Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Oct 2014
Perioperative complications after hemiarthroplasty and total shoulder arthroplasty are equivalent.
Total shoulder arthroplasty (TSA) results in superior clinical outcomes to hemiarthroplasty (HA); however, TSA is a more technical and invasive procedure. This study retrospectively compares perioperative complications after HA and TSA using the National Surgical Quality Improvement Program (NSQIP) database. ⋯ Multivariate analysis of patients undergoing TSA or HA in the NSQIP database suggests that patient factors-not the procedure being performed-are significant predictors of major complications. Controlling for patient comorbidities, we found no increased risk of perioperative major complications in patients undergoing TSA compared with HA.
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We used intraoperative neuromonitoring to define the stages of the Latarjet procedure during which the nerves are at greatest risk. ⋯ The nerves, in particular the axillary and musculocutaneous nerves, are at risk during the Latarjet procedure, especially during glenoid exposure and graft insertion.
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J Shoulder Elbow Surg · Oct 2014
Successful injection of the acromioclavicular joint with use of ultrasound: anatomy, technique, and follow-up.
Injection into the acromioclavicular (AC) joint is often inaccurate (approximately 50%) even in experienced hands. In light of new anatomic observations, we evaluate accuracy of an innovative ultrasound-guided method and follow the clinical course of successful therapeutic injections. ⋯ This high level of clinical injection success, irrefutably substantiated with arthrography, has not been previously demonstrated. The anterior superior aspect of the joint is the preferred place for entry. Initial intra-articular blockage to fluid inflow is common but can be surmounted. Encouraging 6-month results of steroid instillation in isolated AC disease do not apply to patients with coexisting shoulder pathologic processes.
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Although shoulder arthroplasty procedures are more frequently performed in the United States, there is insufficient information on outcome measures such as hospital readmission rates or factors for readmission after surgery. ⋯ Patients undergoing RTSA had higher hospital readmission rates than those undergoing hemiarthroplasty or TSA, but most readmissions after shoulder arthroplasty were due to medical causes.
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J Shoulder Elbow Surg · Sep 2014
Minimally invasive plate osteosynthesis for proximal humeral fractures: clinical and radiologic outcomes according to fracture type.
This study evaluated the clinical and radiologic outcomes, according to fracture type, of proximal humeral fractures treated by the minimally invasive plate osteosynthesis (MIPO) technique. ⋯ Satisfactory clinical and radiologic outcomes were obtained by the MIPO technique in proximal humeral fractures. In addition, medial cortical support can be performed with an inferomedial screw or fibular allograft in the MIPO technique. However, the MIPO technique for 4-part fractures showed relatively inferior outcomes compared with 2- and 3-part fractures. Conversion to open plating is also considered if adequate reduction, that is, a neck-shaft angle >120°, is not able to be obtained in the MIPO technique for 4-part fractures of the proximal humerus.