Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · May 2013
Randomized Controlled Trial Multicenter StudySodium hyaluronate for the treatment of chronic shoulder pain associated with glenohumeral osteoarthritis: a multicenter, randomized, double-blind, placebo-controlled trial.
Nonoperative treatments for glenohumeral osteoarthritis (GH-OA) are limited. Intra-articular therapy with sodium hyaluronate (HA) has been effective in treating OA of the knee. Therefore, we sought to evaluate the efficacy and safety of HA in treating chronic pain associated with GH-OA. ⋯ A numeric advantage, but without statistical significance, was found for HA ITT patients with GH-OA. Although data for a subset of HA patients without concomitant pathologies reached statistical significance, additional randomized trials are needed to confirm the clinical implication of this outcome.
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J Shoulder Elbow Surg · Jan 2013
Multicenter StudyCurrent strategies for the treatment of proximal humeral fractures: an analysis of a survey carried out at 348 hospitals in Germany, Austria, and Switzerland.
The therapeutic spectrum for the treatment of displaced proximal humeral fractures ranges from conservative therapy to head-preserving surgical interventions and joint replacement. This study initiated a survey on the current treatment options with regard to diagnostics, choice of therapy, and complications that are encountered at trauma surgeries and orthopedic hospitals in Germany, Austria, and Switzerland. ⋯ A preference for surgical treatment of proximal humeral fractures was found, with stabilization predominantly being attempted by the use of angle-stable implants. The 2 most common complications were "nonanatomic reduction of fractures" and the more specific problem of "implant perforation" when fixed-angle implants were used for treatment.
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J Shoulder Elbow Surg · Jun 2012
Randomized Controlled Trial Multicenter Study Comparative StudyDoes hyaluronate injection work in shoulder disease in early stage? A multicenter, randomized, single blind and open comparative clinical study.
This study assessed the hypothesis that injection of high-molecular weight hyaluronate in the treatment of subacromial impingement syndrome is effective and safe, compared with corticosteroid injection in the shoulder joint. ⋯ A subacromial hyaluronate injection to treat impingement syndrome produces similar pain and functional improvement to corticosteroid at a short-term follow-up.
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J Shoulder Elbow Surg · Jan 2009
Randomized Controlled Trial Multicenter StudyA multicenter, prospective, randomized, controlled trial of open reduction--internal fixation versus total elbow arthroplasty for displaced intra-articular distal humeral fractures in elderly patients.
We conducted a prospective, randomized, controlled trial to compare functional outcomes, complications, and reoperation rates in elderly patients with displaced intra-articular, distal humeral fractures treated with open reduction-internal fixation (ORIF) or primary semiconstrained total elbow arthroplasty (TEA). Forty-two patients were randomized by sealed envelope. Inclusion criteria were age greater than 65 years; displaced, comminuted, intra-articular fractures of the distal humerus (Orthopaedic Trauma Association type 13C); and closed or Gustilo grade I open fractures treated within 12 hours of injury. ⋯ TEA may result in decreased reoperation rates, considering that 25% of fractures randomized to ORIF were not amenable to internal fixation. TEA is a preferred alternative for ORIF in elderly patients with complex distal humeral fractures that are not amenable to stable fixation. Elderly patients have an increased baseline DASH score and appear to accommodate to objective limitations in function with time.
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J Shoulder Elbow Surg · Jan 2008
Multicenter Study Comparative StudyThe surgical approach for locking plate osteosynthesis of displaced proximal humeral fractures influences the functional outcome.
This study evaluated the influence of the surgical approach for locking plate osteosynthesis in proximal humeral fractures during a 1-year period. We performed a comparative study in 83 patients to evaluate possible benefits for an early functional result for function, pain, activity levels, radiographic evaluation, and complications. In 39 cases, the extended anterolateral deltoid-splitting approach was used (group DS); in 44 cases, the deltopectoral approach was used (group DP). ⋯ One case of avascular necrosis was observed in group DS and 3 in group DP. We conclude that the choice of approach for exposure of the proximal humerus region may influence the functional outcome. Stable osteosynthesis is important, but the outcome of operatively treated proximal humerus fractures is dependent on soft tissue management as well.