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Background: Golf is a popular sport involving overhead activity and engagement of the rotator cuff (RC). This study aimed to determine to what level golfers were able to return to golf following RC repair, the barriers to them returning to golf and factors associated with their failure to return to golf. Methods: Patients preoperatively identifying as golfers undergoing RC repair at the study centre from 2012 to 2020 were retrospectively followed up with to assess their golf-playing status, performance and frequency of play and functional and quality of life (QoL) outcomes. Results: Forty-seven golfers (40 men [85.1%] and 7 women [14.9%]) with a mean age of 56.8 years met the inclusion criteria, and 80.1% were followed up with at a mean of 27.1 months postoperatively. Twenty-nine patients (76.3%) had returned to golf with a mean handicap change of +1.0 (P=0.291). Golf frequency decreased from a mean of 1.8 rounds per week preinjury to 1.5 rounds per week postoperatively (P=0.052). The EuroQol 5-dimension 5-level (EQ-5D-5L) index and visual analog scale (EQ-VAS) score were significantly greater in those returning to golf (P=0.024 and P=0.002), although functional outcome measures were not significantly different. The primary barriers to return were ipsilateral shoulder dysfunction (78%) and loss of the habit of play (22%). Conclusions: Golfers were likely (76%) to return to golf following RC repair, including mostly to their premorbid performance level with little residual symptomatology. Return to golf was associated with a greater QoL. Persistent subjective shoulder dysfunction (78%) was the most common barrier to returning to golf. Level of evidence: Level IV.

The primary aim assessed whether preoperative anemia was associated with a worse knee-specific functional outcome after total knee arthroplasty (TKA). The secondary aims assessed the association of preoperative anemia with generic health and patient satisfaction.A retrospective cohort study was undertaken to compare patients who did and did not have anemia (Hb13.0 g/dL for men and Hb11.5 g/dL for women). During a 1-year period, 497 patients underwent a total knee arthroplasty with complete preoperative and postoperative data, including 215 (43.3%) men and 282 (56.7%) women, who had a mean age of 70 years (range 45-93). Patient demographics, comorbidities, preoperative and postoperative (1 year) Oxford Knee Score (OKS), EuroQol 5 dimension (EQ-5D), postoperative Forgotten Joint Score (FJS), and patient satisfaction were collected. Regression analyses were used to adjust for confounding factors between the groups.The 56 (11.3%) patients who had anemia were older (4.6 years, P.001) and more likely to have chronic obstructive pulmonary disease (P = .004), connective tissue (P = .047), or kidney disease (P = .011) compared to those who did not have anemia. There were no differences in the preoperative OKS (P = .752) or EQ-5D (P = .762) scores between the groups. When adjusting for confounding differences, there was a significantly lower postoperative OKS (-3.0 points, P = .035) and FJS (-11.6 points, P = .011) associated with the anemia group. There were no significant differences in the EQ-5D (P = .118) or patient satisfaction between groups (odds ratio 0.84, P = .976).Preoperative anemia is associated with a lower postoperative joint-specific functional outcome. It is not clear if these differences are clinically meaningful. No difference in patient satisfaction was observed.Level III, diagnostic study.

AIMS: To develop a reliable and effective radiological score to assess the healing of isolated ulnar shaft fractures (IUSF), the Radiographic Union Score for Ulna fractures (RUSU).METHODS: Initially, 20 patients with radiographs six weeks following a non-operatively managed ulnar shaft fracture were selected and scored by three blinded observers. After intraclass correlation (ICC) analysis, a second group of 54 patients with radiographs six weeks after injury (18 who developed a nonunion and 36 who united) were scored by the same observers.RESULTS: In the initial study, interobserver and intraobserver ICC were 0.89 and 0.93, respectively. In the validation study, the interobserver ICC was 0.85. The median score for patients who united was significantly higher than those who developed a nonunion (11 vs. 7, p CONCLUSION: The RUSU shows good interobserver and intraobserver reliability and is effective in identifying patients at risk of nonunion six weeks after fracture. This tool requires external validation but may enhance the management of patients with isolated ulnar shaft fractures.

The aim was to compare surgical and nonsurgical management for adults with humeral shaft fractures in terms of patient-reported upper limb function, health-related quality of life, radiographic outcomes, and complications.MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, PubMed, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, International Clinical Trials Registry, and OpenGrey (Repository for Grey Literature in Europe) were searched in September 2021. All published prospective randomized trials comparing surgical and nonsurgical management of humeral shaft fractures in adults were included. Of 715 studies identified, five were included in the systematic review and four in the meta-analysis. Data were extracted by two independent reviewers according to the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Methodological quality was assessed using the revised Cochrane risk-of-bias tool for randomized trials. Pooled data were analyzed using a random-effects model.The meta-analysis comprised 292 patients (mean age 41 [18 to 83] years, 67% male). Surgery was associated with superior Disabilities of the Arm, Shoulder and Hand (DASH) and Constant-Murley scores at 6 months (mean DASH difference 7.6, P = 0.01; mean Constant-Murley difference 8.0, P = 0.003), but there was no difference at 1 year (DASH, P = 0.30; Constant-Murley, P = 0.33). No differences in health-related quality of life or pain scores were found. Surgery was associated with a lower risk of nonunion (0.7% versus 15.7%; odds ratio [OR] 0.13, P = 0.004). The number needed to treat with surgery to avoid one nonunion was 7. Surgery was associated with a higher risk of transient radial nerve palsy (17.4% versus 0.7%; OR 8.23, P = 0.01) but not infection (OR 3.57, P = 0.13). Surgery was also associated with a lower risk of reintervention (1.4% versus 19.3%; OR 0.14, P = 0.04).Surgery may confer an early functional advantage to adults with humeral shaft fractures, but this is not sustained beyond 6 months. The lower risk of nonunion should be balanced against the higher risk of transient radial nerve palsy.Level I.