Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Sep 2014
The incidence of proximal humeral fractures in New York State from 1990 through 2010 with an emphasis on operative management in patients aged 65 years or older.
Proximal humeral fractures are commonly encountered injuries. The development of locking plate technology and reverse shoulder arthroplasty may have changed the treatment patterns of these fractures. ⋯ The incidence of proximal humeral fractures in patients aged 65 or older increased by 28% between 1990 and 2010, and operative management increased by more than 40%. The use of ORIF increased between 2001 and 2010, corresponding with the use of locking plate technology. There was an associated decrease in HA. TSA increased between 2006 and 2010, corresponding to the use of reverse shoulder arthroplasty.
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J Shoulder Elbow Surg · Sep 2014
Does the timing of surgery for proximal humeral fracture affect inpatient outcomes?
Delayed surgical treatment of hip fractures is associated with adverse medical outcomes, but it is unclear whether the same is true for proximal humeral fractures. The purpose of this study was to evaluate the relationship between surgical delay for proximal humeral fracture and inpatient adverse events, in-hospital death, prolonged postoperative stay, and nonroutine discharge. ⋯ Even when comorbidities and complexity are controlled for, delaying surgery for proximal humeral fracture is likely to increase inpatient morbidity, postoperative length of stay, and nonroutine discharge. It appears that avoiding nonmedical delays is advantageous.
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J Shoulder Elbow Surg · Sep 2014
Reverse total shoulder arthroplasty for the treatment of proximal humeral fractures: patterns of use among newly trained orthopedic surgeons.
This study compared the use of reverse and hemishoulder arthroplasty for the treatment of proximal humeral fractures among orthopedic surgeons taking part II of the American Board of Orthopaedic Surgery board examination. We hypothesized that the use of reverse shoulder arthroplasty for fractures in the elderly is increasing amongst newly trained orthopedic surgeons. ⋯ Overall, the use of a hemiarthroplasty for fracture is still more common (62% in 2012), although the relative proportion of reverse implants is rising. Among shoulder surgeons, more than 50% of the arthroplasties performed for fractures during the past 3 years (2010-2012) have been reverse arthroplasties.
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J Shoulder Elbow Surg · Aug 2014
Factors influencing K-wire migration in tension-band wiring of olecranon fractures.
Tension-band wiring is a popular method of internal fixation for simple olecranon fractures. Although fracture union rates and clinical outcomes are good, up to 80% of patients require removal because of prominent/symptomatic metalwork. The current literature remains unclear as to the best orientation of the longitudinal wires to minimize hardware failure. The aim of this study was to determine the surgically modifiable factors related to spontaneous wire pullout. ⋯ To minimize postoperative pullout of wires, we suggest anatomic reduction and transcortical wire orientation, without bending, in the subchondral bone close to the articular surface.
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J Shoulder Elbow Surg · Aug 2014
Long-term functional outcomes (median 10 years) after locked plating for displaced fractures of the proximal humerus.
Locked plating has become an accepted treatment for displaced fractures of the proximal humerus. However, to our knowledge, long-term outcomes have not been reported. ⋯ Ten years after locked plating of displaced proximal humeral fractures, patients show good to excellent outcomes in the majority of cases with no relevant decline compared with the shoulder function 1 year after surgery. However, poor long-term outcome is seen in 16% of patients and relates to a low CS 1 year after surgery. Thus, patients developing poor long-term outcomes may be identified at an earlier stage.