Previous trauma remains the most common cause of elbow stiffness. Dr. Adey evaluated the results of 46 patients who had undergone elbow capsulectomy in order to examine if there were any factors predictive of outcome. These patients were followed for an average of 48 months after capsular excision. The average improvement in ulno-humeral motion was 58 degrees and the average flexion arc was 103 degrees at final follow-up. Twenty-nine percent of patients required a second capsular excision. Dr. Adey found that pain and ulnar nerve dysfunction were more important determinants than range of motion in overall function, as measured by the DASH and MEPI outcomes instruments.

Dr. Blazar commended Dr. Adey on addressing factors that may limit the restoration of function and mobility after elbow capsulectomy. Dr. Blazar highlighted the finding that thirty percent of patients required revision surgery. He also noted that in these patients, symptoms related to ulnar nerve dysfunction will improved over time. Overall, elbow capsulectomy is useful to restore functional mobility in stiff elbows with limited arthrosis, although more than one procedure may be needed.
 

Up to 75% of pediatric fractures occur in the upper extremity, with supracondylar fractures being the most common injury pattern. Over the past several decades, there has been a shift from non-operative to surgical treatment of displaced supracondylar fractures. Dr. Ponce retrospectively reviewed complications from a consecutive case series of 104 displaced supracondylar humerus fractures treated with closed reduction and percutaneous pinning at Children’s Hospital, Boston. The purpose of Dr. Ponce’s study was to evaluate the necessity of clinical and radiographic evaluation within 10 days of closed reduction and percutaneous pinning. Group 1(52 patients) had initial follow-up radiographs with 10 days and Group 2 (52 patients) had follow-up radiographs after 10 days or at time of pin removal. The overall complication rate was 7.7%. No association between late follow-up and complications was identified. It was concluded that clinical and radiographic evaluation of displaced supracondylar fractures requiring closed reduction and percutaneous pinning can be safely delayed until time of pin removal.

Dr. Kasser commended Dr. Ponce for investigating the relationship between follow-up and complications in an injury for which Children’s Hospital manages approximately 250 cases per year. Dr. Kasser questioned what 10-day follow-up may offer, when the primary decision point is the 3 week pin removal. In this investigation, no benefit or decrease in complications was shown by clinical and radiological evaluation at 10 days.
 

In Part I, Dr. Giza discussed his analysis of soccer injuries in the first two years of the Women’s United Soccer Association (WUSA). In this preliminary study, information on injuries was obtained from an insurance company database and subsequently confirmed by team trainers. The overall injury incidence rate was 1.93 injuries per 1000 player hours. The most common location was the knee (31.8%), followed by the head (10.4%), ankle (9.3%), and foot (9.3%). Of the head injuries, fractures of nasal and facial bones were the most common, followed by concussions. More injuries occurred in the latter portion of the season which may be related to deconditioning and increased intensity during the playoffs.

In Part II, Dr. Giza reported on his work on implementing an injury database for professional soccer, in an effort to prospectively study injuries and improve the safety and health of professional athletes. The goals of this database include improving the standard of medical record keeping for professional soccer players, evaluating the effectiveness of current treatment methods, and providing a large sample of epidemiological data.

Dr. Martin commended Dr. Giza on this preliminary study of injuries in professional female soccer players. She raised the notion of under-reporting of injuries by players and questioned whether the true incidence of injury can be accurately obtained in order to institute an injury prevention program. Interestingly, Dr. Martin noted that despite a lower injury rate compared to the men’s MLS league, WUSA players still had a higher ACL injury rate. Therefore, even with higher levels of training, the ACL injury rate in female athletes remains higher than in males. Dr. Martin also expressed her concern over the number of head injuries and encouraged efforts to monitor their effects over time.
 

Historically, outcomes after shoulder surgery have largely relied upon physician-based assessments. Over the past decade, however, the importance of patients' subjective evaluations of outcome has been recognized. In Dr. O’Holleran's three-part study, he examined the determinants of patient satisfaction after rotator cuff surgery and anterior instability surgery. He also examined the reliability and validity of the American Shoulder and Elbow Surgeons (ASES) shoulder score. Dr. O'Holleran found that the most robust associations with patient satisfaction after rotator cuff repair and anterior instability surgery and outcomes were related to subjective variables of symptoms and function. Overall, most patients would have the surgery again and most would recommend it to another. In the third part of Dr. O'Holleran’s study, the ASES shoulder score demonstrated an acceptable psychometric performance for outcomes assessment in patients with rotator cuff disease, instability, and arthritis.

Dr. Gill commended Dr. O'Holleran on a timely and elegant study which will contribute to the ongoing debate on outcome assessments. Historically, patient satisfaction had rarely been addressed, but Dr. O'Holleran’s study emphasizes the importance of patient-derived subjective assessments in evaluating the outcomes of shoulder surgery.