Purpose: Surgeons used minimal clinically important differences (MCID) to interrogate outcomes using patient-reported outcomes(PROMs) to determine whether a patient can achieve clinical benefit following orthopedic surgeries. This study aimed to investigate the association between achieving MCID and patient-reported satisfaction after ASCR. Methods: Patients with ≥2-year follow-up and receiving questionnaires were included. Patient-reported outcome measures were collected pre and postoperatively, including VAS, ASES, and SANE scores. MCID were determined using the anchor-based method. Patient-reported satisfaction was evaluated with the following question: “Are you satisfied with your superior capsular reconstruction surgery?” [Yes/No]. The association between achieving MCID and patient-reported satisfaction was evaluated.
Results: All three scores had acceptable areas under the curve values for MCID. Patients achieving MCID for patient-reported outcome measures had significantly greater improvement levels in clinical outcomes than their counterparts, except for the VAS score that demonstrated no difference between patients achieving and not achieving the MCID for SANE score. Achieving MCID for PROMs was associated with a significantly higher proportion of patients feeling satisfied with the outcomes than the group failing to achieve the MCID. However, the percentages of patients who failed to achieve MCID for pain VAS, ASES, and SANE scores feel satisfied at 63.3%, 54.5%, 59.1%, and 43.8%, respectively.
Conclusion: Achieving MCID thresholds on the VAS, ASES, and SANE scores was predictive of patient-reported satisfaction after ASCR two years postoperatively.
However, half of the patients who failed to achieve MCID were still satisfied, regardless of clinical outcome improvements.

Introduction: Regaining normal range of joint movement is the second most important goal following the aim of union of any intra-articular fracture. This is only achieved by reestablishment of joint line via adequate exposure; i.e., wide tissue dissection and/or osteotomy. The complexity of regional elbow anatomy and multifragmentary fracture patten made the exposure challenging and the procedure demanding (by dissection and multiple hardware insertion), then adversely affect joint function. There are many approaches for distal intra-articular humerus fractures: triceps-splitting (very limited articular visualization), triceps-reflecting, triceps-reflecting anconeus pedicle (though entire extensor mechanism reflection; limited exposure, triceps weakness and/or avulsion) and trans-olecranon osteotomy (maximum visualization on fracture fragments with a minimal consequence on extensor mechanism). Method: From 2015 to 2023 prospectively 18 patients (14 male and 4 female) aged (17-62 years) with type B&C AO/OTA distal humerus Fracture. All fractures approached posteriorly via olecranon osteotomy after isolation and taping of ulnar nerve. The fractures fixed with double column anatomical plates. Active Elbow movement started immediately post operatively, followed by intense course of physiotherapy. Results: All fractures get union within 12-14 weeks with full range of elbow movement apart of one case of 5 degrees limitation of full extension. There was no major complication like nonunion (at fracture and osteotomy), infection or stiffness. Conclusion: Though it is demanding and associated manageable complication(s), Trans-olecranon osteotomy approach ensures maximum exposure with a minimal effect on extensor mechanism, resulted in adequate fixation and proper union and hence normal range of elbow movement.

Introduction
Elbow Arthroscopy is a high stakes procedure due to numerous neurovascular structures surrounding the surgical site. Multiple portal locations have been described in the literature, but no single approach has been accepted as the standard. The purpose of this study is to define a novel approach to placement of an anterior portal for elbow arthroscopy that is normalized to each individual patient. Our proposed location for portal placement is the transepicondylar distance (TED) distal to the midpoint of the transepicondylar line (TEL).
Methods
Using our proposed method of portal placement, portals were placed in 43 cadaver arms. The cadavers were subsequently dissected and the distance of the portal from essential neurovascular structures was measured.
Results
The transepicondylar distances of the cadaver elbows used in this study averaged 63.45 mm with a standard deviation of 5.88 mm. The range of the transepicondylar distances was 23 mm. The portal placement averaged 2.77 ± 2.79 mm from the lateral cutaneous nerve, 7.17 ± 3.16 mm from the radial nerve (RN), and 14.5 ± 9.00 mm to the radial artery.
Discussion/Conclusion
In conclusion, this novel method for placement of an anterior portal offers access to the radial tuberosity, radial head, coronoid, anterior capsule, and the brachialis insertion while consistently avoiding all neurovascular structures other than the lateral cutaneous nerve. Care should be taken when making the portal due to the locality of the lateral cutaneous nerve branches, with in-line blunt spreading dissections substituted for sharp dissections.

Background: This study compared clinical, biomechanical and radiological outcomes in Latarjet vs alternative bone block (ABB) procedures in adult patients experiencing recurrent traumatic anterior shoulder instability or in cadavers in order to evaluate the effectiveness of the sling effect. Methods: PubMed, Embase and Medline databases were searched on February 22nd, 2024. Only comparative studies were selected. We assessed studies using RoB 2.0, ROBINS-I, and QUACS tools. Results: Twenty studies met the inclusion criteria. 7 studies (545 patients, mean age 27.4 years, mean follow-up 37.9 months) underwent meta-analysis, including 3 retrospective, 3 prospective cohort studies, and 1 randomised controlled trial, while 13 studies were synthesised narratively, including 7 biomechanical and 6 anatomic studies. The meta-analysis showed no significant differences in PROMs (WOSI, Rowe, VAS, SSV) between Latarjet and ABB. For ROM, only abduction favoured Latarjet (157.8° vs 146.5°; SMD: 0.47; 95% CI: 0.19-0.74; P=.03; 2 studies, 150 patients), with no significant differences in other measures. Rates of adverse events and recurrence showed no significant differences, although Latarjet had a higher, nonsignificant reoperation rate (7.04% vs 3.87%; RR: 1.51; 95% CI: 0.86-2.67; P=.11; 5 studies, 380 patients). Studies assessing area restoration, contact pressure, peak force, and translation reported conflicting data or no significant difference between procedures. Conclusion: The limitations of our meta-analysis include high heterogeneity and risk of bias of studies. There was no clear clinical benefit from the sling effect of Latarjet, indicating that ABB procedures could be a viable and safe alternative whilst preserving the native coracoid process. PROSPERO CRD42024517955.

Background: Our aim was to determine an expression timeline of various collagens in contracted post-traumatic elbow joint capsules, from the initial trauma.
Hypothesis: We hypothesized that several collagens are expressed in response to capsular injury, in addition to the well documented collagen types I and III.
Methods: We surgically excised the anterior capsules of 7 post-traumatically injured and stiff patients’ elbow joints, recalcitrant to conservative management, in order to improve their range of motion. These excised capsules were immediately preserved in dry ice and underwent basic histological and more detailed western blot analysis for collagen sub-type analysis.
Results: The results indicated that type I and type III collagen levels, as well as lesser collagens II, V, VI and X, were detected at differing levels in all patients. The amalgamated data of all the specimens showed a maximum expression of collagens between 3 and 7 months from the traumatic event. After 4 months post-trauma, the levels of collagen type II, V and X were consistently less than collagen VI. Collagen VI showed consistent expression throughout the time from injury (1 to 18 months). There was a relative down-regulation of collagen II, V, and X, which progresses as the time from elbow trauma increases.
Conclusions: Our study demonstrates a complex time-dependent expression of various collagens from the time of elbow injury. This data may be useful for understanding an elbow contracture at the molecular level, and for future work into the complex interplay between collagen subtypes.

Objectives: To explore the clinical efficacy of reconstruction plate combined with cannulated screw for the scapular fractures through the glenoid.
Methods: From October 2021 to May 2023. 21 patients with scapular fractures through the glenoid were treated in our department.They were 16 males and 5 females. 28 to 53 years of age (mean,37.5 years). All the patients were treated through Judet approach, using reconstruction plate and cannulated screw to fix fracture. The shoulder function was evaluated at the last follow-up by Hardegger evaluation standard.
Results: 21 patients were followed up for 9 to 18 months (average,12.8 months). All the 21 patients obtained bony union after 6 to 18 weeks(average,14.8 weeks). At the last follow-up,the shoulder abduction from 80°~180°(average,158°). According to Hardegger evaluation standard,17 patients were excellent,2 good,1 fair,and 1 poor.The excellent to good rate was 85.7%. None of the patients had deep wound infection and nerve vascular injury, One patients appeared shoulder stiffness.
Conclusions:Reconstruction plate combined with cannulated screw is an effective method to treat scapular fractures through the glenoid. It can reduce and fix the fracture effectively and can avoid nerve vascular injury. It has satisfactory clinical effect.
Keywords: Scapular; Fractures; Internal fixation; Reconstruction plate; Cannulated screw

Introduction: Scapular fractures are relatively uncommon (less than 1% of all fractures). Scapula has a special biological and mechanical environment that impact the displacement and stability of the fracture and that is why most are treated non-operatively. The outcome of scapula fractures is less favourable in polytrauma patients, due to higher fracture complexity. Indications for surgery are intra-articular displacement greater than 5mm, “displaced floating shoulder”, glenopolar angle<20º and intra-articular involvement greater than 20%. Methods: Clinical case of a 28 yo male who made a suicide attempt resulting in polytrauma. He suffered a left sacral, left femoral neck, right femur shaft and an explosive spine (multifragmentary glenoid fossa) fractures. Sacral and both femur were stabilized in the same day. Spine fracture only when stable – 2w later.
Results: For spine fracture treatment we made a double approach. First in lateral decubitus we performed a classic Judet approach, reducing the medial and lateral borders and the posteroinferior part of glenoid with specific plates. Secondly, we made a deltopectoral approach and reduced the other glenoide fragment with screws. Discussion: The timing of shoulder surgery in polytrauma patients is always determined by emergent situations that should be treated first, sometimes leading to surgery out of the ideal timing. The complexity of glenoid fractures, associated with extra-articular scapula fractures demand a double approach, as in our case. Conclusion: Complex scapula fractures, especially in polytrauma, are still a great challenge and the decision of going to surgery, the approaches and type of fixation should be individualized.

Background: Proximal humeral fractures are the third commonest fracture in the elderly population and these fractures can be complex and challenging to manage. In recent years, reverse shoulder arthroplasties (RSA) have been increasingly performed to treat these fractures. Traditionally, prosthesis fixation using methylmethacrylate cement has been the gold standard. However, uncemented fixation has been gaining popularity in the field of shoulder arthroplasty as it presents with many advantages. Objectives: At present, only few comparative studies are available in the current literature between uncemented and cemented RSA. This study aims to address this existing literature gap. Study Design: Case series. Level of evidence: 4. Methods: Data for a consecutive series of patients who underwent RSA between 2016-2023 from two hospital sites was collected retrospectively. The operative indications, outcomes and post-operative images was reviewed and collected using electronic records and PACS systems. Results: Clinical and radiological follow-up was obtained for all 59 patients. The mean age for this patient cohort was 75 years (range, 54–91 years). The median operating time was 2 hours 36 minutes. At 1-year post-surgery, the median Oxford Shoulder Scores for this cohort was 45/48. Patients were very pleased with the surgical results and have good post-operative functional outcomes. All patients had satisfactory post-operative radiological findings with satisfactory tuberosities healing and no humeral periprosthetic fractures/dislocation identified. Conclusion: Our study revealed a superiority in clinical outcomes of uncemented fixation in comparison to the documented literature results of cemented RSA, suggesting uncemented RSA as a good treatment option for traumatic PHFs.

Introduction: Distal biceps tendon (DBT) rupture is not one of the most common upper limb injuries. Surgical intervention is recommended for these injuries to restore muscular strength and functionality. Multiple different techniques are documented in the literature, however there is no definitive consensus on the most effective surgical treatment. The objective of this study was to assess the functional results of patients who underwent repair of DBT utilising cortical button fixation procedures. Methods: This study is a retrospective single-unit case series consisting of 54 patients who underwent DBT repair at Heartlands Hospital in Birmingham, United Kingdom. The patients' functional outcome was assessed by the Mayo Elbow Performance Score (MEPS). Results: The mean age was 51±11.01 years. Patients were operated 4.72±7.083 days after the injury. The mean pain Visual Analogue Scale (VAS) 6 months after the surgery was 0.54±0.50. At 6 months follow-up, the average extension deficit was 2.69° (0-10), flexion 132° (120-140), supination76° (50- 85) and 77° for pronation (78-95). Patients were followed up routinely for 6 months. Mayo Elbow Performance (MEP) Score was utilised to assess the functional outcome and the mean MEP score was 91.43±8.26 which showed excellent functional outcomes for the cohort. Conclusion: The functional results of the DBT repair with cortical button fixation are very favourable 6 months postoperatively. The surgical treatment has achieved restoration of supination strength.

The role of subscapularis does not yet have a well-defined role in RSA.The purpose of the present study was to evaluate if the repair of the Ssc in RSA improves overall clinical and radiographic results and if it has the same results using a medialized design humeral stem compared to a lateralized design.84 patients undergoing RSA were retrospectively analyzed. Patients were divided into four groups for data analysis depending on whether they had received a medialized or lateralized design and Ssc repair or not.Patients were reviewed at an average follow-up of40.8±13.1months.Clinical outcome measures includedROM,strength,VAS,Constant-Murley andASES.Radiographic evaluation at final follow-up was performed.No statistically significant clinical differences(p > 0.05)emerged between Lat/Ssc+ and Lat/Ssc-.Conversely,the patients belonging to the Med/Ssc- group reported statistically worse(p<0.05)results than the Med/Ssc+group in terms ofVAS,ASESandCMS.Statistically worse(p < .05)results in the Med/Ssc- group than in the Med/Ssc+were found also in active ROM in FE,ABD,ER1 andER2, and in the strength in FE,ABD and ER2.Scapular notching was reported in 3 shoulders(15.7%)in Lat/Ssc+ group and in 7 shoulders in Lat/Ssc- group,while it was reported in 4 shoulders in Med/Ssc+group and in6shoulders in Med/Ssc-group.Stress shielding was observed in6cases in Lat/Ssc+group, in8cases in Lat/Ssc- group,in3cases in Med/Ssc+group and4cases in Med/Ssc- group.Patients undergoing RSA show clinical improvements at mid-term follow-up with a low rate of complications, regardless of the use of a medialized or a lateralized humeral stem design.Ssc repair is associated with better outcomes in the cohort of medialized stem, while it did not yield significant differences in the cohort of lateralized stem.

Background Ulnar coronoid process fracture is usually caused by high-energy injury of the elbow joint bone structure and ligament structure of the complex injury. The loop plate technique was used to treat ulnar coronoid process fracture in our hospital and achieved good results.
Objectives The aim of this study is to investigate the efficacy of modified loop plate technique combined with Nice knot technique in the treatment of ulna coronoid process fractures, and to provide a better choice for the treatment of ulna coronoid process fractures.
Design and Methods Methods From June 2020 to June 2023, 45 patients with ulnar coronoid process fracture were treated in our department. Among them, 22 patients were treated with modified loop plate technique and Nice knot technique for ulnar coronoid process fracture with traditional loop plate technique, and 23 patients were treated with traditional loop plate technique for ulnar coronoid process fracture. The postoperative elbow flexion and extension, rotation range of motion, Mayo elbow function score were analyzed. P value was set at <0.05.
Results There were no significant differences in operation time, length of hospital stay, total treatment time, intraoperative blood loss, pain management, fracture healing time, and range of motion between the two groups. the clinical efficacy and functional recovery of the two surgical methods are basically the same.
Conclusion This study shows that the modified loop plate technique plus Nice knot technique has the same effect as the traditional loop plate technique in the treatment of ulnar coronoid process fractures.

Background: Distal biceps brachii tendon rupture, often resulting from sports activities, significantly impacts elbow flexion and forearm supination strength. Surgical reconstruction using various fixation methods, notably suture button fixation with or without an interference screw, is commonly preferred due to poor tolerance of the injury by patients.

Objectives: This study evaluates the outcomes of distal biceps tendon repair using suture button fixation alone versus a combination with an interference screw, focusing on the potential benefits or risks associated with the additional fixation.

Methods: A retrospective review of 44 patients who underwent surgical repair for distal biceps tendon rupture at our institution, utilizing either suture button fixation alone or combined with an interference screw. All procedures were performed using an anterior single-incision approach. Patients adhered to a standardized rehabilitation protocol. Outcomes measured included the Quick Disability of Arm, Shoulder, and Hand Score (Q-DASH), Mayo Elbow Performance Score(MEPS), Visual Analogue Pain Score(VAS), and rates of complications, re-ruptures, and patient satisfaction.

Results: Most patients were male, with the dominant arm predominantly affected. Functional outcomes, as measured by Q-DASH, MEPS, and VAS, showed no significant differences between the two fixation techniques. The primary complication observed was paraesthesia of the lateral antebrachial cutaneous nerve. No infections or significant re-ruptures were reported.

Conclusions: Distal biceps tendon repair using either suture button fixation alone or in combination with an interference screw yields similar functional outcomes. The addition of an interference screw to suture button fixation does not appear to enhance surgical results and may be considered unnecessary.