −44 ± 143%, and +103 ± 312% at 3, 6, and 12 months, respectively. For debulking patients, the mean ET-V change was −98 ± 4%, +149 ± 364%, and +192 ± 353% at 3, 6, and 12 months, respectively. During a mean follow-up of 53.7 months (range, 12–83 months), one grade III and one grade IV complication were noted. We found CA to be safe and well tolerated in patients with EAD.

Total shoulder arthroplasty has become an effective treatment option, for both pain relief and restoration of shoulder range of motion. The key factor limiting long-term prosthetic survival remains glenoid implant loosening. Proper glenoid implant positioning and orientation during surgery was shown to significantly reduce complication rates. The emergence of new technologies now allows for three-dimensional (3D) surgical planning, patient-specific instrumentation and augmented-reality-based intraoperative navigation. Such novel tools have been developed to aid and improve the surgeon's performance. The future will tell whether the gains in term of surgical precision will also translate into better functional outcomes for patients and prolonged survival of glenoid implants.La prothèse totale d’épaule permet de nos jours d’obtenir des résultats fiables tant sur le plan de l’antalgie que de la récupération des amplitudes articulaires. Le facteur clé limitant la survie de la prothèse reste le descellement de l’implant glénoïdien. Une orientation correcte de celui-ci permet une diminution du risque de complications. L’essor des nouvelles technologies permet la planification en trois dimensions (3D), la création d’instrumentation spécifique au patient ou encore la navigation peropératoire à l’aide de la réalité augmentée. Ces nouveaux outils ont été développés dans le but d’aider et d’améliorer la performance des chirurgiens. L’avenir devra déterminer si le gain en termes de précision chirurgicale pourra également se traduire par un bénéfice fonctionnel pour le patient et une survie augmentée des implants, notamment glénoïdiens.

Background: Failure rates in anatomic total shoulder arthroplasty (aTSA) are higher in case of asymmetric glenoid bone loss secondary to posterior wear, and in persistent static posterior subluxation of the humeral head (PSH)., Hypothesis: This study aimed to test the hypothesis that the combined use of posterior augmented glenoid (PAG) implants with three-dimensional (3D) surgical planning and patient-specific instrumentation (PSI) guides helps reduce short-term PSH after aTSA in patients with type B2-B3 glenoids., Patients and methods: We included nine consecutive patients with primary glenohumeral osteoarthritis and type B2 or B3 glenoids, who underwent aTSA with cemented keeled PAG implants (posterior augments of 15, 25, or 35 degrees). All patients underwent preoperative shoulder computed tomography (CT) scans, with 3D surgical planning coupled to PSI at the time of surgery. Postoperative shoulder CT scans were performed at an average of 14 weeks (range, 10-21 weeks). Scapulohumeral subluxation and glenoid version and inclination were measured in 3D, on both pre- and post-operative CT scans, using the same reliable quantitative method., Results: There was a significant decrease in scapulohumeral subluxation from 49 +/- 12% preoperatively to 22 +/- 17% postoperatively (p = 0.0039), with a large effect size (Cohen's d = 1.89). Preoperative glenoid version was corrected from - 17.3 +/- 9.4 degrees to - 5.2 +/- 7.5 degrees postoperatively. The absolute difference between the postoperative and surgically planned version and inclination was 5.4 +/- 3.6 degrees and 3.3 +/- 2.0 degrees, respectively., Discussion: The combined use of PAG implants with 3D preoperative planning and PSI results in a significant decrease in short-term PSH and glenoid version in patients with asymmetric posterior glenoid wear. We suggest that such implants should not be limited to posterior augmentation, because glenoid deficiency can also be observed in other glenoid sectors. (C) 2020 Elsevier Masson SAS. All rights reserved.

BACKGROUND The usual treatment of septic shoulder arthritis consists of arthroscopic or open lavage and debridement. However, in patients with advanced osteoarthritic changes and/or massive rotator cuff tendon tears, infection eradication can be challenging to achieve and the functional outcome is often not satisfying even after successful infection eradication. In such cases a two-stage approach with initial resection of the native infected articular surfaces, implantation of a cement spacer before final treatment with a total shoulder arthroplasty in a second stage is gaining popularity in recent years with the data in literature however being still limited. AIM To evaluate the results of a short interval two-stage arthroplasty approach for septic arthritis with concomitant advanced degenerative changes of the shoulder joint. METHODS We retrospectively included five consecutive patients over a five-year period and evaluated the therapeutic management and the clinical outcome assessed by disability of the arm, shoulder and hand (DASH) score and subjective shoulder value (SSV). All procedures were performed through a deltopectoral approach and consisted in a debridement and synovectomy, articular surface resection and insertion of a custom made antibiotic enriched cement spacer. Shoulder arthroplasty was performed in a second stage. RESULTS Mean age was 61 years (range, 47-70 years). Four patients had previous surgeries ahead of the septic arthritis. All patients had a surgical debridement ahead of the index procedure. Mean follow-up was 13 mo (range, 6-24 mo). Persistent microbiological infection was confirmed in all five cases at the time of the first stage of the procedure. The shoulder arthroplasties were performed 6 to 12 wk after insertion of the antibiotic-loaded spacer. There were two hemi and three reverse shoulder arthroplasties. Infection was successfully eradicated in all patients. The clinical outcome was satisfactory with a mean DASH score and SSV of 18.4 points and 70% respectively. CONCLUSION Short interval two-stage approach for septic shoulder arthritis is an effective treatment option. It should nonetheless be reserved for selected patients with advanced disease in which lavage and debridement have failed.

Sciatic nerve injury is a rare but potentially extremely disabling complication of posterior dislocated total hip arthroplasty. Initial closed reduction is recommended followed by a careful neurovascular examination. This procedure and the following stability testing are usually safe and typically associated with a very low complication rate. We report the case of sciatic nerve entrapment around the neck of the femoral stem after closed reduction of a posteriorly dislocated total hip arthroplasty. Immediate postreduction palsy led to surgical exploration, identification, neurolysis of the sciatic nerve and safe reduction was performed. Patient outcome was marked by complete sensitive sciatic nerve recovery, but complete loss of motor sciatic nerve function. This case highlights the importance of careful postreduction neurovascular assessment and prompt surgical exploration when indicated.

Background Due to its bone preserving philosophy, short-stem total hip arthroplasty (THA) has primarily been recommended for young and active patients. However, there may be benefits for elderly patients given a less invasive operative technique due to the short curved implant design. The purpose of this study was to compare the clinical and radiological outcomes as well as perioperative complications of a calcar-guided short stem between a young ( 75 years) population. Methods Data were collected in a total of 5 centers, and 400 short-stems were included as part of a prospective multicentre observational study between 2010 and 2014 with a mean follow-up of 49.2 months. Preoperative femur morphology was analysed using the Dorr classification. Clinical and radiological outcomes were assessed in both groups as well as perioperative complications, rates and reasons for stem revision. Results No differences were found for the mean visual analogue scale (VAS) values of rest pain, load pain, and satisfaction, whereas Harris Hip Score (HHS) was slightly better in the young group. Comparing both groups, none of the radiological parameters that were assessed (stress-shielding, cortical hypertrophy, radiolucency, osteolysis) reached differences of statistical significance. While in young patients aseptic loosening is the main cause of implant failure, in the elderly group particularly postoperative periprosthetic fractures due to accidental fall have to be considered to be of high risk. The incidence of periprosthetic fractures was found to be 0% in Dorr type A femurs, whereas in Dorr types B and C fractures occurred in 2.1 and 22.2% respectively. Conclusions Advanced age alone is not necessarily to be considered as contra-indications for calcar-guided short-stem THA, although further follow-up is needed. However, markedly reduced bone quality with femur morphology of Dorr type C seems to be associated with increased risk for postoperative periprosthetic fractures, thus indication should be limited to Dorr types A and B. Trial registration German Clinical Trials Register; DRKS00012634, 07.07.2017 (retrospectively registered).

Olecranon fractures represent 5 % of all adult fractures. Management is most often surgical. Conservative treatment is recommended for non-displaced fractures or patients who would be poor surgical candidates. Prolonged immobilization of the elbow may cause joint stiffness, whereas surgical treatment can be complicated by loss of reduction or wound issues with secondary infection of the material. In this article, we discuss the pathology and the principles of treatment based on the literature, to allow the general practitioner to guide the patient towards the most suitable treatment.Les fractures de l’olécrâne représentent 5 % de l’ensemble des fractures. Leur prise en charge est le plus souvent chirurgicale et le traitement conservateur est réservé aux fractures non déplacées ou à des patients qui seraient de mauvais candidats à la chirurgie. L’immobilisation prolongée du coude peut être responsable d’une raideur articulaire, alors qu’un traitement chirurgical peut entraîner des complications comme le démontage de l’ostéosynthèse ou des problèmes de cicatrisation avec infection précoce du matériel. Dans cet article, nous voulons rappeler les connaissances anatomopathologiques ainsi que les principes du traitement, basés sur la littérature, afin de permettre au médecin d’orienter son patient vers le traitement le plus adapté.

The surgical treatment of a displaced fracture of the clavicular shaft generally consists in an open reduction and plate fixation. The most common complications of the classic direct "transplatysma" approach are hardware related. These consist of simple hardware irritations requiring secondary plate removal but also feared wound healing problems ranging from dehiscence to superficial and deep wound infections. In the present article, we describe the so-called "platysma-flap" approach in which the platysma muscle is entirely preserved and distally raised as a flap. This modified exposure allows to cover the osteosynthesis with a viable, well perfused soft tissue envelope and is a safe alternative to the standard "transplatysma" approach.

Clavicle fracture is a common injury for the general practitioner, the accident and emergency department doctor and the orthopedic trauma surgeon. Historically, most clavicle fractures were treated conservatively. During the last two decades, clinical studies have shown higher rates of nonunion or symptomatic malunion than previously thought. These publications lead to an increase in surgical management of clavicle fractures. However, recent randomized controlled trials failed to confirm any strong clinical outcome improvement after surgical treatment. Based on recent literature, we present up-to-date recommendations and a treatment algorithm for clavicle fractures management.Les fractures de clavicule représentent une lésion fréquemment rencontrée, aussi bien par le médecin généraliste, l’urgentiste que par le chirurgien orthopédiste. Leur prise en charge, historiquement principalement conservatrice, a connu un bouleversement majeur au cours des deux dernières décennies, suite à la publication d’études qui mettaient en avant des taux de pseudarthrose et de cal vicieux (raccourcissement cliniquement symptomatique) plus importants que ceux publiés par le passé. Ces travaux ont conduit à une augmentation des prises en charge chirurgicales initiales. Cependant, les récentes études contrôlées randomisées peinent à confirmer le bénéfice clinique de l’ostéosynthèse. En s’appuyant sur la littérature récente, nous présentons les recommandations actuelles, ainsi qu’un algorithme de prise en charge, pour les fractures de clavicule.

There are easily accessible tools on smartphones (APP) for measuring elbow range of motion (ROM). The purpose of this study is to evaluate the validity of a particular APP in determining elbow ROM in comparison with the commonly used goniometer (GON), surgeon estimation of range (EST) and measurement on X-ray (XR). The study included 20 patients (40 elbows). Flexion, extension, pronation and supination were measured using three different methods: EST, GON and APP. Radiographic measurements were taken using the average humeral diaphysis axis and dorsal midthird of ulna in flexion and extension. The accuracy of the three different methods has been compared to GON using statistical analysis (ANOVA and paired samples test). There was no statistically significant difference for XR flexion measurement (mean of 2.8° ± 1.5°). The APP overestimated flexion (mean of 6.4° ± 1.0°), and EST underestimated it (mean of − 7.9° ± 1.1°). For extension, the mean difference was 2.8° ± 0.7° for EST and − 26.8° ± 3.1° for XR. The APP method did not significantly differ from GON. Supination accuracy was greater with EST (2.7° ± 1.7°) than with APP (5.9° ± 1.9°). There was no difference for pronation measurement with both EST and APP. This study is the first comparing four measurement techniques of elbow ROM. Our results showed that EST was only accurate for forearm rotation. The XR scored the best for flexion but is less reliable for extension. Surprisingly, compared to GON, APP did not correlate as we expected for flexion and supination, but the other methods were also inaccurate. We found APP to be very useful to measure complete arc of motion (difference between maximal flexion and maximal extension). III, Retrospective review of a prospective cohort of elbow fracture patients: Diagnostic Study.