Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Oct 2014
Randomized Controlled Trial Comparative StudyReverse shoulder arthroplasty versus hemiarthroplasty for acute proximal humeral fractures. A blinded, randomized, controlled, prospective study.
There is no consensus on what type of arthroplasty is best for the treatment of complex proximal humeral fractures in elderly patients. The purpose of this prospective study was to compare the outcomes of reverse shoulder arthroplasty (RSA) and hemiarthroplasty (HA). ⋯ RSA resulted in better pain and function and lower revision rate. Revision from HA to RSA does not appear to improve outcomes.
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J Shoulder Elbow Surg · Oct 2014
Perioperative complications after hemiarthroplasty and total shoulder arthroplasty are equivalent.
Total shoulder arthroplasty (TSA) results in superior clinical outcomes to hemiarthroplasty (HA); however, TSA is a more technical and invasive procedure. This study retrospectively compares perioperative complications after HA and TSA using the National Surgical Quality Improvement Program (NSQIP) database. ⋯ Multivariate analysis of patients undergoing TSA or HA in the NSQIP database suggests that patient factors-not the procedure being performed-are significant predictors of major complications. Controlling for patient comorbidities, we found no increased risk of perioperative major complications in patients undergoing TSA compared with HA.
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We used intraoperative neuromonitoring to define the stages of the Latarjet procedure during which the nerves are at greatest risk. ⋯ The nerves, in particular the axillary and musculocutaneous nerves, are at risk during the Latarjet procedure, especially during glenoid exposure and graft insertion.
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J Shoulder Elbow Surg · Oct 2014
Successful injection of the acromioclavicular joint with use of ultrasound: anatomy, technique, and follow-up.
Injection into the acromioclavicular (AC) joint is often inaccurate (approximately 50%) even in experienced hands. In light of new anatomic observations, we evaluate accuracy of an innovative ultrasound-guided method and follow the clinical course of successful therapeutic injections. ⋯ This high level of clinical injection success, irrefutably substantiated with arthrography, has not been previously demonstrated. The anterior superior aspect of the joint is the preferred place for entry. Initial intra-articular blockage to fluid inflow is common but can be surmounted. Encouraging 6-month results of steroid instillation in isolated AC disease do not apply to patients with coexisting shoulder pathologic processes.