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Context: Sport-specific adaptations in shoulder rotation range of motion (ROM) and the relationship with humeral torsion have been described in overhead-throwing sports. However, information is lacking for other shoulder-loading sports such as field hockey. Therefore, this study's purpose was to evaluate humeral torsion in elite, male field hockey players and explore its association with shoulder ROM. Design: Cross-sectional study. Methods: Twenty-five male, elite field hockey players were included. Humeral torsion and shoulder external and internal rotation ROM were evaluated bilaterally by ultrasound and an inclinometer smartphone application, respectively. Results: Field hockey players showed a significantly increased humeral retroversion on the dominant compared with the nondominant side (P <.001; Cohen d = 1.75), along with a significantly increased external (P =.004; Cohen d = −0.64) and decreased internal rotation ROM (P =.003; Cohen d = 0.65). This finding illustrates a shift in total shoulder rotational ROM arc. Correlation analysis showed a significant moderate association between the increased humeral retroversion and decreased internal rotation ROM on the dominant side (r =.523). Conclusions: Elite male field hockey athletes show sport-specific adaptations regarding humeral torsion and shoulder rotation ROM, similar to throwing athletes. These findings increase our insight into the field hockey athlete's shoulder, which is essential to optimize performance and assist in correctly interpreting shoulder rotational ROM measurements. [ABSTRACT FROM AUTHOR]

BackgroundThe appropriate amount of cementation at the time of reverse total shoulder arthroplasty with significant proximal bone loss or resection is unknown. Extensive cementation of a humeral prosthesis makes eventual revision arthroplasty more challenging, increasing the risk of periprosthetic fracture. We analyzed the degree of subsidence and torque tolerance of humeral components undergoing standard cementation technique vs. our reduced polymethyl methacrylate (PMMA) protocol. Reduced cementation may provide sufficient biomechanical stability to resist physiologically relevant loads, while still permitting a clinically attainable torque for debonding the prosthesis.MethodsA total of 12 cadaveric humeri (6 matched pairs) underwent resection of 5 cm of bone distal to the greater tuberosity. Each pair of humeri underwent standard humeral arthroplasty preparation followed by either cementation using a 1.5-cm PMMA sphere at a location 3 cm inferior to the porous coating or standard full stem cementation. A 6-degree-of-freedom robot was used to perform all testing. Each humeral sample underwent 200 cycles of abduction, adduction, and forward elevation while being subjected to a physiologic compression force. Next, the samples were fixed in place and subjected to an increasing torque until implant-cement separation or failure occurred. Paired t tests were used to compare mean implant subsidence vs. a predetermined 5-mm threshold, as well as removal torque in matched samples.ResultsFully and partially cemented implants subsided 0.49 mm (95% CI 0.23-0.76 mm) and 1.85 mm (95% CI 0.41-3.29 mm), respectively, which were significantly less than the predetermined 5-mm threshold (P

Brodies abscess is a manifestation of subacute to chronic osteomyelitis, characterized as intraosseous abscess formation, usually on the metaphysis of the long tubular bones in the lower extremities of male pediatric patients. Clinically, Brodies abscess presents with atraumatic bone pain of an insidious onset, with absence of systemic findings. Delay in diagnosis is common, as diagnostic imaging, followed by biopsy for culture and histologic examination are generally required to secure a diagnosis of Brodies abscess. Treatment of Brodies abscess is non-standardized, and usually consists of surgical debridement and antibacterial therapy. Despite the variability in therapeutic approaches, outcomes of Brodies abscess treated with surgery and antibiotics are favourable. Herein we report a case of a delayed diagnosis of Brodies abscess in the upper extremity of an adult female. While she improved with treatment of Brodies abscess, the case serves to remind clinicians to consider this entity in adult individuals who present with atraumatic bone pain.

Huaxiazhoulong shouwen gen. et sp. nov. is a new ankylosaurid recovered from the Upper Cretaceous Tangbian Formation of Jiangxi Province, southern China. Huaxiazhoulong shouwen can be diagnosed on the basis of three autapomorphies (the middle shaft and distal end of the ischium are expanded; the ratio of width of distal end to minimum shaft width is greater than 3 in humerus, the maximum length of femur to humerus length ratio is about 1.45) and a unique combination of characters (the centra of anterior caudal vertebrae in anterior view is heart-shaped; the dorsal surface of scapula is straight; the scapulocoracoid has a large medial brace; the humeral head and deltopectoral crest are separated by a distinct notch anteriorly). The phylogenetic analysis shows that Huaxiazhoulong shouwen is an early member of Ankylosauridae. [ABSTRACT FROM AUTHOR]

Biological sex estimation is an integral part of reconstructing the biological profile of an individual in forensic anthropological and bioarchaeological contexts. Formulating population specific discriminant function equations for metric variables is vital for reconstructing biological sex of fragmentary skeletal remains. This study aimed to develop multivariable and univariable sectioning point sex estimation equations from long bones of prehistoric Thailand and Cambodia people dated from 4700 to 1450 BP. A total of 481 individuals (236 females and 245 males) with 997 long bone measurements were analyzed. Discriminant function analysis was used to analyze sexually dimorphic measurements from long bones of humeri (177 females and 183 males), femora (169 females and 178 males), and tibiae (139 females and 151 males). Stepwise and direct multivariable functions offered the highest accuracies of 97.3% for humeri, 97% for femora, and 96.7% for tibiae. Univariable functions indicated that the recommended measurements for use in sex estimations with high cross‐validation accuracies are the humeral epicondylar breadth (89.1%), femoral maximum head diameter (87.1%), and tibial midshaft circumference (88.3%). These equations are applicable for use in sex estimation for the specific prehistoric Southeast Asian populations to improve our understanding of the prehistoric demography. Further evaluation and validation of the equations are required to test whether these equations can also be applied to estimate biological sex of contemporary Southeast Asian populations. [ABSTRACT FROM AUTHOR]

Background: It is accepted that the metabolic response of bone tissue depends on the intensity of the mechanical loads, but also on the type and frequency of stress applied to it. Physical exercise such as running involves stresses which, under certain conditions, have been shown to have the best osteogenic effects. However, at high intensity, it can be deleterious for bone tissue. Consequently, there is no clear consensus as to which running modality would have the best osteogenic effects. Aim: Our objective was to compare the effects of three running modalities on morphological and micro-architectural parameters on forelimb bones. Methods: Forty male Wistar rats were randomly divided into four groups: high intensity interval training (HIIT), continuous running, combined running ((alternating HIIT and continuous modalities) and sedentary (control). The morphometry, trabecular microarchitecture and cortical porosity of the ulna, radius and humerus were analyzed using micro-tomography. Results: All three running modalities resulted in bone adaptation, with an increase in the diaphyseal diameter of all three bones. The combined running protocol had positive effects on the trabecular thickness in the distal ulna. The HIIT protocol resulted in an increase in both medio-lateral diameter and cortical bone area over total area (Ct.Ar/Tt.Ar) at the ulnar shaft compared with sedentary condition. Moreover, the HIIT protocol decreased the mean surface area of the medulla (Ma.Ar) according to sedentary condition at the ulnar shaft. Conclusion: This study has shown that HIIT resulted in a decrease in trabecular bone fraction in favor of cortical bone area at the ulna. [ABSTRACT FROM AUTHOR]

Background: With the application of PCR testing and Metagenomic Next-Generation Sequencing(mNGS), the detection rate of causative organisms in paediatric bone and joint infections has been greatly improved. The aim of our study is to identify some indicators that could be used to distinguish the culture results to optimize the use of PCR and mNGS. Methods: In this study, a total of 117 cases of acute osteomyelitis of long bones in children who underwent pus culture were included. Patients were grouped as culture-negative (n:21) and culture-positive (n:96) groups according to the results of pus culture. Age, sex, duration of onset, maximum body temperature at onset, inflammatory indicators and D-dimer after admission were systematically collected for all patients and were compared for both groups. ROC curve (ROC) was used to evaluate the diagnostic efficiency of culture-negative. Logistic regression analysis was conducted to determine independent risk factors for culture-negative. Results: There was no significant difference in age, sex and erythrocyte sedimentation rate between culture-negative group and culture-positive group (P > 0.05). The duration of onset was longer, and the temperature, white blood cells, neutrophils count, C-reactive protein and D-dimer were less elevated in culture-negative acute osteomyelitis (P < 0.05). Duration of onset, maximum body temperature at onset, white blood cell count, neutrophil count, C-reactive protein, and D-dimer have certain diagnostic efficacy in judging the efficacy of negative culture. Logistic regression analysis indicated that the duration of onset more than 6.5 days, the maximum body temperature at onset lower than 38.35℃ and C-reactive protein lower than 78.40 mg/L were independent risk factors for negative culture (P < 0.05). Conclusions: Our study revealed that duration of onset more than 6.5 days, maximum body temperature at onset lower than 38.35℃ and C-reactive protein lower than 78.40 mg/L were independent risk factors for predicting negative culture. In children with this type of acute osteomyelitis, we recommend that the pus be tested by PCR or mNGS as a priority. [ABSTRACT FROM AUTHOR]

This study aimed to morphologically and histologically examine whether pig is useful as models for rotator cuff tear (RCT). The morphology of the scapula and humerus bones was evaluated by taking X-ray and three-dimensional computed tomography (3D CT) scans of the right shoulders of five female pigs (age: 4 months). The rotator cuff (RC) footprint at the humeral insertion of these was observed and its shape was measured. Next, they underwent general anesthesia and an acute rotator cuff tear/rotator cuff repair (RCT/RCR) model was created using a deltoid split approach. Four weeks after surgery, the animals were euthanized, the shoulder joints were harvested, and the repaired RC was evaluated by hematoxylin and eosin staining and toluidine blue staining. The scapula of the pig had a vestigial acromion, in contrast to that in humans. The supraspinatus and infraspinatus tendons were connected so as to overlap each other and attached to the postero-superior part of the greater tuberosity. These tendons were located extra-articularly, separate from the joint capsule. The average antero-posterior length of the foot print was 17.4 ± 0.7 mm on the medial margin and 19.1 ± 2.2 mm on the lateral margin. The maximum medial-to-lateral width of it was 5.1 ± 0.5 mm. In all RCT/RCR models at 4 weeks after surgery, the repaired RC compound tendon was visually confirmed to be continuous with the footprint. Histologically, it was confirmed that regeneration of the four-layer structure of the bone-tendon junction had occurred. Porcine supraspinatus and infraspinatus attachment to the greater tuberosity have a structure similar to that of sheep and dogs, which is advantageous for creating the RCT/RCR model. It might be used for future in vivo studies of shoulder joint diseases. Pigs could potentially serve as a viable model for rotator cuff tears. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To investigate whether a humeral intracondylar fissure (HIF) alters bone strain in the French Bulldog humerus, we developed a quantitative CT-based 3-D finite element (FE) model for virtual mechanical testing. We hypothesized that higher strains would be seen in the intracondylar region and lateral epicondylar crest if there was a HIF. METHODS: Patient CT scans from 3 (n = 3) French Bulldogs were selected. Dog 1 had a closed distal physis and no HIF. Dog 2 had an open distal humeral physis but no HIF. Dog 3 had an open distal physis and a HIF. A 3-D FE model was built for FE analysis, and pressure was applied to the humerus over the region that contacts the radial head. RESULTS: The maximum principal bone strain patterns differed in each of the models. A path of strain concentration mimicking the typical pattern of a lateral condylar fracture was only found in dog 3. Maximum principal strain exceeded 1% in parts of the lateral epicondylar crest in all 3 dogs. CONCLUSIONS: We developed a patient-specific, quantitative CT-based 3-D FE model for virtual mechanical testing. We accepted our hypothesis. Strain concentration occurred in the intracondylar region and along the lateral epicondylar crest only when a HIF was present. CLINICAL RELEVANCE: The presence of a HIF in French Bulldogs elevates maximum principal bone strain in this region and alters its path in an FE model, which suggests an increased risk of a lateral humeral condylar fracture. [ABSTRACT FROM AUTHOR]

The aim of the study was to evaluate humeral retroversion, shoulder range of motion, and functional mobility in karatekas, boxers, kickboxers, and mixed martial arts fighters. This study investigated adaptive alterations in striking martial arts. Forty young healthy participants took part in the study. 20 people who professionally trained in boxing, kickboxing, karate, and Mixed Martial Arts (MMA) fighters (age: 23.5 ± 7.1, age of participation 11.8 ± 3.65, sports experience 9.55 ± 5.13, body weight 79.2 ± 13 kg, BMI 24.4 ± 3.3) were qualified for the group of athletes. 20 people (age: 27 ± 5.5, body weight 79.4 ± 7.4, BMI 24.5 ± 1.2) were included in the control group, who had no previous experience with striking combat sports. An ultrasound device and a digital inclinometer were used for the examination of the humeral retroversion angle. The mobility of the shoulder was also tested using the Functional Movement Screen (FMS). There was a significant (p < 0.001, r = 0.92) asymmetry between the dominant and non-dominant limb in the humeral retroversion angle in the athlete group. A statistically significant moderate correlation (p < 0.05) was found between the value of the retroversion angle and the range of motion of passive and active internal rotation, and external rotation, and the shoulder mobility in the FMS test. However, there were no statistically significant differences (p > 0.05) in the humeral retroversion angles between groups. The striking martial arts athletes do not exhibit significant differences in humeral retroversion compared to non-athletes, however they display notable asymmetry between limbs, with higher values in the non-dominant arm. Additionally, the observed correlation between humeral retroversion and shoulder rotation range of motion highlights the potential impact of humeral retroversion on upper limb performance and injury risk. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to report on mid- to long-term results following large humeral tumoral resection and reconstruction with the induced-membrane technique in skeletally immature patients suffering from primary malignant bone tumours. Methods: A retrospective analysis identified all children who underwent the two stages of a humeral reconstruction using the induced-membrane technique for primary malignant humerus tumours between 2002 and 2020. Functional assessment was conducted by an independent observer using the Musculoskeletal Tumor Society (MSTS) scoring system for the upper limb. Radiological assessment was performed by two independent observers and the healing index was calculated (i.e., months/cm). Results: Eight adolescents (5 osteosarcomas and 3 Ewing sarcoma), with a mean age of 14.2 years (SD = 2.7), were included. The mean length of the bone resection was 17.4 cm (SD = 3.8), and the mean delay of the resection and reconstruction stages was 9.4 months (SD = 4). The mean follow-up was 6.6 years (SD = 4.3). The mean MSTS score was 77.4% and the global average healing index was 1.04 months/cm (SD = 2.2). Four complications (i.e., prominence device, fracture, aseptic pseudarthrosis, radial palsy) and one local recurrence were observed in four patients, requiring four unplanned surgical procedures in three patients. One patient died fourteen years after the initial treatment due to a lung recurrence. Conclusion: The induced-membrane technique is an effective and safe alternative for reconstructing large humeral bone defects after tumour resection in adolescents. Although this is a two-stage technique, it gives good functional results comparable to other strategies found in the literature. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to observe the effects of changing humeral tray thickness on the resultant of intraoperative glenohumeral joint loads using a load-sensing system (LSS). Methods: An rTSA was performed on fresh frozen full-body cadaver shoulders by using an internal proprietary LSS on the humeral side. The glenohumeral loads (Newtons) and the direction of the resultant force applied on the implant were recorded during four standard positions (External rotation, Extension, Abduction, Flexion) and three "complex" positions of Activity Daily Life ("behind back", "overhead reach" and "across chest"). For each position, the thickness was increased from 0 to 6 mm in a continuous fashion using the adjustment feature of the humeral system. Each manoeuvre was repeated three times. Results: All shoulder positions showed a high repeatability of the glenohumeral load magnitude measured with an intra-class correlation coefficient of over 0.9. For each position, we observed a strong but no linear correlation between humeral tray thickness and joint loads. It was a cubical correlation (rs = 0,91) with a short ascending phase, then a plateau phase, and finally a phase with an exponential growth of the loads on the humeral implant. In addition, an increase in trail-poly thickness led to a recentering of force application at the interface of the two glenohumeral implants. Conclusion: This study provides further insight into the effects of humeral implant thickness on rTSA glenohumeral joint loads during different positions of the arm. Data obtained using this type of device could guide surgeons in finding the proper implant balance during rTSA. [ABSTRACT FROM AUTHOR]

A glomus tumor is a benign mesenchymal tumor comprised of cells that resemble the perivascular modified smooth muscle cells of the glomus body. Glomus tumors typically appear in the superficial lesions of the soft tissue in the extremities, such as the subungual region. However, their occurrence in the bone is rare, with only about 30 cases reported to date. Half of these cases involved the distal phalanges of the fingers or toes, with only three reported cases involving the long bones. Here, we present the first case, a primary glomus tumor in the humerus of a 14-year-old female. An osteolytic and cystic lesion was detected after a pathological fracture occurred during exercise. Despite the tumor's large size, no pathological findings indicated malignancy. The fracture healed through conservative treatment, while the tumor was effectively managed with curettage. Appropriate medical care can be provided to patients by focusing on pathological findings. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to present the follow‐up findings obtained through computed tomography in skeletally immature French bulldogs previously diagnosed with humeral intracondylar fissures. Materials and Methods: Medical records from a surgical referral centre between January 2018 and September 2022 were evaluated for all dogs with a humeral condylar fracture where preoperative CT of both humeri was performed. French bulldogs between the age of 12 weeks and 12 months were identified and evaluated for the presence of contralateral humeral intracondylar fissure. The dogs with follow‐up CT were evaluated for humeral intracondylar fissure resolution. Results: A total of 137 humeral condylar fractures were operated on within the study period, 58 of which were in French bulldogs. Twenty‐seven French bulldogs had a contralateral humeral intracondylar fissure with 12 dogs matching the inclusion criteria. Follow‐up CT demonstrated resolution of the humeral intracondylar fissure in 11 (91.7%) of 12 cases. Clinical Significance: Contralateral humeral intracondylar fissures are common in skeletally immature French bulldogs sustaining humeral condylar fractures and the majority of these fissures tend to fuse within the follow‐up period. Due to the potential for breed variation in ossification of the humeral condyle, follow‐up CT may be warranted in skeletally immature French bulldogs before considering prophylactic transcondylar screw placement. [ABSTRACT FROM AUTHOR]

We report new specimens of the stem group phaethontiform Prophaethon from the early Eocene London Clay of Walton-on-the-Naze (Essex, UK). The two partial skeletons are distinctly smaller than a previously described record of Prophaethon from this locality, which was assigned to P. shrubsolei. Even though some extant aquatic birds show a pronounced sexual dimorphism in size, this is considered unlikely to explain the size disparity of the Prophaethon fossils from Walton-on-the-Naze and the new specimens are here described as P. waltonensis, sp. nov. The distal end of the humerus of the new species differs from that of other Phaethontiformes in the presence of a small but well-defined processus supracondylaris dorsalis. With regard to this feature, it shows a resemblance to the humerus of the Procellariiformes, which is unexpected in light of the recently proposed hypothesis that the sister taxon of the Phaethontiformes are the terrestrial Eurypygiformes. Finally, we comment on prophaethontid remains from the late Paleocene of Kazakhstan, which were assigned to the taxa Zhylgaia Nessov, 1988 and Tshulia Nessov, 1988. We synonymise the latter with the former taxon and also consider it possible that Zhylgaia Nessov, 1988 is a junior synonym of Prophaethon Andrews, 1899. [ABSTRACT FROM AUTHOR]

An understanding of the dynamics of bone growth is key to interpreting life‐history parameters of vertebrates. In this study, we used fluorochrome labels in captive leopard geckos (Eublepharis macularius) to track bone growth and intraskeletal variability from embryonic to adult growth stages. Thirteen individuals were administered fluorochromes from pre‐hatching to 4 years of age. The left tibia, fibula, femur, humerus, radius, and ulna were examined histologically and compared for differences in the number of labels within and between individuals at each sampled growth stage, and the amount of bone growth between labels was calculated. Results suggest that limb elements had differing growth rates; the fibula grew the fastest per day on average and the femur grew the slowest per day on average. All labels administered in ovo were still present in all limb elements in adults except for the tibia, suggesting growth marks are not lost in most elements and accurate calculations of growth rates could be performed in individuals up to 3 years old. All ex ovo labels were accounted for; however, when two fluorochromes were administered 3 weeks apart, the labels could not be differentiated from each other due to the new bone not being deposited at a quantifiable level. Overall, the tibia in leopard geckos is the least reliable limb bone to use for skeletochronology and the humerus, radius, and fibula preserve the longest growth record. This research highlights that, as in other extinct and extant animals, patterns of bone growth are not consistent across reptiles. This study adds to the growing body of knowledge on growth variability in reptiles. [ABSTRACT FROM AUTHOR]

1. The aim of this work was to identify a heritable keel bone phenotype with a correlation to keel bone damage and/or skeletal bone strength that could be easily measured in the living hen to aid selection to prevent welfare issues.2. The scoring system used reflected the observed damage, keel bone dimensions and shape compared to traditional measurements of bone quality.3. Increased keel bone damage was associated with poor humerus and tibia breaking strengths (p < 0.01). Bone damage was associated with higher whole keel density (p < 0.01) due to the effect of callus formation.4. Keel bone depth and area was moderately heritable at indices of 0.32 and 0.40, respectively. Keel bone depth was genetically correlated with tibia (0.36) and humerus density (0.68) and keel bone area was correlated with humerus density (0.59). Deeper keel bones and those with larger areas had small, negative phenotypic correlations with keel bone damage (−0.07 and −0.11, respectively). The second principal component of keel bone shape represented the caudal section of the keel bone and cranial edge concavity. The third principal component represented the differences in the caudal tip of the keel bone, the concavity of the dorsal edge and convexity of the ventral edge. Heritability estimates were 0.44 and 0.39, respectively.5. The results suggested that genetics contribute to morphometric traits. Hens with poorer skeletal quality are likely to accumulate more damage. Some of the traits may be a predictor of damage, although mid keel depth or concavity may simply reflect the effect of damage or deviation. [ABSTRACT FROM AUTHOR]

Conoryctes comma is a member of the enigmatic group Taeniodonta, Paleogene mammals that have been found only in North America. Taeniodonts were part of the first wave of placental mammal diversification after the end-Cretaceous extinction. The lack of postcranial elements has limited the understanding of the anatomy and locomotion of Conoryctes, and how it compared to other taeniodonts. We here describe the postcranial anatomy and functional morphology of Conoryctes, based largely on nine new specimens found in the San Juan Basin, New Mexico, USA. The specimens include elements of the axial column, such as the axis, sacrum, and ribs; the humerus, ulna, radius, and part of the manus; the innominate, femur, tibia, and part of the pes, including the tarsals. Conoryctes was a medium-sized mammal, with a robust humerus, radius, and femur, and with anatomical similarities to other conoryctid taeniodonts and Onychodectes. The tarsal elements of Conoryctes show characteristics of the "leptictimorph astragalocalcaneal morphology" as seen in other Paleogene mammals, such as Escavadodon, Palaeanodon, and Procerberus. Anatomical features of the forelimb and hindlimb of Conoryctes indicate that it was a scratch-digging animal with powerful forearm muscles and well-stabilized digits, features that may have helped it adapt to the subtropical forests of the San Juan Basin, approximately 63 million years ago. This corroborates the previous hypothesis that digging adaptations are seen in all members of Taeniodonta for which the postcranial elements are known, and that digging ability was present in the common ancestor of the clade and potentially central to their radiation after the environmental destruction of the end-Cretaceous extinction. [ABSTRACT FROM AUTHOR]

Orthosuchus stormbergi was a small‐bodied crocodyliform, representative of a diverse assemblage of Early Jurassic, early branching crocodylomorph taxa from the upper Elliot Formation of South Africa. The life history of these early branching taxa remains poorly understood, with only sparse investigations into their osteohistology, yet species like Orthosuchus have potential to inform about the macroevolution of growth strategies on the stem leading to crown crocodilians. In order to elucidate the growth patterns of Orthosuchus, we used propagation phase contrast X‐ray synchrotron micro‐computed tomography to virtually image the osteohistology of the postcrania of two specimens, including multiple elements from the type (SAM‐PK‐K409), and the femur of a referred specimen (BP/1/4242). In total, we scanned nine mid‐diaphyseal sections of the humerus, radius, ulna, radiale, femur, tibia, fibula, and a rib. We then compared our results to osteohistological sections of crocodylomorph taxa from the published literature. Our results show that the most predominant bone tissue type in Orthosuchus is lamellar, with a few patches of woven and parallel‐fibred bone. The type specimen contains four to five lines of arrested growth and the hindlimb elements present outer circumferential lamellae, whereas the referred specimen contains six to seven. Both specimens grew at similar rates, reaching adult skeletal body size at year four or five. The sectioned bones, most notably the radius and ulna, are comparatively thick walled and compact. Our virtual osteohistological sections are one of the first for an early branching crocodyliform, and the broad sample of skeletal elements makes Orthosuchus a key anchor point for understanding the plesiomorphic life history traits of the clade. [ABSTRACT FROM AUTHOR]

Background: Proximal humeral bone deficiency in revision shoulder arthroplasty is an emerging and challenging problem as the use of reverse shoulder arthroplasty (RSA) increases. This paper presents a technical note discussing our detailed preoperative planning steps, surgical techniques, and their rationale in carrying out the use of an allograft prosthetic composite (APC) to address proximal humeral bone deficiency in revision RSA. The outcomes of this technique are also presented. This paper also presents a systematic review to further discuss the existing literature on RSA with APCs. Methods: The preoperative surgical planning and the surgical technique employed to execute proximal humeral reconstruction using APC during revision arthroplasty are discussed in the technical note. The preliminary clinical and radiological results of five patients who underwent revision shoulder arthroplasty with proximal humeral reconstruction using APCs are presented. The PRISMA guidelines were followed to perform the systematic review. A systematic search using PubMed, Embase, and Cochrane databases was conducted. All studies involving RSA and APCs were pooled, and the data were extracted and analyzed. Results: A total of 14 studies were eligible for inclusion in the systematic review, with a total of 255 patients and a mean follow-up of 57 months. All studies in the systematic review and the patients included in the author's case series showed improvements in the level of pain, range of motion, function, and satisfaction. Graft incorporation in the systematic review was 84%. Conclusions: Based on the available literature and the results of our case series, the use of an APC construct is a viable option for proximal humeral bone deficiency in revision shoulder arthroplasty. [ABSTRACT FROM AUTHOR]

During the analysis of a commingled human remains assemblage, pair‐matching is often conducted as part of the inventory to inform the DNA sampling strategy and to calculate the minimum or most likely number of individuals. As commingled assemblages become larger, pair‐matching becomes more difficult, and it is unknown whether accuracy declines. Therefore, a study to determine the accuracy rates of visual pair‐matching for multiple observers was conducted on a large, commingled human assemblage. The sample consisted of 580 left and right humeri (n = 287 and n = 293, respectively) from the commingled remains of the USS Oklahoma, which were undergoing analysis at the Defense POW/MIA Accounting Agency. Five anthropologists completed this study, determining humeri pairs with varying degrees of confidence and non‐pairs. The overall precision was 81.0% and ranged from 74.1% to 95.9% for participants, including all confidence levels. When considering only confident matches, the overall precision for all participants increased to 91.4%. [ABSTRACT FROM AUTHOR]

Purpose: During resuscitation in emergency situations, establishing intravascular access is crucial for promptly initiating delivery of fluids, blood, blood products, and medications. In cases of emergency, when intravenous (IV) access proves unsuccessful, intraosseous (IO) access serves as a viable alternative. However, there is a notable lack of information concerning the frequency and efficacy of IO access in acute care settings. This study aims to assess the efficacy of intraosseous (IO) access in acute care settings, especially focusing on children in a level 1 trauma center. Methods: This retrospective study included patients with IO access presented in a level 1 trauma center emergency department (ED) between January 2015 and April 2020. Data regarding medication and fluid infusion was documented, and the clinical success rate was calculated. Results: Of the 109,548 patients that were admitted to the ED, 25,686 IV lines were inserted. Documentation of 188 patients of which 73 (38.8%) children was complete and used for analysis. In these 188 patients, a total of 232 IO accesses were placed. Overall, 182 patients had a functional IO access (204 needles) (88%). In children (age < 18 years) success rate was lower as compared to adults, 71–84% as compared to 94%. However, univariate regression showed no association between the percentage of functional IO access and gender, age, weight, health care location (prehospital and in hospital), anatomical position (tibia as compared to humerus) or type of injury. Conclusion: Intraosseous access demonstrates a high success rate for infusion, independent of gender, age, weight, anatomical positioning, or healthcare setting, with minimal complication rates. Caution is especially warranted for children under the age of six months, since success rate was lower. [ABSTRACT FROM AUTHOR]

AbstractThis research examined how changes in task constraints impacted the throwing patterns of children. The study involved 24 children, with an equal number of males and females, aged 5 and 6. The primary task constraints were the orientation of the target (horizontal or vertical hoops) and the size of the ball (diameters of 6 cm or 12 cm). We observed throwing patterns and analyzed kinematic changes in the preferred throws’ components. Initially, some children transitioned from using two hands to using one hand, and from underhand to overarm throws, particularly when using the larger balls. However, the preferred pattern for most children was one-hand overarm throwing. The kinematic analysis revealed that the participants adapted their throwing technique based on the size of the ball and the orientation of the hoop. The most significant adjustments occurred in the forearm component in response to changes in the target orientation. Notably, when aiming for a vertical hoop, distinct modifications were observed, including elevating the humerus and pulling the hand backward. These findings support the dynamical systems theory, which explains how movement patterns vary during motor development. The study also discussed the potential benefits of using constraints for skill acquisition in physical education settings. [ABSTRACT FROM AUTHOR]

The construction of a complete biological profile for unknown individuals from skeletal remains plays a key role in the holistic study of archaeological sites. However, the presence of commingled elements, as in the case of mass graves, hinders this process. This work aims to evaluate the diaphyseal cross‐sectional geometric properties of the long bones for pair‐matching and for sex estimation based on the femur, tibia, and humerus bones on archaeological and historical samples. The sample consisted of 3D virtual bone models of 95 individuals (46 males, 39 females, 10 of unknown sex) from both Greek and English assemblages, utilizing the dedicated “csg‐toolkit” GNU Octave package for variable extraction. The pair‐matching sorting algorithm performed adequately in all three assemblages, excluding over 97% of the true mismatched pairs. The accuracy rate for certain pair detection was close to 50% for the lower limbs, and 41% for the humerus, with the algorithm deeming a significant amount of the missed pairs as plausible, resulting in 70% to 80% of total pairs to be detected in some capacity for all bone assemblages. The sex estimation classifiers performed sufficiently in all cases, yielding moderately high accuracy rates in the majority of examined samples, with values consistently higher than 70%. However, the application of contemporary methods on archaeological or historical material needs to be performed with caution, as secular changes and population‐specific trends can affect the applicability of the methods. As such, the utilization of different techniques before reaching a conclusion is vital and should be encouraged. [ABSTRACT FROM AUTHOR]

The osteochondritis dissecans (OCD) is a clinical manifestation of a condition of osteochondrosis (OC), which affects humans and animals. This is a condition resulting in endochondral ossification to change, which leads to a focal thickening of cartilage affecting usually higher pressure areas. In dogs, the OC occurs in specific anatomical locations and often involves joint surfaces that carry weight. The most frequently affected site is the flow of the proximal humeral head. However, it can also occur in the area distomedial humeral trochlea, the femoral condyles, the femoral trochlea and the medial trochlear ridge and lateral talus. This paper aims exemplifies it, through a case report, affecting the scapular humeral joint of a dog. [ABSTRACT FROM AUTHOR]

This paper presents a detailed gross description of all anatomical elements of the humerus in the African green monkey and provides comparative and differential elements on monkey osteology. The osteometric investigation adds value to the gross morphological investigation, adjoining metric data to the gross descriptive data set. An in-depth investigation of the microstructural aspects of the humeral bone tissue is provided, with qualitative and quantitative details and potential for diagnostic applications. Of the gross morphological elements described, several unique features specific to this species include the humeral head shape that presents with distinctive low convexity and caudal placement, the shape of the intertubercular groove, the less developed greater tubercle, and the disposition of the rotator cuff muscle insertion. Furthermore, the overall cranio-lateral curvature of the bone shaft was found to have a distinctive 154–155 degree of angulation of the diaphysis, and the well-developed medial epicondyle was observed with its distinctive medio-caudal retroflexion. The histological investigation was more indicative of a typical non-primate organization of the bone tissue, with laminar vascular and avascular structures combined with the presence of the secondary Haversian system involving a mixture of scattered and dense unorganized secondary osteonal structures. The histomorphometric investigation yielded metrical data for the secondary osteonal structures in terms of area (20,331 ± 5105 µm2), perimeter, and vascular canal area (64,769 ± 257 µm2). [ABSTRACT FROM AUTHOR]

Background: This study aimed to assess the radiographic proximal humerus bony adaptations to stress shielding and associated clinical outcomes following stemless total shoulder arthroplasty. Methods: A retrospective review of all patients who underwent stemless total shoulder arthroplasty surgery at our centre from 2010 to 2020 was performed. Results: In total, 115 stemless total shoulder arthroplasty utilising a single implant design with a minimum one-year follow-up were identified over a 10-year period. The median follow-up was 3.5 years (range: 1–8.9 years). Evidence of stress shielding was observed in 20 cases (17%), (9 mild (8%), 0 moderate (0%), 11 severe (9%). No significant differences were seen between stress shielding and gender, body mass index, post-operative range-of-motion, patient satisfaction, or Oxford shoulder score. No significant differences were seen between the operative technique and stress shielding. No cases had evidence of humeral lucency. In total, 24 cases (21%) had evidence of glenoid lucency of Lazarus grade 0–3. No cases had Lazarus grades 4 or 5. There was no association between stress shielding and humeral lucency, glenoid lucency, or revision procedure. Discussion: Stress shielding in this study occurred at lower rates than anticipated following stemless total shoulder arthroplasty and was not associated with radiographic evidence of lucency, revision procedures, or adverse effect on clinical outcome measures. [ABSTRACT FROM AUTHOR]

Modern shoulder arthroplasties with stemless implants help to preserve the original bone substance of the proximal humerus and to reduce potential risks of conventional implants. Their shape allows newly formed bone to grow directly through the implant. However, it is not fully explained how an optimal fixation of the implant by formation of new bone can be achieved or stimulated. In this context, we develop a method to simulate the mechanical loading of the proximal humerus during the surgery using the finite element method to investigate whether one or more mechanical stress variables can be correlated with measurement data of cell activity in the bone, which is available in the form of SPECT/CT data. This contribution presents measurements with n=12$n=12$ explanted humeral heads from patients undergoing planned total shoulder arthroplasties in order to parameterize a material model for trabecular bone to be used in the finite element simulation. The raw data of these measurements were published and can be accessed for further investigations. [ABSTRACT FROM AUTHOR]

Full‐thickness rotator cuff tears can lead to poor coaptation of the humeral head to the glenoid, disrupting muscle forces required for glenohumeral joint stability, ultimately leading to joint subluxation. The aim of this study was to evaluate muscle forces and glenohumeral joint translations during elevation in the presence of isolated and combined full‐thickness rotator cuff tears. Eight fresh‐frozen upper limbs were mounted to a computer‐controlled testing apparatus that simulated joint motion by simulated muscle force application. Scapular‐plane abduction was performed, and glenohumeral joint translations were measured using an optoelectronic system. Testing was performed in the native shoulder, a following an isolated tear to the supraspinatus, as well as combined tears involving the supraspinatus and subscapularis, as well as supraspinatus, infraspinatus, and teres minor. Rotator cuff tears significantly increased middle deltoid force at 30°, 60°, and 90° of abduction relative to that in the native shoulder (p < 0.05). Significantly greater superior translations were observed relative to the intact shoulder due to combined tears to the supraspinatus and infraspinatus at 30° of abduction (mean increase: 1.6 mm, p = 0.020) and 60° of abduction (mean increase: 4.8 mm, p = 0.040). This study illustrates the infraspinatus‐teres minor complex as a major humeral head depressor and contributor to glenohumeral joint stability. An increase in deltoid force during abduction occurs in the presence of rotator cuff tears, which exacerbates superior migration of the humeral head. The findings may help in the development of clinical tests in rotator cuff tear diagnostics, in surgical planning of rotator cuff repair, and in planning of targeted rehabilitation. [ABSTRACT FROM AUTHOR]

Background: An increased prevalence of benign lesions has been associated with the increased use of radiological tools in orthopedic practice. Purpose: To investigate the inter-observer reliability of the radiographic detection of lesions on the proximal humerus between different observers. Material and Methods: X-ray radiological examinations of 17,243 patients were performed by an orthopedic surgeon to assess the presence of proximal humeral bone lesions. After this initial screening, 201 patients with lesions were identified and these 201 scans were assessed by three different physicians: an orthopedic oncologist, an orthopedic surgeon, and a musculoskeletal radiologist. Of the 201 patients with lesions, 80 had magnetic resonance imaging in addition to X-rays and were assessed. The diagnosis of the lesions was determined by each participant according to their radiological appearance to assess inter-observer reliability. Results: The prevalence of proximal humeral lesions was determined by the orthopedic surgeon to be 1.165% (201 of 17,243 patients). In 201 patients with a lesion, the mean age was 48 ± 17 years (range = 18–91 years). According to the assessments of the orthopedic oncologist, orthopedic surgeon, and musculoskeletal radiologist, the most common bone lesion identified was enostosis, with prevalence percentages of 53.7%, 59.7%, and 64.7%, respectively. A noteworthy consensus exists in the collective diagnosis of bone lesions among the three investigators, demonstrated by a substantial agreement with Fleiss' κ at 0.74 (P < 0.001). Conclusion: There was remarkable agreement between the three investigators on the collective diagnosis of bone lesions. Enostosis was the most common bone lesion at the proximal humerus in our series. [ABSTRACT FROM AUTHOR]

Background: Children who had been delivered with brachial plexus injury often presented with debilitating condition when their shoulder becomes stuck in an inwardly rotated position. Instances of inadequate recuperation following physiotherapy necessitate several surgical alternatives, such as soft tissue interventions like muscle releases and/or transfers, which can rectify this deformity. The current study aimed to present the clinical and radiological outcome after arthroscopic release of shoulder internal rotation contracture in cases of brachial plexus injury during birth. Methods: The current study was done in Zagazig University hospitals and had been included thirty-five participants presented by brachial plexus injury since delivery associated with shoulder internal rotation contracture with subluxation of the humeral head. Results: Mallet score; improved as the median of pre-operative Mallet score was 11 (2) and significantly increased to 16 (3) at the post-operative follow up, external rotation; improved as the median of pre-operative external rotation was 2 (1) and increased to 4 (1) post-operatively (P<0.001). Increase in elevation; as median of pre-operative elevation was 3 (1) and increased to 4 (1) post-operatively (P=0.003). Conclusion: The optimal time to do the arthroscopic release is before the child reaches two years old in order to achieve the greatest range of motion improvement of shoulder and to prevent additional bone alterations such as glenoid retroversion or displacement of the humeral head posteriorly, according to our perspective. [ABSTRACT FROM AUTHOR]

Background/Objectives: We previously reported that traction magnetic resonance imaging (MRI) of the elbow without arthrography increases the width of the radiocapitellar joint (RC) and improves articular cartilage visibility. However, the effects of axial traction on different age groups have not yet been evaluated. We hypothesized that the effect of traction would decrease as the participants' age increased. Methods: We enrolled 30 healthy volunteers, ten each in their 20s, 30s, and 40s. The male-to-female ratio in each age group was 1:1. Elbow MRI was performed without traction and with 3, 5, and 7 kg axial traction. We evaluated joint space width (JW), humeral articular cartilage visibility, and intraprocedural pain/discomfort. We measured JW and cartilage visibility at the RC and the lateral and medial thirds of the ulnohumeral joint. Results: The older age groups exhibited narrower JWs without traction. Axial traction increased the JW and improved the visibility of the RC in all age groups. No significant differences were observed in the ulnohumeral joint's lateral or medial thirds, but pain and discomfort increased with heavier traction weights. Conclusions: For participants in their 20s and 30s, axial traction of 3 kg seemed appropriate, while 7 kg traction was considered for those in their 40s. [ABSTRACT FROM AUTHOR]

Introduction: Ballistic fractures of the humerus secondary to gunshot wounds are increasingly common injuries that pose challenges for orthopedic surgeons. The primary purpose of this study was to examine the rates of neurovascular injury, compartment syndrome, and infection of ballistic humerus fractures relative to blunt, non-penetrating fractures. Methods: A consecutive cohort of 135 patients with ballistic humerus fractures and 167 patients with blunt humerus fractures treated at a level 1 trauma center were identified. A review of patient medical records and radiographic studies was performed to obtain demographic information, injury mechanism, fracture location, choice of treatment, and complications. Statistical analysis was performed using independent sample t -tests, chi-square tests, and odds ratios (p < 0.05 significance). Results: Compared with blunt fractures, patients in the ballistic fracture cohort were younger, male, African American, test positive for illicit drug use, and sustain proximal fractures. Ballistic fractures had significantly lower Injury Severity Scores and New Injury Severity Scores. Ballistic fractures were three times as likely to present with neurovascular injury than blunt fractures (OR: 2.927, p < 0.001). The overall rate of spontaneous recovery of significant motor function for ballistic fractures with neurologic injury was 55%. There were no statistically significant differences in rates of vascular injury, compartment syndrome, infection, non-union, or the need for soft tissue reconstruction. Conclusion: Compared with blunt humeral fractures, ballistic fractures appear to have a significantly higher rate of neurologic injury but no increased risk for compartment syndrome or infection. Surgical treatment of ballistic humeral injuries was not associated with increased neurological recovery compared to non-operatively managed fractures. [ABSTRACT FROM AUTHOR]

Background: This study aims to investigate the morphological characteristics of the distal humerus in healthy adults from northern China using computed tomography and three-dimensional reconstruction techniques and compared whether there were diferences in morphology among populations from diferent geographical regions. Methods: The CT data of 80 patients were imported into Mimics software for three-dimensional reconstruction and measurement. The differences in distal humeral morphological parameters between different genders and sides were compared, and the correlation between the parameters was explored. The distal humeral morphological parameters between Western and Chinese populations based on current and previous pooled results were compared. Results: Thirty-one morphological parameters were measured and analyzed in this study. The average (and standard deviation) of capitellum depth, capitellum width, capitellum height, distal humerus width, epitrochlea width, and humeral metaphyseal width was 10.83 ± 1.18 mm, 17.60 ± 2.06 mm, 21.10 ± 2.03 mm, 44.38 ± 4.07 mm, 12.02 ± 1.90 mm and 58.95 ± 4.86 mm, these parameters were significantly higher (P < 0.001*) in males than females. The capitellum width (r = -0.300, P = 0.007*), anterior lateral trochlear depth (r =-0.227, P = 0.043*), medial crest coronal tangential angle (r = 0.307, P = 0.006*), olecranon fossa volume (r = -0.408, P < 0.001*), olecranon fossa surface area (r = -0.345, P = 0.002*) and coronoid fossa surface area (r = -0.279, P = 0.012*) were significantly correlated with the age of the subjects. In the comparison of people from different regions, the capitellum height, lateral trochlear high, trochlear groove high, trochlear depth and medial trochlear high of the Western population were 23.25 ± 2.56 m, 21.6 ± 2.20 mm, 17.8 ± 2.00 mm, 17.80 ± 2.00 mm, 29.9 ± 4.10 mm, are significantly higher than those in the Chinese population. while capitellum width (15.55 ± 2.68 mm) and capitellum depth (9.00 ± 1.00 mm) were slightly lower. Conclusion: The findings provide a basis for the design of distal humeral orthopaedic implants, ensuring greater alignment with the anatomical structure of the distal humerus and improved surgical outcomes. Furthermore, the study provides a reference point for the diagnosis and classification of distal humeral diseases, as well as guidance for patient rehabilitation. [ABSTRACT FROM AUTHOR]

Talpid moles (Talpidae, Eulipotyphla) are mammals highly specialised in burrowing using their forelimbs. Fossoriality has allowed moles to expand their ecological niche by enabling access to subterranean resources and spaces. This specialisation in burrowing has led to adaptations in the forelimb bones of moles for humeral rotation digging, a distinctive strategy unparalleled among other diggers. While bone robustness has been examined in moles through external morphology, the adaptation of bone microstructure to digging strategy remains unclear. Based on two assumptions, (1) the humerus of moles is subjected to a torsional load due to humeral rotation digging, and (2) the magnitude of torsional load correlates with the compactness of the substrate in which the individuals can dig, we hypothesised that humeral rotation digging influences bone microstructure. Comparative analyses of transverse sections from the humeri and femora of three mole species (Mogera imaizumii, Mogera wogura and Urotrichus talpoides; Talpidae) and an outgroup eulipotyphlan (Suncus murinus; Soricidae) revealed that (1) vascular canals distributed in the humeri of moles align more predominantly circumferential along the bone walls, indicating an adaptation to the torsion generated by humeral rotation digging, and (2) the laminarity of vascular canals, particularly in Mogera species compared with Urotrichus, potentially reflects differences in the magnitude of load due to substrate compactness during digging. The aligned vascular canals are distinctive traits not observed in mammals employing other digging strategies. This suggests that vascular canal laminarity can be an indicator of not only humeral rotation digging in fossorial animals, but also the variation of eco‐spaces in talpid species. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study is to establish the correlation of clinically measured carrying angle with four radiological angles, i.e., Humerus–Elbow–Wrist angle (HEWA), Humero-ulnar angle, Metaphyseal–Diaphyseal angle, and Baumann's angle, and to find out which of the above-mentioned angles co-relates best with the clinically measured carrying angle. Methods: We studied 100 patients in the age group of 2–12 years after Ethics committee approval and informed consent from parents. Clinical angle was measured using goniometer and radiological angles marked on antero-posterior elbow X-ray using a standard method. Collected data were studied using statistical tests to find out correlation. Results: Pearson correlation coefficient for humerus–elbow–wrist angle found to be 0.674 followed by Humero-Ulnar angle (r = 0.417). Regression coefficient for humerus–elbow–wrist angle is 0.635 (p value < 0.001). Conclusion: Humerus–Elbow–Wrist angle correlates better compared to other radiological angles in assessment of varus–valgus angulations of elbow & will not only play a vital role in pre- operative planning of deformity corrections but also in the evaluation & comparison of the post-operative functional outcomes. [ABSTRACT FROM AUTHOR]

Background: This systematic review and meta-analysis sought to compare the clinical outcomes after proximal humerus reconstruction with a reverse allograft-prosthetic composite (APC) versus reverse endoprosthesis. Methods: Per PRISMA guidelines, we queried PubMed/MEDLINE, Embase, Web of Science, and Cochrane databases to identify articles reporting clinical outcomes of reverse APC or reverse endoprosthesis reconstruction of the proximal humerus for massive bone loss secondary to tumor, fracture, or failed arthroplasty. We compared postoperative range of motion, outcome scores, and the incidence of complications and revision surgery. Results: Of 259 unique articles, 18 articles were included (267 APC, 260 endoprosthesis). There were no significant differences between the APC and endoprosthesis cohort for postoperative forward elevation (P =.231), external rotation (P =.634), ASES score (P =.420), Constant score (P =.414), MSTS (P =.815), SST (P =.367), or VAS (P =.714). Rate of complications was 15% (31/213) in the APC cohort and 19% (27/144) in the endoprosthesis cohort. The rate of revision surgery was 12% after APC cohort and 7% after endoprosthesis. APC-specific complications included a 10% APC nonunion/malunion/resorption rate and 6% APC fracture/fragmentation rate. Discussion: Reverse APC and endoprosthesis are reasonable options for proximal humerus reconstruction. APC carries additional risks for complications, warranting evaluation of patients' healing capacity and surgeon experience. Level of Evidence: Level IV; Systematic Review. [ABSTRACT FROM AUTHOR]

Objectives: The study of puberty is a well‐established area of bioarcheological research, which greatly enhances our understanding of adolescence and growth in the past. Since the publications of Shapland and Lewis' works, which have become "standards" for estimating puberty in skeletal material, no additional osteological indicators of puberty have been proposed. Nevertheless, clinical practice constantly develops skeletal maturation markers that could be useful in bioarcheology. This study aims to assess the applicability and reliability of novel puberty indicators as a complementary tool to estimate puberty in skeletal remains. Materials and Methods: Four new maturation markers including spheno‐occipital synchondrosis, humeral head ossification, calcaneal apophysis ossification, and mandibular premolar mineralization were selected and applied to a sample of 85 adolescents from pre‐Roman southern Italy (Pontecagnano, 7th–4th BCE). Results: Despite some limits in adapting the original clinical methods to osteoarcheological material, the use of these novel skeletal indicators had moderate to excellent scoring repeatability and an overall high agreement with the puberty and menarche status previously estimated with standard methods. These results encourage us to apply these markers in bioarcheology. In some cases, minor adaptations of the original scoring systems are suggested to enhance reliability. Discussion: Including the proposed indicators in routine puberty data collection allows us to refine puberty estimation and improve the ability to identify key growth milestones in poorly preserved skeletons. Further application to osteological collections with diverse chronology and geographical differences is needed to assess how and to what extent the newly proposed maturation markers perform. [ABSTRACT FROM AUTHOR]

A new species of Melanorivulus is described from the upper Taquari River drainage, upper Paraguay River basin, in the Western Brazilian Cerrado. This species is a member of the Melanorivulus pictus group, endemic to the central Brazilian plateau and adjacent areas. Melanorivulus terena, new species, is endemic to the Paraguay River basin and is possibly closely related to other species endemic to the upper Paraná River basin, such as M. linearis, M. interruptus and M. egens, by the absence of distinctive dark marks on the humeral region in males. The new species is distinguished from all other species of the M. pictus group by a distal margin of unpaired fins and pelvic fin that is orangish red, and by the number of scales in the transversal series. The possible close relationship between the new species and other species recorded in the Paraná River basin may indicate an ancestral interconnection of the headwaters of the Rio Taquari (Paraguay River basin) with the headwaters of the upper Rio Verde and Rio Pardo (Paraná River basin). [ABSTRACT FROM AUTHOR]

Albatrosses are among the most intensely studied groups of living birds, yet their fossil record remains sparse. Despite modern albatrosses being more abundant and widespread in the Southern Hemisphere, the vast majority of fossil albatrosses identified to date come from Northern Hemisphere localities. Here, we describe Plotornis archaeonautes sp. nov., a new albatross species from the earliest Miocene that represents the earliest record of Procellariiformes in New Zealand and the earliest uncontroversial record of the clade Pan-Diomedeidae from the Southern Hemisphere. Phylogenetic analyses support the placement of Plotornis outside of the clade uniting all extant albatrosses. The new fossil reveals that stem lineage albatrosses were widespread by the onset of the Neogene. Although the humerus of Plotornis archaeonautes exhibits a short processus supracondylaris dorsalis, this early species may have possessed at least one of the unique ossifications associated with the patagial bracing system present in modern albatrosses. [ABSTRACT FROM AUTHOR]

Background: Stress injuries are often missed secondary to their insidious onset, milder symptoms, and subtle or initially absent findings when imaged. Main Body: This review aims to provide strategies for evaluating and treating upper extremity stress fractures. This article outlines the classic presentation of each fracture, the ages during which these injuries often occur, the relevant anatomy and biomechanics, and the mechanism of each injury. Diagnostic imaging and management principles are also discussed, including the use of conservative versus surgical management techniques. Short Conclusion: Upper extremity stress fractures are often mild injuries that resolve with conservative management but can lead to more serious consequences if ignored. Given their increasing incidence, familiarity with diagnosis and management of these injuries is becoming increasingly pertinent. Key Points: Stress injuries are often missed secondary to their insidious onset, milder symptoms, and subtle or initially absent findings when imaged. This review aims to provide strategies for evaluating and treating upper extremity stress fractures. [ABSTRACT FROM AUTHOR]

Background: Recent literature has found a consensus in favor of conservative treatment for type II supracondylar humeral fractures (SCHF). This retrospective observational study compares the short- to medium-term functional outcomes of conservative versus surgical treatment in 31 patients with SCHF (Gartland II and III) to assess the potential superiority of one approach over the other. Materials and methods: Thirty-one pediatric patients treated for SCHF—19 classified as Gartland II and 12 as Gartland III—were assessed in our department. Eight patients underwent closed reduction and cast immobilization, 22 were treated with closed reduction and percutaneous pinning, and one underwent open reduction and internal fixation with plates. Clinical and functional data were collected during follow-up, including elbow and forearm range of motion (ROM), grip strength, carrying angle, Flynn's criteria, and Disabilities of the Arm, Shoulder, and Hand (DASH) score. Results: The average follow-up was 3.3 years (± 1.4 years). All patients demonstrated good functional recovery. According to Flynn's criteria, 85% and 81% of the patients achieved a satisfactory outcome in elbow flexion and carrying angle, respectively. No cases of nerve injuries were reported. Four patients developed cubitus varus in the Gartland II group, which was treated with closed reduction and casting with the initial alignment maintained (without a loss of reduction during the first week). However, compared to this group that was conservatively treated, functional and clinical outcomes were significantly better in the group with SCHF Gartland II treated with reduction and pinning (p < 0.05). Conclusions: Although some recent studies have demonstrated positive outcomes with conservative treatment for both Gartland IIA and IIB fractures, the short- to medium-term functional results in our study emphasize that superior outcomes were obtained with surgical treatment for Gartland II fractures when compared to those treated conservatively. Trial registration: This study was performed in line with the principles of the Declaration of Helsinki. Ethics approval was obtained from our institute's ethics committee (registry no. 3511). Level of evidence: Therapeutic level III [ABSTRACT FROM AUTHOR]

Background: Control of humeral torsion can present a challenge, especially intraoperatively during closed reduction and fixation of humeral shaft fractures or 2-part surgical neck fractures of the proximal humerus. The objective of this study is to develop and validate an indirect method for the assessment of humeral torsion using an index that is linearly correlated with rotational arm position and can be derived from only a single plain radiographic image of the proximal humerus. Methods: The Humeral Head Offset Index (HHOI) is calculated as the ratio of the medial and lateral offset of the humeral head measured from the outer cortices of the shaft on a plain radiographic or fluoroscopic image. The relationship of HHOI with humeral torsion was first verified on a sawbone model with radiopaque characteristics under fluoroscopic control. Different degrees of retroversion were simulated through manual rotation of the humerus with a digital protractor in 5° increments until 40° internally rotated and then in 5° increments until 40° externally rotated from the neutral position. The same procedure was subsequently performed digitally on Digitally Reconstructed Radiographs (DRRs) from computed tomography (CT) dataset of the sawbone. Next, the HHOI index was applied to eight randomly selected patients with total humerus CT using the same method. Spearman's rho was calculated for the bivariate analysis of correlation between the simulated degree of retroversion and the HHOI. Strength of correlation was classified according to Koo and Li. Interrater and intrarater reliability of three blinded observers with repetition of measurement after three months were analyzed by assessing the intraclass correlation coefficient (ICC). Results: Both in the sawbone model and in DRRs, we demonstrated a high to very high significant linear correlation between simulated retroversion and the HHOI. ICC values demonstrated excellent interrater reliability and excellent intrarater reliability for measurement of the HHOI. Conclusions: The HHOI is a new, simple, reliable index that has a linear relationship to the rotation of the humerus and can therefore allow an indirect control of humeral torsion in comparison to the contralateral side. [ABSTRACT FROM AUTHOR]

Background: The aim of this study is to investigate the potential relationship between shoulder anatomical parameters and the shape of rotator cuff tears (L-shaped, U-shaped, and crescent-shaped). Materials and methods: The study included 160 (n:160) patients. Patients were divided into four groups: crescent type, u type and L type tears and control group. There were 40 cases in each group. The operated patients were divided into three groups based on the shape of the tears in arthroscopic images. Measurements of Critical Shoulder Angle (CSA), Greater Tuberosity Angle (GTA), Acromion Index (AI), Lateral Acromion Angle (LAA), and Humerus Footprint width (coronal width and sagittal width) were taken in each group and compared. Results: Patients were divided into four different groups: Crescent type group (n:40), L type group (n:40), U type group (n:40) and control group (n:40). Upon assessing the coronal and sagittal width measurements, The mean coranal width measurement of the L-type tear group was 12.62 ± 0.29 mm, which was significantly higher than all other groups (p < 0.05). The mean sagittal width of the L-type tear group was 34.95 ± 0.29 mm, which was significantly higher than all other groups (p < 0.05). When the groups were evaluated based on GTA, CSA, and AI data, the mean GTA measurement of the L-type tear group was 73.03 ± 0.95 degrees, which was significantly higher than all other groups (p < 0.05). The mean CSA measurement of the L-type tear group was 34.77 ± 0.66 degrees, which was significantly higher than all other groups (p < 0.05). The mean AI measurement of the L-type tear group was 0.77 ± 0.02, which was significantly higher than all other groups (p < 0.05). When the groups were evaluated based on LAA data, the mean LAA measurement of the L-type tear group was 76.98 ± 1.04 degrees, which was significantly lower than all other groups (p < 0.05). Conclusion: In our study, especially in L-shaped tears, measurements of GTA, CSA, AI, LAA, coronal and sagittal width were found to be different compared to the control group. These results suggest that shoulder anatomy affects the mechanisms of rotator cuff tear formation and that these parameters play a more significant role in L-shaped tears. [ABSTRACT FROM AUTHOR]

With the rising prevalence of shoulder arthroplasty, the incidence of revision shoulder arthroplasty is also increasing. The complexity of these revision procedures poses significant challenges, with bone loss being a critical factor impacting treatment outcomes. Addressing substantial humeral bone defects is crucial for ensuring implant stability and functionality. A comprehensive literature review was conducted using PubMed, Medline, and Google Scholar to identify existing classification systems for proximal humeral bone loss in the context of revision shoulder arthroplasty. The study assessed the advantages and limitations of these classifications, using this information to propose a new diagnostic and therapeutic algorithm. Several classification systems for proximal humeral bone loss were identified. McLendon et al. classify proximal humeral bone loss based on a 5-cm bone loss threshold and suggest an allograft prosthesis composite for losses exceeding this limit. Boileau's system stratifies bone loss into four types based on the extent of loss, with specific recommendations for each category. The PHAROS classification provides a detailed anatomical assessment but lacks quantitative precision. The proposed PHBL-SCORe system offers a novel algorithm incorporating preoperative radiographic measurements to determine the percentage of bone loss and guide treatment options. Proximal humeral bone loss presents significant challenges in revision shoulder arthroplasty, necessitating precise preoperative planning and classification to guide surgical intervention. Existing classification systems provide valuable frameworks but often rely on average population values, neglecting individual anatomical variations. The proposed PHBL-SCORe system offers a patient-specific approach, improving the accuracy of bone loss assessment and optimizing treatment strategies. Implementing this classification in clinical practice could enhance surgical outcomes and reduce complications associated with rRSA (revision Reverse Shoulder arthroplasty). Further studies are required to validate this algorithm and explore its long-term efficacy in diverse patient populations. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the changing experiences of shoulder surgeons working in a district general hospital. Methods: A consecutive series of 395 shoulders (225 male, 170 female) over a 19-year period (2000–2019) with a minimum follow-up of 2 years were analyzed. Outcome measures were length of stay, operating time, satisfaction visual analog score (VAS), pain VAS, Oxford Shoulder Score (OSS), Constant-Murley score, range of movement, complications, and implant survival. Results: The incidence of a diagnosis of osteoarthritis as the surgical indication increased over time. The number of cases by surgeon per year increased from three cases in 2,000 to a peak of 33 in 2011. Up to seven implant manufacturers were used. The incidence of hemiarthroplasties decreased, and more numerous reverse polarity and anatomic arthroplasties were performed (P<0.001). More glenoid and humeral components were cemented and more short-stem implants were used in later years (P<0.001). Length of stay was a median of 1 day with a trend towards daytime surgery in recent years. Patients were satisfied (VAS 8/10) and OSS improved by 8 points on average throughout the observation period. Conclusions: Despite frequent introductions of new implants, patient outcome, satisfaction, and complication rates remained good. There appears to be a need for large-scale, generalizable studies to understand why technological advancements leading to changes in implants do not influence clinical outcomes. Level of evidence: III. [ABSTRACT FROM AUTHOR]

For most shoulder surgeons, addressing massive rotator cuff tears that have retracted ends poses a significant challenge. This study introduces a technique, termed the "sandwich augmentation technique," which incorporates the long head of the biceps tendon (LHBT) into a single-row rotator cuff repair. The procedure, performed arthroscopically with the patient in the lateral decubitus position, involves attaching the LHBT and rotator cuff tissues together to the greater tuberosity. This effectively sandwiches them within the rotator cuff footprint. The goal of this technique is to enhance the thickness of the fully interposed cuff margin, thereby providing better support for the repair. The sandwich augmentation technique, which integrates the biceps into the rotator cuff repair, has demonstrated positive clinical outcomes and moderate anatomical results. It also prevents superior migration of the humeral head in cases of large or massive rotator cuff tears. Further research is required to assess the long-term effectiveness of this procedure. [ABSTRACT FROM AUTHOR]

Manual testing for dynamic shoulder instability includes noting and shifting of the humeral head, but the corresponding shift of the axis of rotation has been given little attention. The purpose of this study is to clarify translation of the humeral head during active glenohumeral rotation. Magnetic resonance images were taken at 2 images/s on 22 shoulders of 11 healthy men. At 1 5 0 ∘ shoulder elevation, the supine subject internally and externally rotated the humerus repeatedly over 20 s. The location over the glenoid of the center of the humeral head (CENHED) projected was studied. During external rotation, projection of CENHED on the glenoid began posterior to the center of the glenoid and migrated to anterior. During internal rotation, this projection was initially positioned above the glenoid center and midway through the motion, shifted inferiorly to nearly the glenoid center. The projection of CENHED did not significantly differ in location over the glenoid at any position along the range of motion during shoulder rotation. Initial values are now available for judging excessive movements of the humeral head on the glenoid fossa during rotation at 1 5 0 ∘ of abduction in the scapular plane. The method used in this study is amenable to clinical use. [ABSTRACT FROM AUTHOR]

Background: Achondroplasia can result in many skeletal manifestations, and degenerative osteoarthritis can develop in patients with achondroplasia. Morphologic changes to both the humerus and glenoid--short humeri with patulous metaphyses and a medialized glenoid--can cause challenges that must be overcome to achieve a successful surgical result in a patient with shoulder dysfunction. Because patients with achondroplasia have near-normal life expectancies, the operative shoulder must be functional as well as quite durable in the long term. In an achondroplastic dwarf with shoulder osteoarthritis and rotator cuff insufficiency, achieving functionality and durability requires the use of a reverse total shoulder arthroplasty (TSA). This procedure has its own set of issues, namely, baseplate fixation and correction of glenoid medialization, if present. Case Report: We present the case of an adult with achondroplastic dwarfism with shoulder osteoarthritis and rotator cuff insufficiency and report the 2-year clinical results for this patient after reverse TSA. Conclusion: Reverse TSA is a viable treatment option for adult achondroplastic patients with shoulder dysfunction. Careful pre-operative planning is required to ensure a good clinical result in patients with potentially dysplastic anatomy. [ABSTRACT FROM AUTHOR]

The "Validated Entheses‐based Reconstruction of Activity" (V.E.R.A.) method has proven to be a reliable method for the quantification and analysis of entheses. However, this method has only been successfully applied to human hand bones and animal long bones. This study tests the general applicability of the V.E.R.A. method to the human humerus, focusing on evaluating its reliability and repeatability. The sample included 23 humeri of unknown origin and background. The V.E.R.A. method was applied to six entheses of the humerus, comprising the subscapularis, supraspinatus, infraspinatus, teres minor, common extensor origin, and common flexor origin. Lin's concordance correlation coefficient (CCC) and percentage of error statistics were used to measure intraobserver error. Interobserver error was assessed through analysis of variance (ANOVA) tests, the intraclass correlation coefficient (ICC), and Lin's CCC. Intraobserver rates were between 1.83% and 3.23%. Interobserver error values were excellent, with no significant differences found in the ANOVA tests; Lin's CCC values were all above 0.90, with only the common extensor origin being 0.87; and ICC values were all above 0.97. Our results showed that the V.E.R.A. method is highly reliable and reproducible for the six entheses of the human humerus selected for this study. These results demonstrate the vast potential for the V.E.R.A. method to be applied to other parts of the human skeleton. [ABSTRACT FROM AUTHOR]