Objective To compare the effectiveness of simultaneous and delayed repair of combined full-thickness rotator cuff rupture in proximal humerus fracture. Methods Between January 2015 and January 2017, 44 patients with proximal humerus fractures complicated with full-thickness rotator cuff injuries were included. Twenty-four patients underwent open reduction and internal fixation (ORIF) and rotator cuff repair simultaneously (simultaneous operation group), and 20 patients underwent delayed arthroscopic rotator cuff repair more than 90 days after ORIF (delayed operation group). There was no significant difference in gender, age, cause of injury, and side of injury between the two groups (P>0.05). The fracture healing was observed by X-ray films. The shoulder function was assessed at 3, 6, and 12 months after operation by using the University of California at Los Angeles (UCLA) score. Results All incisions healed by first intention. All patients were followed up 12-24 months (mean, 17 months). Fractures all healed at 3 months after operation in simultaneous operation group. According to UCLA score, the patients had achieved significantly better outcomes in function, active forward flexion, strength of forward flexion, and subjective satisfaction in simultaneous operation group than in delayed operation group at 3, 6, and 12 months after operation (P<0.05). However, there was no significant difference in pain between the two groups (P>0.05). Conclusion For patients with proximal humerus fracture complicated with full-thickness rotator cuff rupture, performing ORIF and simultaneous repair of rotator cuff can improve shoulder function and achieve better effectiveness when compared with delayed repair of rotator cuff.
Objective To evaluate the clinical effectiveness and safety of tranexamic acid (TXA) in arthroscopic rotator cuff repair by meta-analysis. Methods Randomized controlled trials evaluating the clinical effectiveness and safety of TXA use in the perioperative period of arthroscopic rotator cuff repair were identified from the Cochrane Library, PubMed, Embase, VIP Chinese Science and Technology Periodical Database, Chinese National Knowledge Infrastructure, and Wanfang database, with a search time span from the inception of the database to August 2024. Meta-analysis was conducted using RevMan 5.3 software, and mean difference (MD) and risk difference (RD) were used as measures of effect size. Results A total of 7 randomized controlled trials were included. Meta-analysis demonstrated significant differences in good visual clarity [MD=9.10, 95% confidence interval (CI) (4.05, 14.15), P=0.0004] and operative time [MD=?12.07 min, 95%CI (?17.21, ?6.93) min, P<0.00001]. There was no significant difference in mean arterial pressure [MD=?1.08 mm Hg (1 mm Hg=0.133 kPa), 95%CI (?3.13, 0.98) mm Hg, P=0.30] or adverse event rate [RD=0.02, 95%CI (?0.01, 0.06), P=0.22] between the two groups. Conclusion TXA is effective and safe in enhancing visual clarity and significantly reducing operative time in arthroscopic rotator cuff repair, without increasing the incidence of adverse events.
Objective To investigate the efficacy and safety of dexmedetomidine combined with brachial plexus block in shoulder arthroscopy surgery via meta-analysis. Methods Databases including China National Knowledge Infrastructure, Web of Science, Cochrane Library, Chongqing VIP, PubMed, Wanfang and Embase were searched from databases establishment to July 2026. Randomized controlled trials concerning dexmedetomidine combined with brachial plexus block in shoulder arthroscopy surgery were enrolled. Mean difference (MD) and risk ratio were adopted as effect sizes, and RevMan 5.3 software was used for meta-analysis. Results A total of 9 studies were included. The meta-analysis demonstrated that the dexmedetomidine group had significantly lower postoperative 12-hour Visual Analogue Scale (VAS) scores (MD=–0.72), postoperative 24-hour VAS scores (MD=–0.53), and morphine consumption within 24 hours postoperatively (MD=–14.38 ?mg) compared with the control group (P<0.05). The duration of nerve block was longer in the dexmedetomidine group (MD=2.87?h, P<0.05). There were no statistically significant differences between the two groups in postoperative 48-hour VAS scores, incidence of intraoperative or postoperative bradycardia, and incidence of postoperative nausea and vomiting (P>0.05). Conclusion Current evidence suggests that dexmedetomidine combined with brachial plexus block in shoulder arthroscopy surgery can prolong the duration of nerve block, alleviate pain within 24 hours after surgery, and does not increase complications.