Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Sep 2007
Comparative StudyComparison of elbow contracture release in elbows with and without heterotopic ossification restricting motion.
We compared 16 patients with post-traumatic heterotopic ossification (HO) restricting elbow motion (but not complete bony ankylosis) after elbow trauma with 21 patients with capsular contracture alone to test the hypothesis that HO is associated with diminished motion after release. Patients with burns or head injury were excluded. ⋯ After all subsequent procedures (including procedures to address residual stiffness in 1 patient in the HO cohort and 4 patients in the capsular contracture cohort), the flexion arc averaged 116 degrees in the HO cohort and 98 degrees in the capsular contracture cohort (P = .19). Open release of post-traumatic elbow stiffness is more effective when HO hindering motion is removed than when there is capsular contracture alone.
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J Shoulder Elbow Surg · Jul 2007
Indwelling interscalene catheter use in an outpatient setting for shoulder surgery: technique, efficacy, and complications.
Indwelling interscalene catheters are utilized for inpatient postoperative pain control after shoulder surgery. Improved medical equipment and advanced techniques may allow safe and efficacious outpatient use. One hundred and forty-four consecutive indwelling interscalene catheter placements were reviewed to determine adverse events, complications, and efficacy. ⋯ The average last recorded PACU pain score on a scale of 1 to 10 was 0.6. Catheter placement under real-time ultrasound guidance is accurate. Outpatient use of indwelling interscalene catheters is safe and efficacious.
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J Shoulder Elbow Surg · Jul 2007
Case ReportsAcute deep infection after surgical fixation of proximal humeral fractures.
Acute deep infection after open reduction-internal fixation of proximal humeral fractures is uncommon. Currently, there are no reported series on the outcomes of patients treated for infection after surgery for proximal humeral fractures. The purpose of this study was to review the frequency, clinical presentation, bacteriology, treatment, and outcomes of patients with such fractures complicated by acute deep infection. ⋯ At a mean final follow-up of 6.4 years, the American Shoulder and Elbow Surgeons score averaged 53 points (range, 33-75 points) and the Simple Shoulder Test score averaged 6.2 points (range, 1-10 points). Acute deep infection after open reduction-internal fixation of proximal humeral fractures is a devastating complication. Patients should be counseled that the results of treatment of deep infection are plagued with high complication rates, poor functional outcome, and a notably high nonunion rate.
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J Shoulder Elbow Surg · Jul 2007
Case ReportsThe types and severity of complications associated with interscalene brachial plexus block anesthesia: local and national evidence.
Interscalene brachial plexus block is a commonly used anesthetic. However, substantial complications can be associated with its use. Our study included 15 years of data from a local medical center and 3 decades of records from the national American Society of Anesthesiology Closed Claims Project. ⋯ The American Society of Anesthesiology Closed Claims database had 20 peripheral neurologic injuries, 10 respiratory complications, 5 central nervous system complications, 4 deaths, 2 emotional disturbances, and 1 other unknown event. Of the complications, 19 were described as permanent. Interscalene brachial plexus block can be accompanied by substantial and disabling complications, especially when administered by less experienced anesthesiologists.