Top PDF Three lateral divergent pinning for displaced supracondylar humerus fractures in children

Three lateral divergent pinning for displaced supracondylar humerus fractures in children

Three lateral divergent pinning for displaced supracondylar humerus fractures in children

by an assistant. Three Kirschner wires (1.5 to 2 mm) were then inserted from the lateral side. The pin size was subjectively chosen by the surgeon on the basis of the patient’s age and size. The K-wires were placed in a divergent manner as possible to stabilize medial and lateral columns. Fracture stability was assessed on image intensifier by screening the fracture under varus/ valgus and flexion/extension stresses. The wires were then bent and cut outside the skin, well padded. The limb was immobilized in an above-elbow slab with the elbow at 60 to 90 degrees. All patients were observed in ward for 24 to 48 hours before discharge.
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Original Article Comparison of Kirschner wires and Orthofix external fixator for displaced supracondylar humerus fractures in children

Original Article Comparison of Kirschner wires and Orthofix external fixator for displaced supracondylar humerus fractures in children

Abstract: Objective: Closed reduction and percutaneous fixation is known as the optional treatment for displaced supracondylar humerus fractures. The retrospective study is to compare external fixator versus K-wires to evaluate the clinical and radiological results for displaced supracondylar humerus fractures. Methods: Among all of 40 pa- tients, there were 16 girls and 24 boys with the mean age of 7.26 years (range from 4 to 13 years). Closed reduction followed by percutaneous fixation of external fixator or K-wires were performed in our department. Medical records were reviewed to obtain demographic information as well as preoperative and postoperative clinical and radiologi- cal data regarding fracture type, displacement of fracture, neurovascular status, range of motion and infections. The Flynn’s criteria et al. was used to evaluate the clinical outcomes. Results: There was no significant different in age, gender, affected sides, the type and displacement of fracture and nerve palsy between two group (P>0.05). According to the Flynn’s criteria et al., two groups showed the similar to clinical outcome (P>0.05). Two (13.3%) children presented skin infection around screws, while five (20%) patients presented skin infection in K-wires, in which four (80%) patients develop the migration of K-wires. There was significant different in skin infection between two groups. Three (12%) patients presented ulnar nerve palsy in K-wires, while one (6.7%) patient presented radial nerve palsy in external fixator. Conclusion: The percutaneous K-wires or external fixator fixation following closed reduction is an effective method in the treatment of displaced supracondylar fractures of humerus. K-wires have the risk of ulnar nerve palsy and skin infection or the migration of wires. External fixator could facilitate to reduce the fracture by the direct manipulation of external fixing frame and provide the stabilization of fracture without the neurological risk to ulnar nerve.
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CROSSED PINNING VERSUS TWO LATERAL WIRES IN THE MANAGEMENT OF DISPLACED SUPRACONDYLAR HUMERUS FRACTURES IN CHILDREN

CROSSED PINNING VERSUS TWO LATERAL WIRES IN THE MANAGEMENT OF DISPLACED SUPRACONDYLAR HUMERUS FRACTURES IN CHILDREN

series of 375 patients by Lyons JP et al., they observed that 6% of the patients had an iatrogenic ulnar nerve palsy postoperatively [18]. They also stated that these are usually neuropraxia which resolves almost completely in majority of the situations. There were 25 cases in Group B in the present study, who had ulnar nerve neuropraxia postoperatively and who recovered completely within three weeks of surgery. The incidence of neuropraxia can be reduced by keeping the elbow in 45-50 degrees of flexion rather than the usual hyperflexed position used while inserting the lateral pin. No pin removal was required in the present study for the neuropraxia. In all the patients where cross pinning was executed, a mini- open approach was used, the ulnar nerve was palpated and the K-wire was introduced with the elbow in semi- extended position.
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Review Article Open or closed reduction and percutaneous pinning for pediatric displaced supracondylar humerus fractures: a meta-analysis and system review

Review Article Open or closed reduction and percutaneous pinning for pediatric displaced supracondylar humerus fractures: a meta-analysis and system review

Nowadays, the preferred approach on the tre- atment of displaced pediatric SHF is closed reduction and percutaneous pinning; then in- ternal fixation following an open reduction will be preferred, if not possible [25]. Controversy exists regarding treatment strategies of SHF in Children between CRPP and ORPP, especially for the extra-articular and intra-articular frac- ture. Someone believed that even displaced intra-articular fractures can be treated with CRPP, while others recommend that ORPP is the best choice [26, 27]. The treatment of OR- PP for extra-articular fractures was associ- ated with poorer outcomes when compared with CRPP, while the patients with intra-articu- lar fracture preferred ORPP. Current studies showed that the number of patients adopting ORPP for failed closed treatment increases rap- idly [19]. The data shows that the patients of successful closed reduction and percutaneous fixation of intra-articular fractures in skeletally mature adolescents does not own higher com- plication rate, such as nerve injuries, pin tract infection and cubitus varus [28]. Moreover, a concern about open reduction is prolongation of anesthesia, soft-tissue injury and radiation exposure through the repetitive closed reduc- tion efforts. An obvious disadvantage of percu- taneous pinning is the reduction loss, which may result in deformity and bone union. The choice of the best treatment for SHF in Children depends on variation in skeletal maturity and patient size relative to age as well as the varia- tion in injury characteristics [19]. The surgeon should take several points into consideration, including the best balance of accurate reduc- tion, stable fixation, and minimal iatrogenic injury. The treatment of ORPP can also be used for the open fracture which was associated with vascular or nerve injury, or functional re- duction cannot be ensured by CRPP. An study reported that the rate of case, who had to pre- ferred open reduction for their first choices for SHF, is no more than 46% [29].
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Comparision of functional outcome between traditional and lateral crossed pinning in supra condylar humerus fractures of children

Comparision of functional outcome between traditional and lateral crossed pinning in supra condylar humerus fractures of children

Although closed reduction and percutaneous pinning stabilization is the current gold standard in managing displaced supracondylar fractures of the humerus in children, there is still controversy on the pin configuration of K-wires based on fracture stability biomechanics and ulnar nerve safety. In this series, a modified cross wiring technique, performed from the lateral side only ,was studied. In the present study, using Flynn’s score [9] , 80 % of the patients achieved a satisfactory outcome and 4 patients (20%) achieved unsatisfactory result (loss of range of movement).
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Comparision of functional and cosmetic outcome of supracondylar fractures in children treated by percutaneous pinning and open reduction and internal fixation with K-wires

Comparision of functional and cosmetic outcome of supracondylar fractures in children treated by percutaneous pinning and open reduction and internal fixation with K-wires

From the structural and functional stand points the distal humerus is divided into separate medial and lateral components each containing an articular and non-articulating portion. Included in the non-articulating portion are the epicondyle which are the terminal points of the supracondylar ridges. The lateral epicondyle contains a roughened anterolateral surface from which the superficial forearm extensor muscles arise. The medial epicondyle is larger than the lateral counter part and serves as the origin of forearm flexor muscles.
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A comparative study of two percutaneous pinning techniques (lateral vs medial–lateral) for Gartland type III pediatric supracondylar fracture of the humerus

A comparative study of two percutaneous pinning techniques (lateral vs medial–lateral) for Gartland type III pediatric supracondylar fracture of the humerus

applying a valgus or varus force at the fracture site. The posterior displacement of the distal fragment was then corrected by applying a force to the posterior aspect while the elbow was gently hyperflexed and the elbow was secured in hyperflexion, and the reduction was confirmed by the image intensifier. The medial pin was placed directly through the apex of the medial epicondyle. The lateral pin was placed at the center of the lateral epi- condyle. For the lateral fixation technique, two or three pins were inserted from the lateral aspect of elbow across the lateral cortex to engage the medial cortex keeping the elbow in hyperflexion. Pins were placed either in parallel or divergent configuration with adequate separation at the fracture site. For the medial-lateral fixation technique, first the lateral pin was inserted from lateral cortex to engage the medial cortex keeping the elbow in hyperflexion. The elbow was then extended to\ 90° and the ulnar nerve rolled back with the opposite thumb and the medial pin was inserted to engage the lateral cortex with the elbow in\ 90° of flexion. The pin configuration was considered to be acceptable if one pin was placed in the lateral column and another in the central or medial column. If this was not achieved, we realigned the configuration by changing the pin placement. In the coronal plane, the pins were placed at an angle of 30° with the long axis of the humerus. After the pins were placed, the elbow was extended and the carrying angle was measured and compared with that on the non- affected side. The adequacy and stability of the reduction were checked under image intensification (Figs. 2, 3). The pins were bent to prevent migration and cut off outside the skin to allow removal in the outpatient clinic.
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Management of Grossly Displaced Paediatric Supracondylar Humeral Fractures with Delayed Presentation by Closed Reduction and Percutaneous Pinning

Management of Grossly Displaced Paediatric Supracondylar Humeral Fractures with Delayed Presentation by Closed Reduction and Percutaneous Pinning

France and Strong [10] compared the various modalities of treatment of these fractures and found closed reduction and percutaneous pinning to be superior. Cheng et al [11] and Topping et al [12] compared lateral and cross k- wiring and found equivalent excellent results in both groups. The results of our study indicate that the majority of widely displaced supracondylar fractures of the humerus even with a delay in presentation of up to 6 days can be safely treated with our technique of closed reduction and percutaneous pinning with excellent clinical results. In our series, closed reduction and percutaneous pinning was possible in all our patients. The rate of conversion to open reduction in delayed presentations of these fractures has been reported in literature as ranging from less than 10% up to 36% [4, 13]. Archibeck et al [14] reported entrapment of brachialis muscle as a cause in 90% of irreducible supracondylar fractures. We did not encounter any such problems in our series.
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A two-stage retrospective analysis to determine the effect of entry point on higher exit of proximal pins in lateral pinning of supracondylar humerus fracture in children

A two-stage retrospective analysis to determine the effect of entry point on higher exit of proximal pins in lateral pinning of supracondylar humerus fracture in children

The second stage of this study started from January 2017 and ended in December 2017. Based on the findings of the first stage (see the “Results” section), two of the sur- geons (EW and LS), after placing the lower/distal lateral pins, started to insert the proximal lateral pins from lateral (pins laid in the lateral third of the ONC or lateral to the ONC) and posterior (pins laid in the posterior third of the ONC or posterior to the ONC) in hyperflexed position under Jones radiographs (Fig. 3), and intentionally aimed at exiting in zone + 1. The location and configuration of the pins were confirmed by intra-operative radiographs. When the lateral pin fixation was found to be satisfactory and stable with no distal fragment rotation, removal and reinsertion of the pins for further proximal exit or inser- tion of another new pin was avoided. Patients were then immobilized in a long arm cast in 80 to 90° flexion for a period of 4 to 5 weeks depending on the age of the patient. This group of data was collected as the intended group, while the data of the other surgeons, who continued to fix the fractures according to the regular, standard pinning protocol, were categorized as the random group. Similar demographic data, fracture characteristics, and measure- ment data were also collected and recorded as in the first stage of the study.
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Functional Outcomes In Fracture Of Supracondylar Humerus In Children Treated With Percutaneous Pinning With Cross KWiresLaxmi Narayan Meena, D.R Galfat

Functional Outcomes In Fracture Of Supracondylar Humerus In Children Treated With Percutaneous Pinning With Cross KWiresLaxmi Narayan Meena, D.R Galfat

Fracture of Supracondylar humerus is a very common injury in children. Complications associated with this fracture warrant appropriate and optimum management of this injury. Closed reduction and percutaneous pinning with medial and lateral cross K-wires offers an excellent method to reduce and fix these fractures accurately. Some biomechanical studies advocate cross pinning technique as a more stable biomechan- ical construct. Increased time from presentation to surgery is not associated with increased morbidity from the injury or treatment complications. Early mobilization is an advantage with this treatment. The use of a medial entry pin for the treatment of paediatric supracondylar humerus fractures is safe as far as iatrogenic ulnar nerve injury and vascular complications are concerned, if an adequate technique is followed. None of the patients had any vascular compromise.
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Biomechanical analysis between Orthofix® external fixator and different K-wire configurations for pediatric supracondylar humerus fractures

Biomechanical analysis between Orthofix® external fixator and different K-wire configurations for pediatric supracondylar humerus fractures

Configurations using lateral-only entry K-wires have been recommended to decrease the risk of iatrogenic injury to the ulnar nerve. Zionts et al. [15] compared the stability provided by different pin configurations and demonstrated that crossed-pin configuration provides the most stable torsional fixation, followed by the fix- ation achieved with two and three lateral pins. In our study, two crossed K-wire configuration was significantly stiffer than two lateral divergent K-wires, especially in varus and valgus direction loading. Adding a third lateral K-wire to the crossed or two lateral K-wire configuration could provide more stability in the fracture than previ- ous K-wires, but the difference was not significant in the same directions. This finding suggests that the surgeon faced with a biomechanically unstable fracture pattern or a less-than-anatomic reduction may use additional lateral K-wires to supplement biomechanical stability. In Larson et al. ’ s study [16], the three crossed-pin construct was most stable in the fracture followed by three lateral pins, and two lateral divergent pins demonstrated the least torsional stability. However, Srikumaran et al. [8] reported that gross observation suggests that the addition of a third lateral pin to the crossed configuration increased
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Management of displaced radial neck fractures in children: percutaneous pinning vs. elastic stable intramedullary nailing

Management of displaced radial neck fractures in children: percutaneous pinning vs. elastic stable intramedullary nailing

A K-wire was contoured and bent at the tip at an angle of 30–45°. Depending on the age of the child, the diameter of the pin used was 1.2–2.0 mm. The distal radial epiphysis of the radius was identified using an image intensifier and a longitudinal 0.5-cm postero-radial skin incision overlying the distal radial metaphysis was made. The soft tissue was dissected by taking care not to injure the cutaneous branch of the radial nerve. The lateral cortex was exposed and perforated using a Pfriem-type trocar and the curved flex- ible pin was inserted and pushed cranially until it reached the inferior aspect of the displaced epiphysis. At this stage, the intramedullary wire was gentle pushed so that the point fixed in the epiphysis, in order to raise it up to reposition under the lateral condyle. In order to reduce the remaining radial-lateral displacement, the wire was rotated through 180° so that the tip pointed towards the ulna, thereby forcing the fragment to shift medially and facilitating anatomical reduction of the radial head within the joint. The distal part of the pin was cut and bent, and the skin was closed. If the reduction was still not satisfactory, a K-wire was inserted percutaneously, through the fracture from the lateral side and used as a lever arm to reduce the fracture, as suggested by Bohler [15]. This association of the Metaizeau and Bohler techniques was necessary in three cases.
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Outcome of operative treatment of displaced lateral condyle fractures of the humerus in children in relation to time of presentation

Outcome of operative treatment of displaced lateral condyle fractures of the humerus in children in relation to time of presentation

most probably more active .the left more than right, this is for unknown reason, although all cases are right hand dominant, these finding similar to result of Song KS et al and P.S. Marcheix et al (Song, 2010 and Kwang Soon Song, 2008). All patients have similar mechanisms which are fall from height (wall, furniture, etc.) (Robin Smithuis, 2012) except three cases; road traffic accident, fall during sport injury and third case fall on flexed elbow. It's more difficult to decide the specific type of mechanism whether compression or pulling off in our locality because the parent are not well descriptive the sort and the detail of injury history, this Corresponds to a study done by Eksioglu et al (2008), Kirkos et al. (2003) and Pouliart & De Boeck (Pouliart, 2002 and Jakob, 1975). Open reduction and internal fixation is necessary in cases of unsatisfactory reduction, completely displaced, rotated fragments and in long-standing untreated cases hence it is fracture of necessity means that reduction can seldom be achieved by closed means because the fragment is frequently rotated by the pull of the wrist extensor muscles attached to it and cannot be replaced by manipulation, nor can it be held in the reduced position simply by a plaster cast (Johnm, 2010 ; Canale and Beaty, 2008 and Kwang Soon Song, 2008). These are identical to our series where the Jakob et al advocated open reduction and internal fixation for stage II and III (Jakob, 1975 and Launy, 2004). Jakob I (less than 2 mm) can be treated conservatively, also an undisplaced fracture treated by long cast for 4 weeks. Although this method is safe, but needed closed observation every 5 to 7 days. Good quality plain radiographs of the elbow (best taken with the cast off) are obtained to make sure that the reduction has been maintained
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Outcome analysis of cross pinning versus lateral pinning in supracondylar fractures of humerus in children

Outcome analysis of cross pinning versus lateral pinning in supracondylar fractures of humerus in children

This is to certify that this dissertation titled “OUTCOME ANALYSIS OF CROSS PINNING VERSUS LATERAL PINNING IN SUPRACONDYLAR FRACTURES OF HUMERUS IN CHILDREN” is a bonafide record of work done by Dr.R.SENTHIL KUMAR, during the period of his Post graduate study from May 2012 to November 2013 under guidance and supervision in the Institute of Orthopaedics and Traumatology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai-600003, in partial fulfillment of the requirement for M.S.ORTHOPAEDIC SURGERY degree Examination of The Tamilnadu Dr. M.G.R. Medical University to be held in April 2014.
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A prospective randomised, controlled clinical trial comparing medial and lateral entry pinning with lateral entry pinning for percutaneous fixation of displaced extension type supracondylar fractures of the humerus in children

A prospective randomised, controlled clinical trial comparing medial and lateral entry pinning with lateral entry pinning for percutaneous fixation of displaced extension type supracondylar fractures of the humerus in children

fractures: type I, Undisplaced; type II, displaced with the posterior cortex intact; and type III, completely dis- placed with no cortical contact. Supracondylar fractures may be associated with a number of complications such as neurovascular injuries, malunion, compartment syn- drome, iatrogenic neurovascular injury and elbow stiff- ness [1,2,5]. Cubitus varus due to malunion is the most common angular deformity and the incidence varies from 5% according to Flynn et al. [6], to 21% according to Arino et al. [7]. Incidence of iatrogenic ulnar nerve

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Assessment of the Outcome of Anterior versus Posterior Approach in the Management of Displaced Pediatric Supracondylar Humerus Fracture

Assessment of the Outcome of Anterior versus Posterior Approach in the Management of Displaced Pediatric Supracondylar Humerus Fracture

All patients who were admitted to emergency department, a complete history and physical examination un- dertaken carefully. Special attention was made for exclusion of vascular injury and thorough nerve examination was done. Ethical approval was obtained from the Institutional Review Board of Sulaimani University hospital. Informed consent was obtained from both parents prior to the procedure; though some parents understood the right of voluntary participation and withdrawal from the trial. After those informed consents were taken from the parents about the anaesthesia, the approach type and the possible complications including tourniquet palsy, risk of ulnar nerve injury and wound infection. Surgeries were performed under general anaesthesia; pneumatic tourniquet was applied, closed reduction done first to reduce skin tenting (Figure 2(a)), the standard. Henry ap- proach of the distal humerus uses the interval between the brachialis and brachioradialis muscles with protection of the radial nerve was applied for the anterior group while standard Campbell approach which involve vertical split in the substance of the triceps tendon was used for posterior approach. The K wires inserted in crossed manner in both groups and their ends kept outside and bent (Figure 2(b), Figure 3(a) & Figure 3(b)). For both groups, repeated neurovascular examination post-operatively undertaken and follow up kept up to 2 weeks when the stitches were removed and the posterior splint changed. Four weeks after surgery, the posterior splints were removed, and radiographic signs of callus formation were used to confirm the union. The follow up period was divided into 3 intervals according to Flynn criteria (Table 1 & Table 2) [4]: the early results which started from the first day to 4 weeks post operatively, the second interval was between second and fourth (Table 3 & Table 5) months and the last follow up was at sixth month and represented the late results (Table 4 & Table 6).
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Isolated fracture of the humeral trochlea: a case report and review of the literature

Isolated fracture of the humeral trochlea: a case report and review of the literature

to the ulno-humeral compartment [3]. Evaluation of radio- graphs in the anteroposterior view may show an irregularity at the ulno-humeral joint [2,3,5-7], but the image can be interpreted ‘normal’ [4,8-11]. In a lateral view, the appearance of an articular half-moon-shaped fragment moved up and forward could suggest a capitellar frac- ture. For this reason, diagnosis is based on the results of a CT scan [2,3,6,8,10,11]. CT allows the treating phys- ician to determine the size of the fragment and its

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Open reduction internal fixation vs non operative management in proximal humerus fractures: a prospective, randomized controlled trial protocol

Open reduction internal fixation vs non operative management in proximal humerus fractures: a prospective, randomized controlled trial protocol

The PROFHER trial [39] is currently the largest multi-centered randomized controlled trial to compare operative vs nonoperative treatment of proximal hu- merus fractures. The trial did not show a significant dif- ference in functional outcome between treatment groups using the Oxford and SF-12 functional outcome scoring. The PROFHER trial had a few methodological limita- tions that the authors of the current study have sought to address. The PROFHER trial included patients from age > 16 years. The functional demands in younger pa- tients differ and are not necessarily generalizable to older patients. Although there was a subgroup analysis for age < 65 and > 65, having wide age inclusion criteria makes interpretation of the results difficult. The current trial inclusion criteria limits the study to patients over the age > 60. Other limitations in the PROPHER study in- cluded lack of blinding, the inclusion of hemiarthroplasty in the surgical arm, lack of standardization between re- habilitation programs in the operative and nonoperative arms, and very low enrollment in certain centers; all of these potential shortcomings have been addressed in the current trial including blinding of research personnel, lim- iting surgical treatment to ORIF, standardization of re- habilitation protocols, and limiting enrollment to a large, high-volume, tertiary care center.
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Triceps-sparing approach for open reduction and internal fixation of neglected displaced supracondylar and distal humeral fractures in children

Triceps-sparing approach for open reduction and internal fixation of neglected displaced supracondylar and distal humeral fractures in children

8.6 years). All patients had an initial treatment in the form of closed reduction and above elbow slab in private clinics or local hospitals and presented to the author late. The duration between their initial injury and presentation ran- ged from 16 to 34 days (mean 19 days). Twelve patients (80 %) had neglected extension type supracondyar frac- tures, two patients (13.33 %) had neglected flexion-type supracondylar fractures, while the last patient (6.67 %) had a neglected lower fourth humeral fracture. At the time of presentation, two patients (13.33 %) had skin abrasions and crusts with signs of radial nerve involvement in one patient and ulnar nerve involvement in the other. No patients had vascular involvement. No patients had open supracondylar fractures. No patients had any previous trial of surgical intervention in the form of closed reduction with percuta- neous pinning.
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Effect of osteosynthesis, primary hemiarthroplasty, and non surgical management for displaced four part fractures of the proximal humerus in elderly: a multi centre, randomised clinical trial

Effect of osteosynthesis, primary hemiarthroplasty, and non surgical management for displaced four part fractures of the proximal humerus in elderly: a multi centre, randomised clinical trial

Methods/Design: We will conduct a randomised, multi-centre, clinical trial including patients from ten national shoulder units within a two-year period. We plan to include 162 patients. A central randomisation unit will allocate patients. All patients will receive a standardised three- month rehabilitation program of supervised physiotherapy regardless of treatment allocation. Patients will be followed at least one year. The primary outcomes will be the overall score on the Constant Disability Scale, and its pain subscale, measured at 12 months. A blinded physiotherapist will carry out the assessments. Other secondary outcomes are Oxford Shoulder Score, and general health status (Short Form-36).
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