Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Aug 2019
Is shortening of displaced midshaft clavicle fractures associated with inferior clinical outcomes following nonoperative management? A systematic review.
Management of displaced midshaft clavicle fractures is controversial. Nonoperative treatment can lead to shortening, a risk factor for nonunion and poor functional outcomes. These inferior results have resulted in authors recommending surgical fixation for fractures with significant shortening. The aim of this systematic review was to analyze the effect of fracture shortening on shoulder function and nonunion rates in nonoperatively managed displaced midshaft clavicle fractures. ⋯ There is no significant association between fracture shortening and nonunion rates or shoulder outcome scores in displaced midshaft clavicle fractures managed nonoperatively.
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J Shoulder Elbow Surg · Jul 2019
A biomechanical cadaveric study of patellar tendon allograft as an alternative graft material for superior capsule reconstruction.
In a cadaveric irreparable rotator cuff tear model, patellar tendon allograft-superior capsule reconstruction (PT-SCR) will restore glenohumeral stability and reduce subacromial contact pressures without significant graft deformation during testing. ⋯ PT-SCR was able to reduce superior translation of the humeral head and peak subacromial contact pressure without restricting ROM. Furthermore, there was no significant graft deformation during testing. PT-SCR in this validated cadaveric model demonstrates favorable biomechanical properties and is a viable source of graft material for SCR.
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J Shoulder Elbow Surg · Jul 2019
Modified frailty index is an effective risk-stratification tool for patients undergoing total shoulder arthroplasty.
Frailty, as quantified by the modified frailty index (mFI), has emerged as a promising method to identify patients at high risk of complications after surgery. Several studies have shown that frailty, as opposed to age, is more predictive of adverse surgical outcomes. We hypothesized that a 5-item mFI could be used to identify patients at elevated risk of complications after total shoulder arthroplasty (TSA). ⋯ Frailty is associated with increased rates of 30-day postoperative complications, readmission, reoperation, adverse hospital discharge, and hospital LOS after TSA. Use of a simple frailty evaluation may help inform decision making and risk assessment when considering TSA.
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J Shoulder Elbow Surg · Jul 2019
Distal suprascapular nerve block-do it yourself: cadaveric feasibility study.
A bone landmark-based approach (LBA) to the distal suprascapular nerve (dSSN) block is an attractive "low-tech" method available to physicians with no advanced training in regional anesthesia or ultrasound guidance. The primary aim of this study was to validate the feasibility of an LBA to blockade of the dSSN by orthopedic surgeons using anatomic analysis. The secondary aim was to describe the anatomic features of the sensory branches of the dSSN. ⋯ An LBA for anesthetic blockade of the dSSN by an orthopedic surgeon is a simple, reliable, and accurate method. Injection close to the suprascapular notch is recommended to involve the dSSN proximally and its 3 sensory branches.
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J Shoulder Elbow Surg · Jul 2019
Comparative StudyScrew-tip augmentation versus standard locked plating of displaced proximal humeral fractures: a retrospective comparative cohort study.
This study compared the clinical and radiologic outcomes of screw tip-augmented locking plate osteosynthesis vs. standard locked plating in elderly patients with displaced proximal humeral fractures. ⋯ Loss of fixation was less frequent when augmentation of screw tips was performed; however, at the 2-year follow-up, the clinical and radiologic outcomes were not significantly different compared with standard locked plating without augmentation.