From the Tufts University School of Medicine, Boston, MA (Mr. Mandalia); the Department of Orthopedic Surgery, New England Baptist Hospital, Boston, MA (Mr. Mandalia and Dr. Shah); New England Shoulder and Elbow Center, Boston, MA (Mr. Mandalia, Dr. Ross, and Dr. Shah); and the Sports Medicine Institute, Hospital for Special Surgery, Manhattan, NY (Dr. Gulotta).
J Am Acad Orthop Surg Glob Res Rev. 2024 Mar 28;8(4). doi: 10.5435/JAAOSGlobal-D-24-00045. eCollection 2024 Apr 1.
Immobilization for acromial and scapular spine stress AU4fractures (AF/SSF) after reverse total shoulder arthroplasty (RSA) is associated with patient dissatisfaction. Our study reports the effects and safety of intranasal calcitonin alongside sling immobilization on pain and function in the treatment of AF/SSF after RSA. The treatment was regimented calcitonin (salmon) 200 unit/actuation nasal spray (1 spray/day) for 6 weeks with sling immobilization for 4 weeks. Each patient was monitored through blood work. Visual analog scale, American Shoulder and Elbow Surgeons score, and active range of motion were collected preoperatively, postoperatively, at presentation of AF/SSF, and after completion of calcitonin treatment. Two hundred eighty-two RSAs were performed by two board-certified orthopaedic surgeons, of which 18 patients sustained AF/SSF (6.4%). Ten patients met inclusion criteria (nine AFs and one SSF). After calcitonin treatment, patients demonstrated an average improvement of visual analog scale of 5.8 points, active range of motion of 46_, and American Shoulder and Elbow Surgeons score of 43.6 points at average 7.53 months after RSA. No medical complications were reported at 6-month follow-up after calcitonin treatment. The use of intranasal calcitonin was not associated withadverse events including no aberrations/signs of cancer at 6-month follow-up after administration. Calcitonin with sling immobilization markedly improved clinical and functional outcomes of patients with nondisplaced AF/SSF and may be considered by orthopaedic surgeons for symptom management.
肩峰和肩胛脊柱应力 AU4 骨折(AF/SSF)固定后反向全肩关节置换术(RSA)与患者不满意有关。我们的研究报告了鼻内降钙素联合吊带固定治疗 RSA 后 AF/SSF 的疼痛和功能的效果和安全性。治疗方案为鲑鱼降钙素(200 单位/喷)鼻喷雾剂(每天 1 喷),共 6 周,吊带固定 4 周。每位患者都通过血液检查进行监测。术前、术后、出现 AF/SSF 时和降钙素治疗结束时,收集视觉模拟评分、美国肩肘外科医生评分和主动活动范围。两位经过董事会认证的骨科医生共进行了 282 例 RSA,其中 18 例发生 AF/SSF(6.4%)。10 名患者符合纳入标准(9 例 AF 和 1 例 SSF)。在降钙素治疗后,患者在 RSA 后平均 7.53 个月时,视觉模拟评分平均改善 5.8 分,主动活动范围平均增加 46°,美国肩肘外科医生评分平均增加 43.6 分。在降钙素治疗后 6 个月的随访中,没有报告任何医疗并发症。鼻内使用降钙素与不良事件无关,包括在给药后 6 个月的随访中没有发现癌症的异常/迹象。降钙素联合吊带固定显著改善了无移位 AF/SSF 患者的临床和功能结果,骨科医生可能会考虑用于症状管理。