Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Mar 2019
Fragility of randomized clinical trials of treatment of clavicular fractures.
Statistical significance, as reported by the P value, has traditionally been the most commonly reported way to determine whether a difference exists between clinical interventions. Unfortunately, P values alone confer little about the robustness of a study's conclusions. An emerging metric, the fragility index (FI), helps to address this challenge by quantifying the number of events per outcome group that would need to be reversed to the alternative outcome in order to raise the P value above the 0.05 threshold. ⋯ The median FI reported in the recent literature on clavicular fractures is only 2. The FI is a useful metric to analyze the robustness of study conclusions that should complement other methods of critical data evaluation, including the P value or effect sizes. Future efforts are needed to increase institutional collaboration and patient recruitment to strengthen the robustness of RCT conclusions, especially in the realm of clavicular fracture management.
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J Shoulder Elbow Surg · Feb 2019
Multicenter StudyGrammont Award 2018: Scapular fractures in reverse shoulder arthroplasty (Grammont style): prevalence, functional, and radiographic results with minimum 5-year follow-up.
Scapular fractures after reverse shoulder arthroplasty (RSA) are an increasingly reported complication. Information is missing regarding midterm to long-term follow-up consequences. The aim of this study was to determine the rate of scapular fracture (acromial base and spine) after Grammont-style RSA and to report functional and radiographic results of patients with a minimum 5-year follow-up. ⋯ Scapular fractures after Grammont-style RSAs are rare (1.3%) but remain a concern. These fractures occur mainly in the early postoperative 6 months. Immobilization with an abduction splint frequently resulted in nonunion or malunion. Final functional outcomes are poor regardless of acromial or spine fracture compared with primary RSA without fracture.
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J Shoulder Elbow Surg · Feb 2019
Displaced humeral surgical neck fractures: classification and results of third-generation percutaneous intramedullary nailing.
The high rates of complications and reoperations observed with the early designs of first-generation (unlocked) and second-generation (bent design) humeral intramedullary nail (IMNs) have discouraged their use by most surgeons. The purpose of this study was to report the results of a third-generation (straight, locking, low-profile, tuberosity-based fixation) IMN, inserted through a percutaneous approach, for the treatment of displaced 2-part surgical neck fractures. ⋯ Antegrade insertion of a third-generation IMN through a percutaneous approach provides a high rate of fracture healing, excellent clinical outcome scores, and a low rate of complications. No morbidity related to the passage of the nail through the supraspinatus muscle and the cartilage was observed. The proposed A, B, and C classification allows choosing the optimal entry point for intramedullary nailing.
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J Shoulder Elbow Surg · Feb 2019
Multicenter Study Comparative StudyLocal infiltration analgesia versus interscalene nerve block for postoperative pain control after shoulder arthroplasty: a prospective, randomized, comparative noninferiority study involving 99 patients.
The aim of this study was to compare the efficacy of local infiltration analgesia (LIA) and interscalene nerve block (ISB) for early postoperative pain control after total shoulder arthroplasty (TSA). The hypothesis was that LIA is not inferior to ISB. ⋯ LIA is not less effective than ISB for early postoperative pain control after TSA.
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J Shoulder Elbow Surg · Feb 2019
Randomized Controlled TrialCounterforce bracing of lateral epicondylitis: a prospective, randomized, double-blinded, placebo-controlled clinical trial.
Counterforce bracing is one of the common treatment modalities for tennis elbow. The objective of this study was to determine whether counterforce bracing offers any additional benefit over placebo bracing in the treatment of tennis elbow. ⋯ The counterforce brace provides significant reduction in the frequency and severity of pain in the short term (2-12 weeks), as well as overall elbow function at 26 weeks, compared with the placebo brace.