Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Mar 2013
ReviewPreventing venous thromboembolism in elective upper limb surgery.
Deep venous thrombosis (DVT) and pulmonary embolism (PE) have considerable clinical and economic consequences. The prevention of venous thrombosis and PE are increasingly seen as quality markers for surgery. Guidance is available from a number of sources to stratify risk for different patients and procedures and to define an appropriate standard of care. Despite this, best practice is unclear. ⋯ Review Article.
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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.
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The number of times an article has been cited has been used as a marker of its influence in a medical specialty. The purpose of this study was to determine the 50 most cited articles in shoulder surgery and their characteristics. ⋯ Articles that introduced instruments for outcome evaluation or that introduced classification systems (methodologic) were highly cited regardless of the date of publication. The top 50 list presented provides residency and fellowship directors with a group of "classic" articles in the subspecialty of orthopedic shoulder surgery that can be included in reading curriculums for their trainees.
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J Shoulder Elbow Surg · Mar 2012
Review Comparative StudyTreatment of clavicle fractures: current concepts review.
Clavicle fractures are common in adults and children. Most commonly, these fractures occur within the middle third of the clavicle and exhibit some degree of displacement. Whereas many midshaft clavicle fractures can be treated nonsurgically, recent evidence suggests that more severe fracture types exhibit higher rates of symptomatic nonunion or malunion. ⋯ Surgical intervention may be required in cases of neurovascular compromise or significant fracture displacement. In children and adolescents, these injuries mostly consist of physeal separations, which have a large healing potential and can therefore be managed conservatively. Current concepts of clavicle fracture management are discussed including surgical indications, techniques, and results.
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J Shoulder Elbow Surg · Mar 2012
ReviewA systematic review and comprehensive classification of pectoralis major tears.
Reported descriptions of pectoralis major (PM) injury are often inconsistent with the actual musculotendinous morphology. The literature lacks an injury classification system that is consistently applied and accurately reflects surgically relevant anatomic injury patterns, making meaningful comparison of treatment techniques and outcomes difficult. ⋯ A contemporary injury classification system is proposed that includes (1) injury timing (acute vs chronic), (2) injury location (at the muscle origin or muscle belly, at or between the musculotendinous junction and the tendinous insertion, or bony avulsion), and (3) standardized terminology addressing tear extent (anterior-to-posterior thickness and complete vs incomplete width) to more accurately reflect the musculotendinous morphology of PM injuries and better inform surgical management, rehabilitation, and research.