Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Jan 2013
Comparative StudyAcute surgical treatment of acromioclavicular dislocation type V with a hook plate: superiority to late reconstruction.
Outcomes for patients with acromioclavicular joint dislocation, Rockwood type V, treated with acute or delayed hook plate surgery were investigated. ⋯ Patients treated with acute surgery had a more satisfactory outcome than those with late surgery after failed conservative treatment.
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Safely permitting early range of motion after a destabilizing injury to the elbow is believed to optimize return of function. However, the range-of-motion exercises must be balanced against the risk of re-dislocation or subluxation. The goal of this study was to describe the position of the upper limb that permitted the greatest motion while minimizing the risk of re-dislocation or subluxation. ⋯ The overhead motion protocol is a safe protocol for unstable elbows. The supine position results in the least amount of ulnohumeral distraction across flexion angles from 10° to 90°. The upright protocols, especially with the hinged elbow brace, exhibited ulnohumeral distraction that may result in dislocation.
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J Shoulder Elbow Surg · Jan 2013
Improvement in shoulder rotation in complex shoulder fractures treated by reverse shoulder arthroplasty.
Reverse shoulder arthroplasty in complex shoulder fractures is now a common practice. Unfortunately, loss of rotation is observed when tuberosity excision is used, impairing function and patient satisfaction. The purpose of this study was to evaluate the advantage of tuberosity repair in terms of the functional result. ⋯ Management of complex fractures of the superior extremity of the humerus by reverse shoulder arthroplasty is an accepted approach, but such treatment is restricted to elderly patients. Shoulder rotational ability is improved by systematically repairing the tuberosities around the implant. However, their consolidation should be anatomic; otherwise, the result is impaired by the lack of rotation. Nonunion or malunion does not lead to a functional disaster, as is sometimes the case with hemiarthroplasty without tuberosity healing.
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J Shoulder Elbow Surg · Dec 2012
Comparative StudyChange in labrum height after arthroscopic Bankart repair: correlation with preoperative tissue quality and clinical outcome.
Arthroscopic factors, such as labral and capsular tissue quality or anterior labral periosteal sleeve avulsion (ALPSA) lesion, affect postoperative labral height stability. Labral height stability has a correlation with clinical outcome. ⋯ The patients with less labral height decrease between 3 months and 1 year or higher labral height at 1 year postoperatively showed higher Rowe scores at 1 year postoperatively. Shoulders with ALPSA lesions, Hill-Sachs lesions, and a poor labrum with poor capsular tissue quality correlated more strongly with postoperative labral height decrease.
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J Shoulder Elbow Surg · Dec 2012
ReviewEvaluation of the osteoporotic proximal humeral fracture and strategies for structural augmentation during surgical treatment.
Fractures of the proximal humerus are relatively common injuries in the elderly population. Given the association between proximal humeral fractures and osteoporosis, elderly patients who sustain these injuries should always undergo a fragility fracture workup. ⋯ Optimal management of osteoporotic proximal humeral fractures has evolved and may now includes use of locking plates and augmentation with intramedullary fibular grafts, calcium phosphate or sulfate cement, and iliac crest bone graft. This article reviews the demographics of patients who sustain proximal humerus fractures, the appropriate postinjury fragility fracture workup, modalities for quantifying osteoporosis in the proximal humerus, techniques for augmenting fixation of proximal humerus fractures, and the authors' preferred approach to the treatment of these injuries.