Instability and results after non-operative treatment of large anterior glenoid rim fractures
Notice bibliographique
Résumé
\(\bf Introduction\) There is little data available on non-operative treatment of anterior glenoid rim fractures (GRF). Nothing is known about fracture size and displacement in comparison to clinical outcomes and instability in a mainly middle-aged patient population. The aim of this study was to demonstrate the results of non-operative treatment in anterior glenoid rim fractures with the special focus on potential instability/recurrence. \(\bf Methods\) The inclusion criteria were non-operatively treated anterior GRF of at least \(\geq\) 5 mm width using the age- and gender-matched Constant/Murley score (a.-/g.-CMS) and the Western Ontario Instability Index (WOSI). Radiographic parameters (fracture morphology, displacement, major tuberosity fractures and Hill–Sachs lesion using initial CT and radiographs) and the proportion of the fractured glenoid were detected (2D-CT-circle-method) and osteoarthritis (A.P. and axial radiographs) was classified according to Samilson/Prieto. Proportion of fractured glenoid and medial displacement were correlated with the recurrence rate and the clinical scores. \(\bf Results\) \(\it N\) = 36 patients could be followed-up after a mean of 4.4 years [12–140 month, average age: 58 (\(\pm\) 13, 33–86) years]. The a.-/g.-CMS was 93 (\(\pm\) 11, 61–100) points, and the WOSI was 81% (\(\pm\) 22%, 35–100%) on average. The mean intraarticular displacement was 4 mm (\(\pm\) 3 mm; 0–14 mm). The 2D-circle-method showed a mean glenoid fracture involvement of 21% (\(\pm\) 11, 10–52%). Two cases of frozen shoulders and one case with biceps pathology were associated with the trauma. Within the followed-up patient group re-instability has occurred in \(\it n\) = 2 patients (6%) within the first two weeks after trauma. Osteoarthritis was found in \(\it n\) = 11 cases. There was no correlation between the scores and the fracture size/displacement [(a.-/g.-CMS vs. displacement: \(\it r\) = − 0.08; \(\it p\) = 0.6; vs. size: \(\it r\) = − 0.29; \(\it p\) = 0.2); (WOSI vs. displacement: \(\it r\) = − 0.14; \(\it p\) = 0.4; vs. size: \(\it r\) = − 0.37; \(\it p\) = 0.06)], but very large (\(\geq\) 21%) fractures with displacement \(\geq\) 4 mm showed slightly worse results without significant difference (a.-/g.-CMS \(\it p\) = 0.2; WOSI \(\it p\) = 0.2). The apprehension test was negative in all patients at final follow-up. \(\bf Conclusion\) Non-operative treatment of anterior GRF was associated with overall good results within a mainly middle-aged larger patient group. Re-instability is rare and is not associated with fragment size but can occur in the first weeks after trauma. Size and dislocation of the fracture is not a criterion for the prognosis of potential instability. \(\textbf {Level of evidence}\) Level IV, retrospective case series.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».