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Hofmann V, Diepold J, Moursy M, Birke MT, Deininger C, Wichlas F. Minimally invasive plate osteosynthesis (MIPO) for distal humeral fractures: a cadaveric study and first clinical application. BMC Musculoskelet Disord 2023; 24:206. [PMID: 36934262 PMCID: PMC10024368 DOI: 10.1186/s12891-023-06189-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 01/23/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND The indication for minimally invasive plate osteosynthesis (MIPO) may include articular fractures depending on the fracture pattern. The goal of this study was to evaluate the feasibility of the MIPO technique for extra- and intra-articular distal humeral fractures. METHODS The feasibility of the MIPO technique was assessed on 8 cadaveric elbows and 2 clinical cases. The four surgical approaches tested included a 20-mm ulnar incision, a 20-mm dorsoradial incision, and two incisions for olecranon osteotomy (A and B). Surgical incision A was 40 mm on the osteotomy level of the olecranon, and surgical incision B was an extension of the radial incision toward the osteotomy of the olecranon (80 mm). The four approaches were tested on 4 extra-articular (AO 13 A3) fractures and 4 intra-articular (AO 13 C3) fractures. RESULTS Reduction and plate fixation of all distal humeral fractures (8 cadaveric) with and without osteotomy was feasible. However, when using approach B, the soft tissue tension is reduced due to the wider incision. Nevertheless, both approaches A and B showed the same adequate intra-articular fracture control and reduction. CONCLUSION The MIPO technique for reduction and plate fixation in distal humeral fractures is feasible. LEVEL OF EVIDENCE As a feasibility study, this study cannot be clearly classified into a level of evidence. It corresponds most closely to level IV.
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Affiliation(s)
- Valeska Hofmann
- Department of Traumatology and Reconstructive Surgery, Eberhard Karls University Tübingen, BG Trauma Center Tübingen, Tübingen, Germany.
- No Limit Surgery, e.V., Salzburg, Austria.
| | - Julian Diepold
- Department of Orthopedics and Traumatology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Mohamed Moursy
- Department of Orthopedics and Traumatology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Marco T Birke
- Institute of Anatomy and Cellular Biology, Paracelsus Medical University, Salzburg, Austria
| | - Christian Deininger
- No Limit Surgery, e.V., Salzburg, Austria
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, 5020, Salzburg, Austria
| | - Florian Wichlas
- No Limit Surgery, e.V., Salzburg, Austria
- Department of Orthopedics and Traumatology, Paracelsus Medical University Salzburg, Salzburg, Austria
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El-Azab H, Moursy M, Mohamed MA, Elsayed M. A comparison of the outcomes of anterior curciate ligament reconstruction with large-size graft versus reconstruction with average-size graft combined with extraarticular tenodesis. Injury 2023; 54:976-982. [PMID: 36720663 DOI: 10.1016/j.injury.2023.01.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 01/01/2023] [Accepted: 01/16/2023] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Many patients who have had anterior cruciate ligament (ACL) reconstruction (R) complain of instability, inability to return to previous levels of sports activity, and possible ACL graft failure. Graft size was discovered to be an important factor in lowering ACL failure rates. Also, extraarticular tenodesis decreases recurrent instability, A comparative study was done to compare the effect of graft size and lateral external tenodesis on the recurrence of instability after ACL-R. PATIENTS AND METHODS A Prospective Blinded Randomized Controlled study included 100 consecutive patients who underwent ACL-R with hamstring tendon grafts in our Hospital. The patients were allocated into two groups (Group A and B) with randomization; group A received ACL-R with a large-size ACL-graft diameter of 6 strands, and group B received ACL-R of 4 strands combined with lateral extraarticular tenodesis (LET) (Modified Lemaire). Each group had fifty patients. The follow-up time was two years. They were examined for graft failure, anterolateral rotatory instability with the pivot shift test, and clinical outcomes, which were evaluated with the International Knee Documentation Committee score (IKDC) both subjective and objective. RESULTS In this study; group A, graft failure occurred in three (6.3%) patients, a positive pivot shift test grade I was detected in eight (17.8%) patients, grade II in three (6.7%) patients, and grade III in one (2.2%) patient. The subjective IKDC score was 87.9 (± 7.19) points. The objective IKDC score was normal or nearly normal in 43 (93.4%) patients. In group B, one (2.1%) patient had graft failure, five (10.9%) had a positive pivot shift test grade I, one (2.1%) had a grade II, and no patient had a grade III. The subjective IKDC score was 91.9 (± 8.9) points. The objective IKDC score was normal or nearly normal in 44 (95.6%) patients. As regard the subjective IKDC score, there was a non-significant difference between both groups (p value = 0.465). CONCLUSION Both groups showed a low ACL-graft failure rate, low anterolateral rotatory instability, and a good clinical outcome. Although there was no significant difference in subjective IKDC score between both groups, the failure rate and anterolateral rotatory instability were significantly lower in the ACL-R (4 strands) with LET combination group than in the group with the large-diameter (6 strands) graft. LEVEL OF EVIDENCE Level 1; Randomized Comparative Study.
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Affiliation(s)
- Hossam El-Azab
- Department of Orthopaedics and Traumatology, Sohag Faculty of Medicine, Sohag University, Egypt.
| | - Mohamed Moursy
- Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria
| | - Mohamed A Mohamed
- Department of Orthopaedics and Traumatology, Sohag Faculty of Medicine, Sohag University, Egypt
| | - Moustafa Elsayed
- Department of Orthopaedics and Traumatology, Sohag Faculty of Medicine, Sohag University, Egypt
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Dawood S, Sharaf AEM, Fouda H, Moursy M. Vegetation Structure and Species Association in High-Altitude Mountain Island in Egypt. Egyptian Academic Journal of Biological Sciences, H Botany 2022. [DOI: 10.21608/eajbsh.2022.257570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Ibrahiem E, Moursy M, Haggag M, Ghanem N. Limiting chemical parameters in soil and water controlling the presence of the fern Adiantum Capillus Veneris L. In South Sinai and Sharkia governorates in Egypt. Egypt J Chem 2022. [DOI: 10.21608/ejchem.2022.131090.5776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Moursy M, Wegmann K, Wichlas F, Tauber M. Distal humerus fracture in patients over 70 years of age: results of open reduction and internal fixation. Arch Orthop Trauma Surg 2022; 142:157-164. [PMID: 33151362 PMCID: PMC8732916 DOI: 10.1007/s00402-020-03664-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 10/15/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Due to the complexity of distal humerusfractures and often poor bone quality in elderly patients, these entities remain a challenge. However, because of a high rate of complications related to total elbow prostheses, reconstruction of distal humerus fractures should still be considered a therapeutic option, also in the elderly patient. The purpose of the present study was to investigate the clinical outcomes after open reduction and internal fixation and to evaluate whether the results justify reconstruction even in elderly patients. We hypothesized that despite advanced age, reasonable clinical results can be achieved, using a standardized surgical technique and aftertreatment protocol for the treatment of distal humerus fractures in elderly patients. METHODS Between 2004 and 2012, 30 patients with a mean age of 78 years at the time of injury with a recent distal humerus fracture were evaluated. All patients underwent the identical aftertreatment protocol with no weight bearing for 6 weeks and weekly increasing range of motion. Follow-up rate was 90%. 22 patients were treated with double plate, 4 with single plate, and 1 with screw fixation only. Patients were evaluated based on clinical criteria. Primary outcome measures were Mayo Elbow Performance Score, VAS and joint range of motion, secondary was radiological evaluation. RESULTS After a mean follow-up period of 3.8 years (min. 1 year, max. 9 years, SD ± 2), the average range of motion was flexion of 127° (min. 100°; max. 150°; SD ± 16.5) and average loss of extension of 20.9° (min. 5°; max. 40°; SD ± 11). Average pronation and supination was 68.3° (min. 0°; max. 90°; SD ± 25.3) and 75.3° (min. 0°; max. 90°; SD ± 19.7), respectively. Average Mayo Elbow Performance (MEPS) score was 88.7 (min. 60; max. 100; SD ± 12.1). 6 patients developed heterotopic ossification without significant effect on the clinical outcome. 7 patients had radiological evidence of at least partial non-union with one requiring revision, 2 discrete hardware dislocations were treated conservatively. There were no infections in the presented cohort. Our results regarding the surgical approach showed significantly higher patient satisfaction scores in the osteotomy group, compared to the group with Triceps-On Approach (PTOA). CONCLUSION The present data support indication for open reduction internal fixation (ORIF) even in the elderly patient. Advanced age should not be seen as a contraindication for ORIF of fractures of the distal humerus. Although the rate of complications is higher than in younger patients, complications such as non-union are often asymptomatic, patient satisfaction scores are high, and the possible devastating complications of failed elbow replacement can be evaded. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Mohamed Moursy
- Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria
| | - Kilian Wegmann
- University of Cologne, Faculty of Medicine, Cologne, Germany
- University Hospital Cologne, Center of Orthopedic and Trauma Surgery, Cologne, Germany
| | - Florian Wichlas
- Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria
| | - Mark Tauber
- Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria
- Shoulder and Elbow Surgery, ATOS Clinic, Munich, Germany
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Wichlas F, Hofmann V, Moursy M, Strada G, Deininger C. No implant, no solution, lost cases to surgery: orthopedic trauma triage for surgery in an NGO hospital in Sierra Leone. Arch Orthop Trauma Surg 2022; 142:805-811. [PMID: 33459821 PMCID: PMC7811951 DOI: 10.1007/s00402-020-03747-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 12/19/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION In low-income countries (LIC), international surgeons face the fact that there are patients they cannot treat. The goal of this study was to identify and analyze patients lost to treatment. MATERIAL AND METHODS We analyzed retrospectively the data of 282 trauma victims from a non-governmental organizational (NGO) hospital in Sierra Leone, Africa. During a 3-month period (10.10.2015-08.01.2016), these patients had 367 injuries and underwent 263 orthopedic surgeries. Despite a clear indication, some patients did not receive surgical treatment. We identified these injuries and the reason why they could not be operated. The anatomic region of the injury was evaluated and if they had a bone or soft tissue defect or were infected. RESULTS We identified 95 (25.89%) injuries in 70 patients (47 males; 23 females) that were not be operated. The reasons were lack of specific implants (no implant group; N = 33), no treatment strategy for the injury (no solution group; N = 29), and patients that were lost (lost patient group; N = 33), almost equally distributed by 1/3. In the no implant group were mainly closed fractures and fractures of the pelvis and the proximal femur. The implants needed were locking plates (N = 19), proximal femoral nails (N = 8), and implants for pelvic surgery (N = 6). In the no solution group were nearly all bone (P < 0.0000), soft tissue defects (P < 0.00001) and infections (P = 0.00003) compared to the rest and more open fractures (P < 0.00001). In the lost patients group, most fractures were closed (24 out of 33, P = 0.033). These fractures were mostly not urgent and were postponed repeatedly. CONCLUSION One quarter of the patients did not receive the surgical treatment needed. Besides acquisition of implants, surgical skills and expertise could be a solution for this issue. Nevertheless, these skills must be passed to local surgeons.
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Affiliation(s)
- F Wichlas
- Department of Orthopedics and Traumatology, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020, Salzburg, Austria.
- No Limit Surgery, Ernest-Thun-Strasse 6, 5020, Salzburg, Austria.
| | - V Hofmann
- Department of Orthopedics and Traumatology, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020, Salzburg, Austria
- No Limit Surgery, Ernest-Thun-Strasse 6, 5020, Salzburg, Austria
| | - M Moursy
- Department of Orthopedics and Traumatology, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020, Salzburg, Austria
| | | | - C Deininger
- Department of Orthopedics and Traumatology, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020, Salzburg, Austria
- No Limit Surgery, Ernest-Thun-Strasse 6, 5020, Salzburg, Austria
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Minkus M, Königshausen M, Maier D, Mauch F, Stein T, Greiner S, Moursy M, Scheibel M. Immobilization in External Rotation and Abduction Versus Arthroscopic Stabilization After First-Time Anterior Shoulder Dislocation: A Multicenter Randomized Controlled Trial. Am J Sports Med 2021; 49:857-865. [PMID: 33596092 PMCID: PMC7961655 DOI: 10.1177/0363546520987823] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Treatment of first-time shoulder dislocation (FSD) is a topic of debate. After high rates of recurrent instability after nonoperative management were reported in the literature, primary repair of FSD significantly increased. At the same time, new concepts were proposed that had promising results for immobilization in external rotation (ER) and abduction (ABD). PURPOSE The aim of this study was to evaluate the recurrence rates (primary outcome) and clinical outcomes (secondary outcome parameters) of immobilization in ER+ABD versus arthroscopic primary stabilization after FSD. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS In a multicenter randomized controlled trial, patients with FSD were randomized to either treatment with immobilization in 60° of ER plus 30° of ABD (group 1) or surgical treatment with arthroscopic Bankart repair (group 2). Clinical evaluation was performed 1, 3, and 6 weeks as well as 6, 12, and 24 months postoperatively or after reduction, including range of motion, instability testing, subjective shoulder value, Constant-Murley score, Rowe score, and Western Ontario Shoulder Instability Index. Recurrent instability events were prospectively recorded. RESULTS Between 2011 and 2017, a total of 112 patients were included in this study. Of these, 60 patients were allocated to group 1 and 52 to group 2. At the 24-month follow-up, 91 patients (81.3%) were available for clinical examination. The recurrence rate was 19.1% in group 1 and 2.3% in group 2 (P = .016). No significant differences were found between groups regarding clinical shoulder scores (P > .05). Due to noncompliance with the immobilization treatment protocol, 4 patients (6.7%) were excluded. CONCLUSION Immobilization in ER+ABD versus primary arthroscopic shoulder stabilization for the treatment of FSD showed no differences in clinical shoulder scores. However, recurrent instability was significantly higher after nonoperative treatment.
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Affiliation(s)
- Marvin Minkus
- Department for Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Matthias Königshausen
- Department of Trauma Surgery and Orthopaedics, Ruhr-University Hospital Bergmannsheil Bochum, Bochum, Germany
| | - Dirk Maier
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Frieder Mauch
- Department of Shoulder and Elbow Surgery, Sportklinik Stuttgart, Stuttgart, Germany
| | - Thomas Stein
- Department of Sport Traumatology, Knee and Shoulder Surgery, Berufsgenossenschaftliche Unfallklinik, Frankfurt am Main, Germany,Department of Sports Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany
| | | | - Mohamed Moursy
- Orthopedics & Trauma Centre, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany,Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria
| | - Markus Scheibel
- Department for Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité Universitaetsmedizin Berlin, Berlin, Germany,Department of Shoulder and Elbow Surgery, Schulthess Clinic Zurich, Zurich, Switzerland,Markus Scheibel, MD, Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany ()
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Ragab S, Kamel M, Bream A, Moursy M. Studying the Interaction Between Asphondylia punica and Its Host Plant, Atriplex halimus, and Predicting Their Potential Geographic Distribution in Egypt by Using Maxent Technique. Egyptian Academic Journal of Biological Sciences A, Entomology 2020. [DOI: 10.21608/eajbsa.2020.117504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Zunke P, Auffarth A, Hitzl W, Moursy M. The effect of manual therapy to the thoracic spine on pain-free grip and sympathetic activity in patients with lateral epicondylalgia humeri. A randomized, sample sized planned, placebo-controlled, patient-blinded monocentric trial. BMC Musculoskelet Disord 2020; 21:186. [PMID: 32209068 PMCID: PMC7093973 DOI: 10.1186/s12891-020-3175-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 02/27/2020] [Indexed: 12/17/2022] Open
Abstract
Background The treatment of first choice for lateral epicondylalgia humeri is conservative therapy. Recent findings indicate that spinal manual therapy is effective in the treatment of lateral epicondylalgia. We hypothesized that thoracic spinal mobilization in patients with epicondylalgia would have a positive short–term effect on pain and sympathetic activity. Methods Thirty patients (all analyzed) with clinically diagnosed (physical examination) lateral epicondylalgia were enrolled in this randomized, sample size planned, placebo-controlled, patient-blinded, monocentric trial. Pain-free grip, skin conductance and peripheral skin temperature were measured before and after the intervention. The treatment group (15 patients) received a one-time 2-min T5 costovertebral mobilization (2 Hz), and the placebo group (15 patients) received a 2-min one-time sham ultrasound therapy. Results Mobilization at the thoracic spine resulted in significantly increased strength of pain-free grip + 4.6 kg ± 6.10 (p = 0.008) and skin conductance + 0.76 μS ± 0.73 (p = 0.000004) as well as a decrease in peripheral skin temperature by − 0.80 °C ± 0.35 (p < 0.0000001) within the treatment group. Conclusion A thoracic costovertebral T5 mobilization at a frequency of 2 Hz shows an immediate positive effect on pain-free grip and sympathetic activity in patients with lateral epicondylalgia. Clinical trial registration German clinical trial register DRKS00013964, retrospectively registered on 2.2.2018.
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Affiliation(s)
- Philipp Zunke
- Physiozentrum Salzburg, Innsbrucker Bundesstraße 35, 5020, Salzburg, Austria. .,Department of Orthopedics and Traumatology, Paracelsus Medical University Salzburg, Muellner Hauptstr. 48, 5020, Salzburg, Austria.
| | - Alexander Auffarth
- Department of Orthopedics and Traumatology, Paracelsus Medical University Salzburg, Muellner Hauptstr. 48, 5020, Salzburg, Austria
| | - Wolfgang Hitzl
- Paracelsus Medical University Salzburg, Research Office (biostatistics), Strubergasse 20, 5020, Salzburg, Austria.,Department of Ophthalmology and Optometry, Paracelsus Medical University Salzburg, Muellner Hauptstr. 48, 5020, Salzburg, Austria.,Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Mohamed Moursy
- Department of Orthopedics and Traumatology, Paracelsus Medical University Salzburg, Muellner Hauptstr. 48, 5020, Salzburg, Austria
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Moursy M, Schmalzl J, Kadavkolan AS, Bartels N, Lehmann LJ. Latissimus dorsi transfer for massive posterosuperior rotator cuff tears: what affects the postoperative outcome? J Shoulder Elbow Surg 2019; 28:2191-2197. [PMID: 31262636 DOI: 10.1016/j.jse.2019.03.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 02/27/2019] [Accepted: 03/07/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The management of irreparable posterosuperior rotator cuff tears (IPSRCTs) in young active individuals is still a challenge. The aim of this study was to evaluate the influence of sex, surgical technique, previous surgical procedures, tear genesis, and presence of a preoperative external rotation lag sign on the functional outcome after latissimus dorsi transfer (LDT) for IPSRCTs. METHODS Retrospectively, all patients with IPSRCTs treated with LDT during a 10-year period were followed up. Preoperative evaluation included the visual analog scale (VAS) score, range of motion, and the Constant score (CS). Postoperatively, the VAS score, range of motion, CS, American Shoulder and Elbow Surgeons score, and Subjective Shoulder Value were recorded. Preoperative and postoperative radiologic evaluation was performed using the Hamada-Fukuda classification and the acromiohumeral interval. RESULTS In total, 67 of 79 patients (85%), with a mean age of 63 years, were available for follow-up at 54 ± 28 months. The CS improved from 24 ± 6 points preoperatively to 68 ± 17 points at follow-up (P < .001). Active flexion increased from 83° ± 47° to 144° ± 35°; abduction, from 69° ± 33° to 134° ± 42°; and external rotation, from 24° ± 18° to 35° ± 21°. Postoperatively, the Subjective Shoulder Value was 69% ± 19% and the American Shoulder and Elbow Surgeons score was 76 ± 21. The VAS score decreased from 6.3 ± 1.1 to 1.8 ± 2 (P < .001). Abduction strength increased from 0.4 ± 0.4 kg to 3.6 ± 2.2 kg (P < .001). The acromiohumeral interval decreased from 7.9 ± 2.6 mm to 5.1 ± 2.2 mm, and arthropathy worsened from Hamada-Fukuda stage 1.4 to stage 2.1. The rate of conversion to a reverse prosthesis was 6%. CONCLUSION LDT represents a reliable and reproducible treatment option with good clinical midterm results after surgical treatment. Sex, genesis, preoperative presence of an external rotation lag sign, and previous surgical procedures do not affect the overall clinical outcome.
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Affiliation(s)
- Mohamed Moursy
- Orthopaedic and Trauma Surgery Centre (OUZ), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Department of Traumatology and Orthopaedic Surgery, University Hospital Salzburg, Salzburg, Austria.
| | - Jonas Schmalzl
- Department of Traumatology and Hand Surgery, St. Vincentius Clinic, Teaching Hospital Albert-Ludwigs-University Freiburg, Karlsruhe, Germany
| | - Aditya S Kadavkolan
- Orthopaedic and Trauma Surgery Centre (OUZ), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Dr. LH Hiranandani Hospital, Mumbai, India
| | - Niko Bartels
- Orthopaedic and Trauma Surgery Centre (OUZ), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Lars-Johannes Lehmann
- Orthopaedic and Trauma Surgery Centre (OUZ), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Department of Traumatology and Hand Surgery, St. Vincentius Clinic, Teaching Hospital Albert-Ludwigs-University Freiburg, Karlsruhe, Germany
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Moursy M, Niks M, Kadavkolan AS, Lehmann LJ. Do the radiological changes seen at mid term follow up of stemless shoulder prosthesis affect outcome? BMC Musculoskelet Disord 2019; 20:490. [PMID: 31656176 PMCID: PMC6815366 DOI: 10.1186/s12891-019-2870-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 10/09/2019] [Indexed: 01/30/2023] Open
Abstract
Background The Eclipse® (Eclipse® is a trademark of Arthrex, Naples, Florida) stemless shoulder prosthesis offers the surgeon the advantage of bone stock preservation and at the same time avoids the drawbacks of a resurfacing arthroplasty. Previous studies have shown radiographic changes on serial follow up of the Eclipse prosthesis. This study attempts to assess the significance of these radiographic changes and effect of cuff related pathology on the mid-term outcome of the Eclipse prosthesis. Methods Between July 2005 and October 2008, 29 shoulders underwent shoulder arthroplasty with the Eclipse prosthesis; 23 shoulders, (seven women and 16 men) were available for the final follow up. The range of motion, Constant Score; age adjusted Constant Score, Subjective Shoulder Value and radiographs were assessed at serial follow-ups. Results Significant improvements were seen in the Constant Score (78.9 ±20.1) compared to pre-operative score (32.9 ±5.2); also forward elevation, abduction and external rotation improved to 142.9 ± 36.6 °, 135.2 ± 40.5 ° and 49.8 ± 21.9 ° at 72 months (p < 0.001). Radiolucent lines and localised osteopenia, did not statistically impact on the clinical outcome. Partial tears of the supraspinatus and subscapularis had a negative impact on the Subjective Shoulder Value (p < 0.05) Partial or complete tears of the subscapularis led to worse Constant Score on follow up (p < 0.05). Conclusions The presence of radiolucent lines or localised osteopenia does not influence the mid term clinical outcome. Pre -operative partial supraspinatus tears or tears of the subscapularis lead to an inferior outcome.
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Affiliation(s)
- Mohamed Moursy
- Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria.
| | - Milan Niks
- Dept. of Traumatology, Emergency hospital Graz, Graz, Austria
| | - Aditya S Kadavkolan
- Consultant Arthroscopy, Sports Medicine & Shoulder surgery, Dr. LH Hiranandani Hospital, Powai, Mumbai, 400076, India
| | - Lars J Lehmann
- Orthopedic & Trauma Centre, Medical Faculty Mannheim, Heidelberg University Mannheim, Mannheim, Germany
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Moursy M, Emara E, Abd EL Hamid S, HAMED L. Response of Allium crops to nitrogen fertilization rates and different irrigation water sources. Egypt J Soil Sci 2019; 59:1-14. [DOI: 10.21608/ejss.2019.12340.1271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Schmalzl J, Niks M, Moursy M, Scharf HP, Lehmann LJ. Eight-year follow-up after scapulectomy in a neonate with congenital Ewing sarcoma of the scapula. J Shoulder Elbow Surg 2018; 27:e288-e293. [PMID: 29934281 DOI: 10.1016/j.jse.2018.04.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 04/18/2018] [Indexed: 02/01/2023]
Affiliation(s)
- Jonas Schmalzl
- Department of Traumatology and Hand Surgery, St. Vincentius Clinic, ViDia Clinics, Karlsruhe, Germany.
| | - Milan Niks
- Department of Traumatology, Emergency Hospital Graz, Graz, Austria
| | - Mohamed Moursy
- Department of Traumatology and Orthopaedic Surgery, University Hospital Salzburg, Salzburg, Austria
| | - Hanns-Peter Scharf
- Orthopaedic and Trauma Surgery Centre (OUZ), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Lars-Johannes Lehmann
- Department of Traumatology and Hand Surgery, St. Vincentius Clinic, ViDia Clinics, Karlsruhe, Germany
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Lehmann L, Schmalzl J, Moursy M, Rzepka D. Skapulothorakaler Rhythmus, Skapulasporn und Incisura-scapulae-Syndrom. Arthroskopie 2017. [DOI: 10.1007/s00142-017-0132-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Lehmann LJ, Cafaltzis K, Hünnebeck S, Moursy M. Are there any prognostic prediction parameters (PPPs) in the treatment of the massive rotator cuff tear with latissimus dorsi transfer? Latissimus dorsi transfer in massive rotator cuff tears. Acta Chir Orthop Traumatol Cech 2013; 80:125-130. [PMID: 23562256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE OF THE STUDY Especially in such complex salvage procedures as latissimus dorsi transfer for irreparable rotator cuff tears there is a need for valid prognostic prediction parameters. Parameters such as osteoarthritis, acromiohumeral distance, subscapularis, or teres minor insufficiency are controversial. The aim of this study is to present our data and to evaluate the literature regarding such parameters. METHODS Fifty-seven patients with a follow-up of 3 years (range, 18-72 months, n = 57) were selected for this study. Average age of patients at the time of surgery was 64.9 years. Patients were evaluated using the age and gender adjusted scoring system according to Constant and Murley score (CS). Standard radiography was attempted containing a true-ap, outlet, and axillary view. The acromio-humeral distance was measured in the true ap view. The grade of glenohumeral osteoarthritis and cuff tear arthropathy was detected using the classification of Hamada et al. Differences in CS were compared for each of the PPP. RESULTS Mean Constant score increased significantly (p < 0.0001) 3 years postoperatively from initially 22.7 points to 66.0 points (adjusted CS 80.3%). We found a major difference in the Constant score in patients with or without previous surgery (80.4% vs, 65.2%). CONCLUSION Latissimus dorsi transfer is an excellent option in the treatment of irreparable postero-superior tears of the rotator cuff in well-selected patients. The literature remains ambiguous with regard to valid prognostic predictive parameters for complex salvage procedures, owing to the consistent use of small study samples. Thus, there is an overwhelming need for a multicenter study.
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Affiliation(s)
- L J Lehmann
- Shoulder and elbow surgery unit, Orthopaedic and Trauma Surgery Center, University Medical Center Mannheim, Mannheim, Germany.
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Moursy M, Cafaltzis K, Eisermann S, Lehmann LJ. Latissimus dorsi transfer: L'Episcopo versus Herzberg technique. Acta Orthop Belg 2012; 78:296-303. [PMID: 22822567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The purpose of this study was to compare the clinical results of two different techniques of latissimus dorsi transfer used in 28 patients, either a modified single incision mini-invasive Herzberg transfer (HT) or a combined latissimus dorsi and teres major transfer according to L'Episcopo (LE). Twenty-eight patients fulfilled the inclusion criteria. Minimum follow-up was 24 months. Sixteen patients were treated with the Herzberg transfer (HT group) and 12 patients had the L'Episcopo technique (LE group). The Constant score rose from 272 initially to 73.5 four years post-operatively in the LE group and from 32.2 to 76 three years and 3 months post-operatively in the HE group (statistically similar). The pre-operative acromiohumeral distance remained unchanged statistically. Radiological signs of osteoarthritis increased. Constant-Murley score, acromiohumeral distance and progression of rotator cuff tear arthropathy were not significantly different between the two groups.
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Affiliation(s)
- Mohamed Moursy
- Center of Orthopedics and Trauma, Mannheim Faculty of Medicine of the University of Heidelberg, Germany.
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17
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Lehmann LJ, Moursy M, Lederer C. [Is the patient age a negative predictive factor in the reconstruction of SLAP lesions?]. Sportverletz Sportschaden 2012; 26:109-13. [PMID: 22441977 DOI: 10.1055/s-0031-1299421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The treatment strategy of SLAP (superior labrum anterior posterior) lesions is generally a matter of controversy, particularly in patients over 40 years of age. Various factors, such as the increasing number of associated injuries in older age, play a role in the decision-making process. There currently is no empirical evidence for the greater efficacy of treatment planning for SLAP repair as compared to tenodesis/tenotomy. The aim of this study was to analyse, as part of a cohort comparison, the results after SLAP repair in patients under and over 40 years of age. METHODS We followed 45 patients after surgical treatment of a SLAP lesion, with a mean follow-up of 60 months (5 years), clinically using the Constant score (CS), the Rowe score, and the "subjective shoulder value" (SSV). Of these, 18 patients in group 1 (age at surgery<40 years, mean age at surgery 29 years, range: 21-39 years) and 27 patients in group 2 (age≥40 years at surgery, mean age at surgery 50 years, range: 40-60 years). RESULTS A mean CS of 89% (min 16%-max 105%) resulted. The Rowe score averaged 90 points (min. 35 points-max 100 points), while the SSV averaged 90% (min 20%-max 100%). In comparing the two groups, neither displayed a significant difference in the CS (p=0.198) (group 1: min 58%-max 105%, median 92%, group 2: min 16%-max 105%, median 89%) nor in the Rowe score (p=0.5) (group 1: min 55-max 100 points, median 85 points, group 2: min 35-max 100 points, median 92.5 points). The SSV also showed no significant difference in level (p=0.068) between the two groups (group 1: min 60%-max 100%, median 95%, group 2: min 20%-max 100%, median 90%), although the SSV in group 1 had a better correlation with the CS than in group 2. DISCUSSION The patient's age seems to have less influence on the outcome after reconstruction of SLAP than previously thought. Even at age≥40 years results show that the reconstruction results of the complex SLAP are comparable with the known literature data, and that it is good clinical practice. Impact on the long-term outcome seems to be particularly dependent on the number and severity of associated injuries, not the patient's age.
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Affiliation(s)
- L J Lehmann
- Orthopädisch-Unfallchirurgisches Zentrum, Medizinische Fakultät Mannheim der Universität Heidelberg, Universitätsmedizin Mannheim.
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Tauber M, Moursy M, Forstner R, Koller H, Resch H. Latissimus dorsi tendon transfer for irreparable rotator cuff tears: a modified technique to improve tendon transfer integrity: surgical technique. J Bone Joint Surg Am 2010; 92 Suppl 1 Pt 2:226-39. [PMID: 20844178 DOI: 10.2106/jbjs.j.00224] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Latissimus dorsi tendon transfer is a well-established method for the treatment of massive irreparable posterosuperior defects of the rotator cuff. Subsequent rupture of the transferred tendon may contribute to the rate of failure of the index procedure. We hypothesized that modification of our technique of tendon harvesting would lead to greater fixation stability and a reduced failure rate. METHODS Forty-two patients (mean age, fifty-eight years) with a massive irreparable posterosuperior tear of the rotator cuff were managed with a latissimus dorsi tendon transfer. Sharp separation of the latissimus tendon from the humerus was performed in twenty-two patients (Group A), whereas the tendon harvest was carried out with a modified technique that involved removal of some bone along with the tendon at the humeral insertion in a subsequent group of twenty patients (Group B). The mean duration of follow-up was forty-seven months. Outcome measures included the Constant and American Shoulder and Elbow Surgeons (ASES) scores and a patient subjective satisfaction scale. Standard radiographs were made to determine the stage of osteoarthritis and proximal migration of the humeral head, and magnetic resonance imaging was performed to assess the integrity of the transferred muscle. RESULTS In Group A, the mean Constant score improved from 43.4 preoperatively to 64.8 points at the time of follow-up and the mean ASES score improved from 49.3 to 69.6 points (p < 0.05). In Group B, the mean Constant score increased from 40.2 to 74.2 points and the mean ASES score, from 47.2 to 77.1 points (p < 0.05). The Constant pain score improved from 5.6 to 11.9 points in Group A and from 5.2 to 13.8 points in Group B. The results in Group B were significantly superior to those in Group A (p < 0.05). Magnetic resonance imaging revealed complete rupture at the tendon insertion with tendon retraction in four patients in Group A and none in Group B. The final outcome was rated as poor in 27% of the patients in Group A and in 10% in Group B. CONCLUSIONS Latissimus dorsi tendon transfer achieves satisfactory clinical results in most patients who have a massive irreparable posterosuperior tear of the rotator cuff. Harvesting the tendon along with a small piece of bone enables direct bone-to-bone transosseous fixation, resulting in better tendon integrity and clinical results.
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Affiliation(s)
- Mark Tauber
- Department of Traumatology and Sports Injuries, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020 Salzburg, Austria.
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Moursy M, Forstner R, Koller H, Resch H, Tauber M. Latissimus dorsi tendon transfer for irreparable rotator cuff tears: a modified technique to improve tendon transfer integrity. J Bone Joint Surg Am 2009; 91:1924-31. [PMID: 19651951 DOI: 10.2106/jbjs.h.00515] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Latissimus dorsi tendon transfer is a well-established method for the treatment of massive irreparable posterosuperior defects of the rotator cuff. Subsequent rupture of the transferred tendon may contribute to the rate of failure of the index procedure. We hypothesized that modification of our technique of tendon harvesting would lead to greater fixation stability and a reduced failure rate. METHODS Forty-two patients (mean age, fifty-eight years) with a massive irreparable posterosuperior tear of the rotator cuff were managed with a latissimus dorsi tendon transfer. Sharp separation of the latissimus tendon from the humerus was performed in twenty-two patients (Group A), whereas the tendon harvest was carried out with a modified technique that involved removal of some bone along with the tendon at the humeral insertion in a subsequent group of twenty patients (Group B). The mean duration of follow-up was forty-seven months. Outcome measures included the Constant and American Shoulder and Elbow Surgeons (ASES) scores and a patient subjective satisfaction scale. Standard radiographs were made to determine the stage of osteoarthritis and proximal migration of the humeral head, and magnetic resonance imaging was performed to assess the integrity of the transferred muscle. RESULTS In Group A, the mean Constant score improved from 43.4 preoperatively to 64.8 points at the time of follow-up and the mean ASES score improved from 49.3 to 69.6 points (p < 0.05). In Group B, the mean Constant score increased from 40.2 to 74.2 points and the mean ASES score, from 47.2 to 77.1 points (p < 0.05). The Constant pain score improved from 5.6 to 11.9 points in Group A and from 5.2 to 13.8 points in Group B. The results in Group B were significantly superior to those in Group A (p < 0.05). Magnetic resonance imaging revealed complete rupture at the tendon insertion with tendon retraction in four patients in Group A and none in Group B. The final outcome was rated as poor in 27% of the patients in Group A and in 10% in Group B. CONCLUSIONS Latissimus dorsi tendon transfer achieves satisfactory clinical results in most patients who have a massive irreparable posterosuperior tear of the rotator cuff. Harvesting the tendon along with a small piece of bone enables direct bone-to-bone transosseous fixation, resulting in better tendon integrity and clinical results.
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Affiliation(s)
- Mohamed Moursy
- Department of Traumatology, University Hospital of Salzburg, Muellner Hauptstrasse 48, 5020 Salzburg, Austria
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Tauber M, Moursy M, Eppel M, Koller H, Resch H. Arthroscopic screw fixation of large anterior glenoid fractures. Knee Surg Sports Traumatol Arthrosc 2008; 16:326-32. [PMID: 18000651 DOI: 10.1007/s00167-007-0437-2] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2007] [Accepted: 10/11/2007] [Indexed: 01/17/2023]
Abstract
Ten patients after traumatic shoulder dislocation with resulting instability due to an acute anterior glenoid fracture involving at least 21 percent of the glenoid length were treated by arthroscopic screw fixation of the fragment. The average fragment size measured 26.2% of the glenoid length. Pre- and postoperative radiographic evaluations were performed with three-dimensional CT scans. A cannulated titanium screw system was used for fragment fixation. All ten patients were followed up radiographically and, by evaluation of the Rowe score, clinically after a minimum of 2 years. At follow-up the Rowe score averaged 94 points. According to the rating scale, seven patients had an excellent result, two patients a good result, and one, fair result. In all patients CT scan confirmed that the fracture had healed in an anatomical position. One patient had one episode of traumatic redislocation with a positive apprehension test at follow up. In one case, removal of the screw was necessary due to mechanical impingement. We recommend this arthroscopic technique allowing for closed reduction and internal screw fixation of large anterior glenoid fractures, ensuring anatomical fracture healing and gleno-humeral joint stability.
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Affiliation(s)
- Mark Tauber
- Department of Traumatology and Sports Injuries, University Hospital of Salzburg, Muellner Hauptstrasse 48, 5020 Salzburg, Austria.
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