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Introduction: The functional outcome after reverse shoulder arthroplasty (RSA) is closely linked to how much the humerus shifts because of the implants. While two-dimensional (2D) angle measurements have been used to capture this shift, it can be measured in three dimensions (3D) as the arm change position (ACP). In a previous study, the ACP was measured using 3D preoperative planning software with the passive virtual shoulder range of motion obtained after RSA. The main objective of this study was to evaluate the relationship between the ACP and the actual active shoulder range of motion measured after RSA. The hypothesis was that the ACP and the active clinical range of motion are related such that the ACP is a reliable parameter to guide the preoperative planning of an RSA. The secondary objective was to assess the relationship between 2D and 3D humeral displacement measurements. Materials and methods: This prospective observational study enrolled 12 patients who underwent RSA and had a minimum follow-up of 2 years. The active range of motion in shoulder flexion, abduction, and internal and external rotation was measured. At the same time, ACP measurements were taken from a reconstructed postoperative CT scan, in addition to the radiographic measurements of humeral lateralization and distalization angles on AP views in neutral rotation. Results: The mean humeral distalization induced by RSA was 33.3 mm (±3.8 mm). A non-statistically significant increase in shoulder flexion was observed for humeral distalization beyond 38 mm (R2 = 0.29, p = 0.07). This “threshold” effect of humeral distalization was also observed for the gains in abduction, as well as internal and external rotations, which seemed better with less than 38 mm or even 35 mm distalization. No statistical correlation was found between the 3D ACP measurements and 2D angle measurements. Conclusion: Excessive humeral distalization seems to be detrimental to joint mobility, especially shoulder flexion. Humeral lateralization and humeral anteriorization measured using the ACP seem to promote better shoulder range of motion, with no threshold effect. These findings could be evidence of tension in the soft tissues around the shoulder joint, which should be taken into consideration during preoperative planning.

The long head of the biceps (LHB) tendon is a common locus of pain in rotator cuff tear and of residual pain after tendon repair. Therefore, systematic LHB tenotomy, with or without tenodesis, is usually recommended. However, the recent literature suggests that long-term functional results of supraspinatus tendon repair are comparable between conservation of a normal biceps and tenotomy. The study objective is to compare functional results between sectioning and sparing a normal LHB in treating isolated grade-1 supraspinatus tendon tear. The study hypothesis is that sparing the normal LHB is clinically preferable to sectioning in the particular case of distal supraspinatus tear.A French nationwide prospective single-blind randomized clinical study will include 194 patients undergoing arthroscopic repair of grade-1 supraspinatus tear with normal LHB. They will be randomized to 2 parallel groups: LHB sparing and sectioning. The main endpoint is Constant-Murley score, and secondary endpoints comprise ASES and SSV scores, clinical assessment of the biceps, pain on VAS, ultrasound assessment of cuff repair healing and conserved LHBs, impact on return to work and sport, pathologic assessment of sectioned LHBs, and analysis of risk factors for cuff repair failure.The protocol has been approved by the data protection committee (art.L.1122-1) and meets the criteria of the Declaration of Helsinki and of the SPIRIT statement defining standard protocol items for clinical trials. Results will be published in a peer-reviewed journal.not applicable.

Introduction: The purpose of this study was to analyze the real range of motion (RoM) measured in patients operated on for reverse shoulder arthroplasty (RSA) and compare it to the virtual RoM provided by the preoperative planning software. Hypothesis: There was a difference between virtual and real RoM, which can be explained by different factors, specifically the scapula-thoracic (ST) joint. Methods: Twenty patients with RSA were assessed at a minimum follow-up of 18 months. Passive RoM in forward elevation abduction, without and with manually locking the ST joint, and in external rotation with arm at side were recorded. The humerus, scapula, and implants were manually segmented on post-operative CTs. Post-operative bony structures were registered to preoperative bony elements. From this registration, a post-operative plan corresponding to the real post-operative implant positioning was generated and the corresponding virtual RoM analysis was recorded. On the post-operative anteroposterior X-rays and 2D-CT coronal planning view, the glenoid horizontal line angle (GH), the metaphyseal horizontal line angle (MH), and the gleno-metaphyseal angle (GMA) were measured to assess the extrinsic glenoid inclination, as well as the relative position of the humeral and glenoid components. Results: There were some significant differences between virtual and post-operative passive abduction and forward elevation, with (55° and 50°, p < 0.0001) or without ST joint participation (15° and 27°, p < 0.002). For external rotation with arm at side, there was no significant difference between planning (24° ± 26°) and post-operative clinical observation (19° ± 12°) (p = 0.38). For the angle measurements, the GMA was significantly higher (42.8° ± 15.2° vs. 29.1°± 18.2°, p < 0.0001), and the GH angle, significantly lower on the virtual planning (85.2° ± 8.8° vs. 99.5° ± 12.5°, p < 0.0001), while the MH was not different (p = 0.33). Conclusions: The virtual RoM given by the planning software used in this study differs from the real post-operative passive RoM, except for external rotation. This can be explained by the lack of ST joint and soft tissues simulation. However, in focusing on the virtual GH participation, the simulation looks informative. Some modifications between the glenoid and humerus starting positions before running the motion analysis could be provided for making it more realistic and predictive of the RSA functional results. Level of evidence: III.

Resume Introduction Les fractures de la cheville et de l’arriere-pied presentent un taux important de complications notamment infectieuses qui varie de 1 a 48 % selon les etudes. Hypothese Le traitement des infections osteo-articulaires (IOA) survenant apres le traitement chirurgical d’une fracture de la cheville et de l’arriere-pied est a haut risque d’echec. Nous avons analyse les resultats du traitement de ces complications. Materiel et methodes Au total, 33 patients (34 cas) ont ete pris en charge pour une IOA de la cheville et de l’arriere-pied entre 2010 et 2015. La guerison de l’infection etait definie par l’absence de fistule, de signes inflammatoires locaux et generaux et la normalisation de la proteine C reactive au recul minimum de 2 ans. L’arthrodese sans infection etait definie comme un succes alors que la recidive de l’infection, et l’amputation etaient considerees comme un echec de prise en charge de ces IOA. L’âge moyen lors du traumatisme etait de 52 ans (16–85). Le delai median du diagnostic d’IOA etait de 44 jours (2–830). Resultats La duree moyenne de suivi etait de 20 mois (3–59). Vingt-deux patients ont ete consideres comme gueris de l’infection (65 %). Sept cas ont necessite une arthrodese (21 %). Le taux d’echec etait de 15 % avec 5 amputations transtibiales. Une couverture cutanee par lambeau a ete necessaire pour 15 patients (44 %), dans un delai median de 33 jours (0–167). Discussion Cette etude, bien que retrospective et avec un effectif reduit, confirme le mauvais pronostic des infections apres traitement chirurgical des fractures de la cheville et/ou de l’arriere-pied, dont le patient doit etre informe. Type d’etude Niveau de preuve : IV, etude retrospective, observationnelle.

In patients with knee infection, arthrodesis by external fixation is a limb-salvage procedure appropriate in highly selected patients. No hardware that might lead to infection is left in situ. However, the fusion rate is limited. Use of a device that applies compression in the coronal plane has been suggested in combination with sagittal external fixation to increase the fusion rate but has not been the focus of published studies. The objectives of this retrospective study were to determine: 1) the fusion rate and, 2) the rate of infection eradication.Knee arthrodesis using an external fixator and a compression clamp provides higher fusion rates compared to reports of external fixation without compression.We retrospectively studied 30 patients who underwent knee arthrodesis using external fixation and a compression clamp. The reason for arthrodesis was recurrent infection after total knee arthroplasty in 18 patients and septic arthritis in 12 patients. There were 16 females and 14 males with a mean age of 66.0±11.6 years (range, 30-83 years). Mean follow-up was 42.5±23.6 months (range, 24-106 months).Fusion was achieved in 25 (83%) patients, after a mean of 7.5 months (range, 6-12 months). Of the 8 patients with severe bone loss (≤25% bone contact), 4 experienced non-union, compared to 1 of the 22 patients whose bone loss was moderate or mild (50% and50% bone contact, respectively) (p=0.01). After at least 2 years of follow-up, the infection was eradicated in 28 (93%) patients. Complications occurred in 9 patients and consisted of pin-site infection managed by lavage (n=3), recurrent infection requiring revision surgery for debridement and lavage combined with material exchange and antibiotic therapy (n=2), and femoral shaft fracture (n=3) or traumatic fracture of the arthrodesis (n=1) treated by changing the clamp and fixator assembly.The fusion rate achieved using this combined technique is high and better than obtained with external fixation alone. Our results confirm that infection eradication is obtained more often than with nailing. This one-stage, simple, reproducible procedure does not leave any foreign material in situ.IV, retrospective observational cohort study.

Although the use of short stem and stemless shoulder prosthesis is trending, the surgical outcome may vary due to varying biomechanics. Objectives were to evaluate and compare the short-term clinical results and radiological changes between anatomical total shoulder arthroplasty (TSA) and reverse TSA (rTSA) with a short-stem humeral design.There is no clinical and radiological difference between TSA and rTSA using a short-stem humeral design.This retrospective study included 66 patients who underwent TSA and rTSA (33 patients each) with a minimum 2-year follow-up. Radiographic findings, including preoperative Tingart cortical index (TCI), postoperative filling ratios of metaphysis (FRmet) and diaphysis (FRdia), bone adaptations, and osteolysis around the humeral stem at the immediate postoperative period, and the most recent follow-up were measured. Pre and postoperative Constant-Murley score, subjective shoulder value (SSV), and complications were noted.At a mean follow-up of 27 (range 24-50) months, FRmet was significantly higher in rTSA group than the TSA group (0.65 vs. 0.60, p=0.009). Bone resorption was similar in both groups (p=0.76) and was correlated to a lower TCI value of2.9mm (p=0.02). Despite significant clinical improvement in individual groups, the comparison between groups was non-significant (p0.05). Negative correlation was observed between TCI and total clinical score (p=0.045) in TSA group, active external rotation (p=0.019), activity (p=0.005), SSV (p=0.008) and total score (p=0.025) in rTSA group. Radiographic changes were not influenced by patient characteristics and clinical results (p0.05).Although no radiographic difference was observed between TSA and rTSA, better short-term clinical results observed with the usage of the short-stem humeral design prosthesis are encouraging.III; Retrospective cohort study.

INTRODUCTION Soft tissue sarcomas (STS) are rare malignant tumors that require regimented treatment at designated cancer centers. The surgical care of groin tumors is difficult because of frequent local complications. Few studies have been done on prognostic factors and complications. This led us to conduct a retrospective study to 1) identify factors associated with local postoperative complications during the surgical care of primary groin STS, 2) identify the factors associated with delayed adjuvant radiation therapy, 3) define the optimal surgical treatment strategy to allow adjuvant treatments to start as early as possible, if applicable. HYPOTHESIS We hypothesized that certain patients presenting with an STS of the groin or inguinal area are at higher risk of complications. MATERIALS AND METHODS This retrospective single-center study included all the patients admitted to our referral sarcoma center between 1995 and 2016 for the resection of a primary STS of the groin. Major complications were defined as surgical revision, an invasive procedure, or prolonged dressing use. RESULTS Of the 55 included patients, 13 suffered major complications (24%) of which 10 were surgical revisions, two were repeated aspirations and one was prolonged dressing use. Among the 10 surgical revisions, there were two pedicled salvage flaps. The patients who suffered major complications were significantly more likely to be smokers than the patients who did not have major complications (31% vs 2% (p = 0.002)). Obesity and surgical bone exposure were most often associated with complications but not significantly (23% vs 5%, p = 0.053 and 38% vs 14% (p = 0.057), respectively). Of the 39 patients (71%) who needed postoperative radiation therapy, 5 patients (13%) had it delayed, and 3 patients (8%) did not receive any at all due to major complications. CONCLUSION In our study, smoking was associated with the occurrence of major complications after groin STS resection and there was a strong trend for obesity and surgical bone exposure. Major complications were associated with a delay in starting postoperative radiation therapy. Thus, we recommend flap coverage after tumor resection in patients who have factors known to contribute to complications. LEVEL OF EVIDENCE IV, Retrospective study.

To compare the clinical outcomes of self-locking T-tenotomy called “tomydesis” to three different techniques of tenodesis for lesions of the long head of the biceps tendon (LHBT) associated with rotator cuff tears. Tomydesis could provide similar clinical outcomes than the other LHBT tenodesis techniques. This prospective multicentre study included 77 patients who underwent rotator cuff repair concomitant with one of four surgical techniques on the LHBT. All patients had a minimum of 6-month follow-up post-operatively. Outcomes were evaluated based on the Constant score, SSV, pain on visual analogue scale, biceps-specific pain and Popeye deformity on photographs. There was no difference for the pain at the biceps muscle belly (p = 0.58), the bicipital groove (p = 0.69) and during resisted supination (p = 0.53), as well as for muscle cramps (p = 0.09), VAS for pain (p = 0.12) and Popeye deformity (p = 0.18). There was more pain in resisted flexion in the tomydesis group (p = 0.032), and significantly better Constant scores and SSV (

Introduction Ankle and hindfoot fractures are associated with high rates of complications, and of infection in particular, for which rates of 1% to 48% are reported. Hypothesis Treatment of bone and joint infection (BJI) secondary to surgery for ankle or hindfoot fracture is at high risk of failure. We analyzed results of treatment of BJI in this context. Material and methods 33 patients (34 cases) were treated for ankle or hindfoot BJI between 2010 and 2015. Cure was defined by absence of fistula and of local or general inflammatory signs and by normal C-reactive protein level, at a minimum 2 years’ follow-up. Fusion without infection was counted as success; recurrent infection and amputation were counted as failure. Mean age at trauma was 52 years (range, 16–85 years). Median time to diagnosis of BJI was 44 days (range, 2–830 days). Results Mean follow-up was 20 months (range, 3–59 months). Twenty-two patients were cured (65%). Seven cases required joint fusion (21%). The failure rate was 15%, including 5 transtibial amputations. Skin cover flap was required for 15 patients (44%), at a median 33 days (range, 0–167 days). Discussion Despite its retrospective design and small numbers, the present study confirmed the poor prognosis of BJI following surgery for ankle and/or hindfoot fracture. Patients need to be informed of this. Type of study and level of evidence IV, retrospective observational.