Nonunion and avascular necrosis (AVN) are frequent complications of scaphoid fractures. We describe the operative technique and long-term results of treatment with pedicle vascularized bone grafts (VBGs) of the distal radius in patients with scaphoid fractures in whom nonunion and AVN developed. During a 4-year period (1997-2000), VBGs pedicled on either the first and second or second and third compartments of the supraretinacular artery of the distal radius were in our hospital used to treat 11 patients with symptomatic scaphoid nonunion involving AVN of the proximal fragment (one with perilunate transscaphoid fracture dislocation and 10 with displaced scaphoid fractures with nonunion). Nine of these 11 patients received fixation with divergent K-wires fixation and two received Herbert screws fixation. Osseous union was achieved in all 11 patients treated with VBGs within an average period of 13 weeks. Functional results of treatment, which were measured using the modified Mayo Wrist Score, were encouraging in all patients in this series (four excellent, six good, and one fair). The deformity of ununited scaphoid was well corrected. The index study suggests that this treatment can be used not only to revascularize necrotic scaphoid, but also to correct humpback deformity and the resulting carpal instability.

The purposes of this study were to investigate the long-term outcomes of radial head replacement and to analyze the relationship between functional outcomes and periprosthetic radiolucency. We retrospectively reviewed 32 patients who underwent unilateral radial head replacement between 2004 and 2011. Data on patient characteristics including age, gender, injury complexity, associated trauma, injury chronicity, and number of surgeries were collected and analyzed. Of these patients, 14 had terrible triad injury, 14 valgus-type injuries, 3 Monteggia fracture, and 1 concomitant distal humerus fracture. Clinical survey was performed at 7 to 15 years after replacement surgery. The Mayo Elbow Performance Score (MEPS) and shortened Disabilities of the Arm, Shoulder, and Hand (quickDASH) score were used for functional evaluation. Residual elbow or forearm pain was evaluated using visual analog scale (VAS). Radiographs were reviewed by orthopedic and radiologic specialists, and periprosthetic radiolucency was measured based on the diameter of radial head prosthesis. The 32 patients returned for follow-up at an average of 8.94 years. None underwent prosthesis revision or removal. MEPS averaged 83.4; good or excellent results were achieved in 26 patients. QuickDASH scores averaged 11.7. Significantly better MEPS (p = 0.023) and quickDASH scores (p = 0.026) were noted when replacement surgery served as the primary surgery instead of late salvage. VAS scores averaged 1.25, with residual pain noted in 24 elbows (75%). Periprosthetic radiolucency was noted in 21 patients (66%) with a mean thickness of 3.53 mm. The difference in functional outcomes was not significant between patients with and without radiolucency, with p values of 0.127 for MEPS and 0.135 for quickDASH scores. Spearman correlation analysis showed low correlation between the measured width of radiolucency and VAS scores (r = 0.143). Sustained, encouraging clinical outcomes were reported in the present study. Although periprosthetic radiolucency did not correlate with functional or pain scores, surgical optimization and meticulous survey were warranted.

The role of surgical fixation of ulnar styloid fractures remains a subject of debate. The purpose of this study was to compare the surgical outcomes following early and late intervention. We retrospectively reviewed 28 patients who underwent surgical repair for unilateral ulnar styloid fractures with distal radioulnar instability between 2004 and 2014. Surgical fixation was performed within 3 months of injury in 13 patients (group A) and beyond 3 months in 15 patients (group B). Patient characteristics and functional outcomes were compared between the two groups. The outcome survey consisted of QuickDASH score, grip strength, range of motion, pain score based on the visual analog scale, and surgical complications. Descriptive statistics were calculated for key variables. A p value of < 0.01 was considered statistically significant. Patient characteristics including age, sex, injured side, dominant side injury, and concomitant distal radius fracture showed no significant differences between the two groups. Time to surgery averaged 1.1 months in group A and 12.3 months in group B. Significantly better outcomes were found in group A than in group B, including QuickDASH scores (4.4 ± 5.9 vs. 12.9 ± 9.9) and grip strength (37.4 ± 5.1 vs. 29.1 ± 5.9 kg). Significantly better range of motion was found in group A than in group B with respect to supination (81.9° ± 4.3° vs. 75° ± 8.5°), extension (84.6 ± 4.3 vs. 76.7 ± 6.5), and flexion (80.4° ± 3.8° vs. 72° ± 4.1°). The difference was not significant in case of pronation (78.8° ± 3° vs. 74.3° ± 5.9°) and with respect to pain scores (0.6 ± 0.7 vs. 1.3 ± 1). Both osseous and soft tissue lesions need to be fully addressed in ulnar styloid fractures. Early detection and surgical repair yielded better outcomes. Higher complication rates in late-treated fractures show that surgeons should select surgical candidates and modalities properly.

Background: The timing to start passive or active range of motion (ROM) after arthroscopic rotator cuff repair remains unclear. This systematic review and meta-analysis evaluated early versus delayed passive and active ROM protocols following arthroscopic rotator cuff repair. The aim of this study is to systematically review the literature on the outcomes of early active/passive versus delayed active/passive postoperative arthroscopic rotator cuff repair rehabilitation protocols. Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) published up to April 2022 comparing early motion (EM) versus delayed motion (DM) rehabilitation protocols after arthroscopic rotator cuff repair for partial and full-thickness tear was conducted. The primary outcome was range of motion (anterior flexion, external rotation, internal rotation, abduction) and the secondary outcomes were Constant-Murley score (CMS), Simple Shoulder Test Score (SST score) and Visual Analogue Scale (VAS). Results: Thirteen RCTs with 1,082 patients were included in this study (7 RCTs for early passive motion (EPM) vs. delayed passive motion (DPM) and 7 RCTs for early active motion (EAM) vs. delayed active motion (DAM). Anterior flexion (1.40, 95% confidence interval (CI), 0.55–2.25) and abduction (2.73, 95%CI, 0.74–4.71) were higher in the EPM group compared to DPM. Similarly, EAM showed superiority in anterior flexion (1.57, 95%CI, 0.62–2.52) and external rotation (1.59, 95%CI, 0.36–2.82), compared to DAM. There was no difference between EPM and DPM for external rotation, retear rate, CMS and SST scores. There was no difference between EAM and DAM for retear rate, abduction, CMS and VAS. Conclusion: EAM and EPM were both associated with superior ROM compared to the DAM and DPM protocols. EAM and EPM were both safe and beneficial to improve ROM after arthroscopic surgery for the patients with small to large sized tears.

This study aimed to report the radiographic findings and surgical outcomes of anteromedial facet (AMF) fracture of the ulnar coronoid process and to suggest an optimal approach. In this retrospective study, 20 consecutive patients with unilateral AMF fracture of coronoid process were surgically treated and divided into two groups without (group A) and with (group B) additional proximal ulnar fractures in equal case number. Time from injury to surgery averaged 4.38 ± 2.56 weeks. Mayo Elbow Performance Score (MEPS) and Shortened Disability of the Arm and Shoulder and Hand (quickDASH) score were used for functional evaluation. Cohen kappa coefficient (kappa) analysis was used to determine interobserver reliability on a radiographic reading. All cases had a mean follow-up of 2.3 years. MEPS at 2 years averaged 87.75 ± 12.51; quickDASH, 7.05 ± 6.19. A significantly higher MEPS was found in subtype 3 than in subtype 2 (p = 0.036) and in group B than in group A (p = 0.020). Significantly lower quickDASH cores were found in group B than in group A (p = 0.011). Kappa analysis showed moderate agreement in the O’Driscoll classification (kappa = 0.56) and substantial agreement in categorization of the additional proximal ulnar fractures (kappa = 0.76). Additional proximal ulnar lesions were considered an integral part of varus posteromedial rotatory instability and required further categorization in the management of AMF fractures. Significantly better functional outcomes were achieved when those lesions were fully addressed.