Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Nov 2018
ReviewLong-term follow-up of corrective ulnar osteotomy for missed Monteggia fractures in children.
Pediatric Monteggia fractures are relatively rare and are commonly missed. Radial head subluxation can persist with long-term consequences if these fractures are left untreated. We evaluated the long-term treatment outcomes after open reduction with ulnar osteotomy for missed Monteggia fractures during childhood. ⋯ Good results can be obtained after open reduction with opening-wedge ulnar osteotomy. Lesser clinical and radiographic outcomes can be expected after a surgical delay of more than 6 months. Furthermore, the radiographic outcome seems better if the patient is younger than 6 years.
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J Shoulder Elbow Surg · Oct 2018
Comparative StudyWhich additional augmented fixation procedure decreases surgical failure after proximal humeral fracture with medial comminution: fibular allograft or inferomedial screws?
The purpose of this study was to compare clinical and radiologic results between treatment with locking plate fixation and fibular allograft augmentation (FA) and treatment with locking plate fixation and additional inferomedial screws (IMSs) in 3- or 4-part proximal humeral fractures with medial comminution in geriatric patients. ⋯ An FA technique is considered a primary additional procedure for medial support in patients with 4-part proximal humeral fractures involving medial metaphyseal comminution when treated with locking plate fixation.
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J Shoulder Elbow Surg · Oct 2018
Comparative StudyLateralization of the glenosphere in reverse shoulder arthroplasty decreases arm lengthening and demonstrates comparable risk of nerve injury compared with anatomic arthroplasty: a prospective cohort study.
Grammont-style reverse shoulder arthroplasty (RSA) has an increased risk of nerve injury compared with anatomic total shoulder arthroplasty (TSA) due to arm lengthening. We hypothesized that an RSA with a lateralized glenosphere and 135° neck-shaft angle would reduce humeral lengthening and decrease the risk of nerve injury to the level of a TSA. ⋯ An RSA design with a lateralized glenosphere and a lower neck-shaft angle decreases arm lengthening compared with the Grammont design. The reduction in lengthening appears to eliminate the historically increased risk of neurologic injury associated with RSA relative to TSA.
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J Shoulder Elbow Surg · Sep 2018
The influence of preoperative opioid use on inpatient opioid requirements and discharge prescriptions after primary shoulder arthroplasty.
Active opioid users experience more pain and require more opioids after primary shoulder arthroplasty than non-opioid users. However, it is unknown whether discharge prescription regimens are tailored to these different postoperative opioid requirements. ⋯ Daily and total opioid regimens prescribed after primary shoulder arthroplasty were similar between prior opioid users and nonusers despite large differences in their inpatient opioid requirements. Tailoring discharge opioid prescription regimens to inpatient use appears feasible and warrants further study.
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J Shoulder Elbow Surg · Sep 2018
Arthroplasty for glenohumeral arthritis in shoulders with a previous Bristow or Latarjet procedure.
Coracoid transfer has become increasingly popular for recurrent anterior shoulder instability. Despite the success, glenohumeral arthropathy develops in some patients. Arthroplasty in this population is complicated by altered anatomy, scarring, and retained hardware. This study evaluated shoulder arthroplasty in patients with a previous Latarjet or Bristow procedure. ⋯ Shoulder arthroplasty in patients after prior coracoid transfer is technically challenging, yet improvements in pain and function are predictable. Instability and glenoid loosening are common reasons for revision surgery, likely related to difficulties in achieving a good soft tissue balance.