Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Sep 2019
Meta AnalysisEfficacy of liposomal bupivacaine in shoulder surgery: a systematic review and meta-analysis.
The aim of this meta-analysis was to compare the safety, efficacy, and opioid-sparing effect of liposomal bupivacaine (LB) vs. nonliposomal local anesthetic agents (NLAs) for postoperative analgesia after shoulder surgery. ⋯ LB is comparable to NLAs with respect to pain relief, the opioid-sparing effect, and adverse effects in the first 48 hours after arthroscopic rotator cuff repair and total shoulder arthroplasty.
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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 · Mar 2019
Meta AnalysisTuberosity healing after reverse shoulder arthroplasty for complex proximal humeral fractures in elderly patients-does it improve outcomes? A systematic review and meta-analysis.
Reverse shoulder arthroplasty (RSA) is being increasingly used for complex, displaced fractures of the proximal humerus in older patients. Anatomic tuberosity healing in RSA has been recognized to restore better shoulder function. We compared the reported clinical and functional outcomes of RSA in proximal humeral fractures with and without tuberosity healing. ⋯ The RSA group with healed greater tuberosity showed better range of motion, especially forward flexion and external rotation and Constant scores, compared with the nonhealed greater tuberosity group. Tuberosity healing may influence overall shoulder function after RSA for proximal humeral fractures in the elderly, and this needs verification with future prospective studies.
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J Shoulder Elbow Surg · Mar 2019
Fragility of randomized clinical trials of treatment of clavicular fractures.
Statistical significance, as reported by the P value, has traditionally been the most commonly reported way to determine whether a difference exists between clinical interventions. Unfortunately, P values alone confer little about the robustness of a study's conclusions. An emerging metric, the fragility index (FI), helps to address this challenge by quantifying the number of events per outcome group that would need to be reversed to the alternative outcome in order to raise the P value above the 0.05 threshold. ⋯ The median FI reported in the recent literature on clavicular fractures is only 2. The FI is a useful metric to analyze the robustness of study conclusions that should complement other methods of critical data evaluation, including the P value or effect sizes. Future efforts are needed to increase institutional collaboration and patient recruitment to strengthen the robustness of RCT conclusions, especially in the realm of clavicular fracture management.
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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.