Journal of shoulder and elbow surgery
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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.
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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.