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1.
Introduction
Revision shoulder arthroplasty presents many unique and complex challenges when glenoid bone loss is involved. A distorted and medialized anatomy prevents the proper mechanics of the reverse prosthesis with regard to deltoid tension and ultimate function. This paper highlights one surgeon’s experience using structural allograft for glenoid bone loss.Patients and methods
In all, 20 patients for a total of 24 surgeries with a medialized glenoid and/or substantial glenoid bone loss of grade IIB or higher were evaluated in this retrospective study. The allograft surgeries were performed as a one-stage procedure except for three patients. Recombinant human bone morphogenetic protein-2 (BMP2) was added to supplement incorporation in all cases. Four patients had two separate allograft procedures. Eight of the allograft procedure were femoral shaft, eleven of the allografts were femoral neck/head, and five of the allograft procedures were from proximal humerus. A graft was considered a success if they had at least 12 months of clinical and radiographic follow-up without subsequent removal of the graft or radiographic failure. Patients with less than 12 months of follow-up were included if the graft was removed or had early failure.Results
All femoral shaft allografts except one failed, and during revision surgery it was often noted that the graft was cracked where the peripheral screws had been drilled. In nine patients the graft was still in place at last follow-up, seven of these were femoral neck/head allografts. Five grafts were removed secondary to infection. Average follow-up was 24 months (range 5–45 months).Conclusions
Femoral neck allografts are an option in patients with substantial bone loss. The authors do not recommend use of femoral shaft allografts.2.
Purpose
When the proximal humeral anatomy is altered because of malunion, shoulder arthroplasty is a challenge for the orthopaedic surgeon, and tuberosity osteotomy should be avoided whenever possible. The purpose of this study was to investigate the clinical and radiological outcomes of anatomic stemless shoulder arthroplasty in cases of malunion. We hypothesized that a stemless prosthesis can be implanted without performing tuberosity osteotomy.Methods
We conducted a continuous, single surgeon, retrospective case series study with a minimum follow-up of two years (mean of 44 months, range 24–80). The Constant-Murley score, active range of motion and X-rays were evaluated in 27 patients (mean age of 60 years, range 37–83) with proximal humeral malunion who were treated with a stemless anatomic shoulder prosthesis.Results
In all patients, the prosthesis was implanted without the need for tuberosity osteotomy. The Constant score improved from 27 to 62 (p?≤?0.001), active anterior elevation from 81° to 129° (p?≤?0.001), and external rotation from 5° to 40° (p?≤?0.001). There was no evidence of radiological loosening.Conclusions
Use of a stemless anatomic shoulder prosthesis avoids the need for tuberosity osteotomy and certain surgical difficulties, even in cases of severe tuberosity malunion, and leads to good functional outcomes in the short term.3.
B. S. Werner J. Stehle A. Abdelkawi P. Plumhoff R. Hudek F. Gohlke 《Der Orthop?de》2017,46(12):1028-1033
Background
Cementless surface replacement of the shoulder represents an alternative to conventional stemmed anatomic prostheses. Glenoid erosion is a well-known complication in hemiarthroplasty. However, there is limited data concerning radiographic evaluation and prognostic factors for this phenomenon.Objectives
The aim of our study was to determine the development of glenoid erosion following shoulder resurfacing using a new measurement technique and detect potential prognostic factors.Materials and methods
We performed a retrospective analysis on 38 shoulders undergoing humeral head resurfacing with a mean follow-up of 65.4 ± 43 months. Clinical and radiographic evaluation followed a standardized protocol including pre- and postoperative Constant score, active range of motion, and X?rays in true anteroposterior view. Three independent observers performed measurements of glenoid erosion.Results
We found good interobserver reliability for glenoid erosion measurements (intraclass correlation coefficient [ICC] 0.74–0.78). Progressive glenoid erosion was present in all cases, averaging 5.5 ± 3.9?mm at more than 5 years’ follow-up. Male patients demonstrated increased glenoid bone loss within the first 5 years (p < 0.04). The mean Constant score improved to 55.4 ± 23.6 points at the latest follow-up. Younger age was correlated to increased functional outcome. Revision rate due to painful glenoid erosion was 37%.Conclusions
Glenoid erosion can be routinely expected in patients undergoing humeral head resurfacing. Painful glenoid erosion leads to deterioration in functional outcome and necessitates revision surgery in a high percentage of cases.4.
P. Magosch P. Habermeyer S. Lichtenberg M. Tauber F. Gohlke F. Mauch D. Boehm M. Loew F. Zeifang W. Pötzl 《Der Orthop?de》2017,46(12):1063-1072
Background
Anatomic shoulder arthroplasty in osteoarthritis with biconcave glenoid wear results in decreased functional results and a higher rate of early glenoid loosening.Aim
The aim of the data analysis of the German shoulder arthroplasty register was to clarify whether reverse shoulder arthroplasty can provide better functional results and a lower complication rate than anatomic arthroplasty in osteoarthritis with biconcave glenoid wear.Methods
The analysis included 1052 completely documented primary implanted arthroplasties with a minimum follow-up of 2 years. In 119 cases, a B2-type glenoid was present. Out of these cases, 86 were treated with an anatomic shoulder arthroplasty, and in 33 cases a reverse shoulder arthroplasty was implanted. The mean follow-up was 47.6 months.Results
The Constant score with its subcategories, as well as the active range of movement improved significantly after anatomic and after reverse shoulder arthroplasty.Discussion
We observed no difference in functional results between both types of arthroplasty; however, reverse arthroplasty showed a significant higher revision rate (21.2%) (3% glenoid loosening, 6% prosthetic instability) than anatomic shoulder arthroplasty (12.8%) (11.6% glenoid loosening, 1.2% prosthetic instability), whereas anatomic shoulder arthroplasty showed a higher rate of glenoid loosening. Functional and radiographic results of both types of arthroplasty are comparable with the results reported in the literature, although our analysis represents results from an implant registry (data pertaining to medical care quality).5.
Background
Posterior glenoid bone loss in primary glenohumeral osteoarthritis (GHOA) presents a challenge when considering replacement surgery. Results with anatomic shoulder arthroplasty are unpredictable due to posterior humeral instability and limited bone stock for glenoid component fixation.Objectives
To describe and evaluate the results of a “shaped” humeral head autograft with reverse shoulder arthroplasty (RSA) for the treatment of primary GHOA with significant posterior glenoid bone loss and an intact, functional rotator cuff.Materials and methods
We retrospectively reviewed 29 “shaped” humeral head autografts with RSA for the treatment of GHOA with B2 (n = 16), B3 (n = 10), or C (n = 3) glenoid morphology based on the Walch classification system. Average glenoid retroversion was 32.3°. Humeral head autografts were “shaped” to match each patient’s individual glenoid morphology. Functional outcome scores, range of motion, strength, and radiographic outcomes were evaluated.Results
At average follow-up of 34.6 months (range 23.7–88.9 months), significant improvements were seen in all functional outcome scores, ranges of motion, and strength (p <0.01). No recurrent instability or glenoid fixation failure occurred. Two complications (1 superficial and 1 deep infection) in 2 patients were identified. All autografts incorporated without radiographic evidence of loosening. Scapular notching was observed in 8 shoulders. No negative correlations were identified with glenoid morphology.Conclusions
“Shaped” humeral head autograft with RSA for the treatment of primary GHOA with significant posterior glenoid bone loss is associated with excellent clinical and radiographic outcomes and a low complication profile at short- to mid-term follow-up.6.
Background
Pyrocarbon (PyC) interposition shoulder arthroplasty can be used to treat advanced collapse of the humeral head after avascular necrosis.Objectives
We examined outcomes for this bone-preserving implant which has a PyC coating and a novel biomechanical concept.Materials and methods
For a minimum of 2 years, we followed 10 patients (4 men, 6 women, 55.6 ± 12.9 years) treated with a free interposition PyC arthroplasty (“snookerball”) due to advanced humeral head collapse but with an intact glenoid and rotator cuff. Anteroposterior radiographs, the Constant score (CS), adjusted CS, DASH score, and the EuroQol 5D–5L score from the preoperative and the latest follow-up presentation were compared.Results
At a mean of 3.6 years (±15 months), the mean absolute CS was 70.6 (±13.6; adjusted CS 81.4 ± 16.4), the DASH score was 25.6 (±16.1), the mean EQ subjective VAS score was 72.6 (±15.9), and the EQ index score was 0.9 (±0.11). Scores improved: CS: +63.2 ± 12.9; adjusted CS: +72.9 ± 15.5; DASH: +47.2 ± 14.7; EQ VAS: +42.6 ± 16.8; EQ index score +0.52 ± 0.23. Mean glenoid erosion was 1.4?mm (±1.3?mm), thinning of the tuberosities was ?0.8?mm (±3.3?mm), and superior migration of the implant was 2.0?mm (±2.2). A thin radiolucent zone around the implant with bone densification on the metaphyseal side was observed in all cases (mean 1.8?±?0.6?mm).Conclusions
Excellent improvement of function and quality of life which are comparable to total shoulder arthroplasty data were observed. Significant bone remodeling occurs in the metaphysis around the implant. Further studies are needed to evaluate longevity and applicability of the implant. These results indicate that advanced collapse of the humeral head with an intact glenoid and rotator cuff are an optimal indication for this implant.7.
C. L. Piccolo M. Galluzzo S. Ianniello M. Trinci A. Russo E. Rossi M. Zeccolini A. Laporta G. Guglielmi V. Miele 《Musculoskeletal surgery》2017,101(1):85-89
Purpose
Reverse shoulder arthroplasty becomes more widely used as treatment for patients with complex cuff arthropathy. Theoretically, a higher retroversion of the humeral component leads to an increase in external rotation ROM and a decrease in internal rotation ROM. There is no consensus in optimal retroversion orientation. We retrospectively describe the effect of retroversion of the humeral component. We hypothesize that 20° humeral retroversion improves postoperative ROM, strength or clinical outcome scores compared to neutral retroversion.Methods
A retrospective clinical study is performed. An Aequalis reverse shoulder prosthesis was placed in 65 shoulders from 58 patients with a mean age of 73.8 years (95% CI 72.0–75.6). Between October 2006 and May 2012, the humeral component was placed in neutral retroversion in 36 shoulders (55%). From June 2012 to June 2014, it was placed in 20° retroversion in 29 shoulders (45%). After a mean follow-up of 36 months with a minimum of 12 months, patients were invited for a study visit. ROM, strength, Constant-Murley and Oxford Scores were measured.Results
ROM, strength and Constant-Murley and Oxford Scores did not differ significantly between both groups.Conclusions
With the Aequalis prosthesis, no significant effect of 0° or 20° retroversion on external and internal rotation ROM, strength or functional outcome scores was found.8.
M. Tyrrell Burrus Jourdan M. Cancienne Jeffrey D. Boatright Scott Yang Stephen F. Brockmeier Brian C. Werner 《HSS journal》2018,14(1):2-8
Background
Humeral head avascular necrosis (AVN) of differing etiologies may lead to shoulder arthroplasty due to subchondral bone collapse and deformity of the articular surface. There have been no large studies evaluating the complications for these patients after they undergo total shoulder arthroplasty (TSA).Questions/Purposes
The first objective of this study is to evaluate the complication rate after TSA in patients with humeral head AVN. The secondary objective is to compare the complication rates among the different etiologies of the AVN.Methods
Patients who underwent TSA were identified in the PearlDiver database using ICD-9 codes. Patients who underwent shoulder arthroplasty for humeral head AVN were identified using ICD-9 codes and were subclassified according to AVN etiology (posttraumatic, alcohol use, chronic steroid use, and idiopathic). Complications evaluated included postoperative infection within 6 months, dislocation within 1 year, revision shoulder arthroplasty up to 8 years postoperatively, shoulder stiffness within 1 year, and periprosthetic fracture within 1 year and systemic complications within 3 months. Postoperative complication rates were compared to controls.Results
The study cohorts included 4129 TSA patients with AVN with 141,778 control TSA patients. Patients with posttraumatic AVN were significantly more likely to have a postoperative infection (OR 2.47, P < 0.001), dislocation (OR 1.45, P = 0.029), revision surgery (OR 1.53, P = 0.001), stiffness (OR 1.24, P = 0.042), and systemic complication (OR 1.49, P < 0.001). Steroid-associated AVN was associated with a significantly increased risk for a postoperative infection (OR 1.72, P = 0.004), revision surgery (OR 1.33, P = 0.040), fracture (OR 2.76, P = 0.002), and systemic complication (OR 1.59, P < 0.001). Idiopathic and alcohol-associated AVN were not significantly associated with any of the postoperative evaluated complications.Conclusions
TSA in patients with humeral head AVN is associated with significantly increased rates of numerous postoperative complications compared to patients without a diagnosis of AVN, including infection, dislocation, revision arthroplasty, stiffness, periprosthetic fracture, and medical complications. Specifically, AVN due to steroid use or from a posttraumatic cause appears to be associated with the statistically highest rates of postoperative TSA complications. Given these findings, orthopedic surgeons should be increasingly aware of this association, which should influence the shared decision-making process of undergoing TSA in patients with humeral head AVN.9.
Background
The treatment of proximal humeral fractures (PHF) is challenging. Recently, more restrictive displacement criteria have been introduced and the lack of treatment algorithms in the literature has been emphasized.Purpose
The primary purpose of this study was to evaluate the epidemiology and treatment reality of PHF at a specialized level-1 trauma center according to current displacement criteria. The secondary aim was to assess whether a standardized treatment algorithm can be adhered to during daily clinical routine.Methods
In all, 566 patients (71.4?% female; average age, 68.1 ± 15 years) with 569 PHF were included in this retrospective cohort study. All medical records and existing x?rays as well as computed tomography scans were analyzed. Only fractures with ad latus displacement of max 0.5 cm and/or a humeral head angulation of less than 20º were classified as nondisplaced. Patients with displaced fractures were included for evaluation of a standardized treatment algorithm.Results
The most common fracture type was a three-part fracture (39.9?%, n = 227); 70.9?% of fractures (389/569) were displaced and therefore treated operatively. The accordance between the final operative treatment that patients received and the recommended surgical treatment on the basis of the algorithm was 90.2?% (351/389).Conclusion
In contrast to the rate of 15?% dislocated fractures reported by Charles Neer in 1970, more than 70?% of fractures were found to be displaced when more restrictive displacement criteria were applied. More than 90?% of displaced fractures were treated as recommended by the treatment algorithm. Fractures that fitted the least into the treatment scheme were more complex fractures of patients aged 60 years and older.10.
S. A. Euler F. S. Kralinger C. Hengg M. Wambacher M. Blauth 《Operative Orthopadie und Traumatologie》2016,28(3):153-163
Objective
Achieve stable fixation to initially start full range of motion (ROM) and to prevent secondary displacement in unstable fracture patterns and/or weak and osteoporotic bone.Indications
(Secondarily) displaced proximal humerus fractures (PHF) with an unstable medial hinge and substantial bony deficiency, weak/osteoporotic bone, pre-existing psychiatric illnesses or patient incompliance to obey instructions.Contraindications
Open/contaminated fractures, systemic immunodeficiency, prior graft-versus-host reaction.Surgical technique
Deltopectoral approach. Identification of the rotator cuff. Disimpaction and reduction of the fracture, preparation of the situs. Graft preparation. Allografting. Fracture closure. Plate attachment. Definitive plate fixation. Radiological documentation. Postoperative shoulder fixation (sling).Postoperative management
Cryotherapy, anti-inflammatory medication on demand. Shoulder sling for comfort. Full active physical therapy as tolerated without pain. Postoperative radiographs (anteroposterior, outlet, and axial [as tolerated] views) and clinical follow-up after 6 weeks and 3, 6, and 12 months.Results
Bony union and allograft incorporation in 9 of 10 noncompliant, high-risk patients (median age 63 years) after a mean follow-up of 28.5 months. The median Constant–Murley Score was 72.0 (range 45–86). Compared to the uninjured contralateral side, flexion was impaired by 13?%, abduction by 14?%, and external rotation by 15?%. Mean correction of the initial varus displacement was 38° (51° preoperatively to 13° postoperatively).11.
Bakir Kadum Hamid Hassany Mats Wadsten Arkan Sayed-Noor Göran Sjödén 《International orthopaedics》2016,40(4):751-758
Purpose
The aim of this study was to investigate the ability of a stemless shoulder prosthesis to restore shoulder anatomy in relation to premorbid anatomy.Methods
This prospective study was performed between May 2007 and December 2013. The inclusion criteria were patients with primary osteoarthritis (OA) who had undergone stemless total anatomic shoulder arthroplasty. Radiographic measurements were done on anteroposterior X-ray views of the glenohumeral joint.Results
Sixty-nine patients (70 shoulders) were included in the study. The mean difference between premorbid centre of rotation (COR) and post-operative COR was 1?±?2 mm (range ?3 to 5.8 mm). The mean difference between premorbid humeral head height (HH) and post-operative HH was ?1?±?3 mm (range ?9.7 to 8.5 mm). The mean difference between premorbid neck-shaft angle (NSA) and post-operative NSA was ?3?±?12° (range ?26 to 20°).Conclusions
Stemless implants could be of help to reconstruct the shoulder anatomy. This study shows that there are some challenges to be addressed when attempting to ensure optimal implant positioning. The critical step is to determine the correct level of bone cut to avoid varus or valgus humeral head inclination and ensure correct head size.12.
Willems WF Kremer T Friedrich P Bishop AT 《Clinical orthopaedics and related research》2012,470(9):2496-2502
Background
Remodeling of structural bone allografts relies on adequate revascularization, which can theoretically be induced by surgical revascularization. We developed a new orthotopic animal model to determine the technical feasibility of axial arteriovenous bundle implantation and resultant angiogenesis.Questions/purposes
We asked whether arteriovenous bundles implanted in segmental allografts would increase cortical blood flow and angiogenesis compared to nonrevascularized frozen bone allografts and contralateral femoral controls.Methods
We performed segmental femoral allotransplantation orthotopically from 10 Brown Norway rats to 20 Lewis rats. Ten rats each received either bone allograft reconstruction alone (Group I) or allograft combined with an intramedullary saphenous arteriovenous flap (Group II). At 16 weeks, we measured cortical blood flow with the hydrogen washout method. We then quantified angiogenesis using capillary density and micro-CT vessel volume measurements.Results
All arteriovenous bundles were patent. Group II had higher mean blood flow (0.12 mL/minute/100 g versus 0.05 mL/minute/100 g), mean capillary density (23.6% versus 2.8%), and micro-CT vessel volume (0.37 mm3 versus 0.07 mm3) than Group I. Revascularized allografts had higher capillary density than untreated contralateral femora, while vessel volume did not differ and blood flow was lower.Conclusions
Axial surgical revascularization in orthotopic allotransplants can achieve strong angiogenesis and increases cortical bone blood flow.Clinical Relevance
Poor allograft revascularization results in frequent complications of nonunion, infection, and late stress fracture. The presented technique of surgical revascularization could therefore offer a beneficial adjunct to clinical segmental bone allografting.13.
Johannes B. Erhardt G. Roderer K. Grob T. N. Forster K. Stoffel M. S. Kuster 《Archives of orthopaedic and trauma surgery》2009,129(10):1367-1374
Objectives
We report early results using a second generation locking plate, non-contact bridging plate (NCB PH®, Zimmer Inc. Warsaw, IN, USA), for the treatment of proximal humeral fractures. The NCB PH® combines conventional plating technique with polyaxial screw placement and angular stability.Design
Prospective case series.Setting
A single level-1 trauma center.Patients
A total of 50 patients with proximal humeral fractures were treated from May 2004 to December 2005.Intervention
Surgery was performed in open technique in all cases.Main outcome measures
Implant-related complications, clinical parameters (duration of surgery, range of motion, Constant–Murley Score, subjective patient satisfaction, complications) and radiographic evaluation [union, implant loosening, implant-related complications and avascular necrosis (AVN) of the humeral head] at 6, 12 and 24 weeks.Results
All fractures available to follow-up (48 of 50) went to union within the follow-up period of 6 months. One patient was lost to follow-up, one patient died of a cause unrelated to the trauma, four patients developed AVN with cutout, one patient had implant loosening, three patients experienced cutout and one patient had an axillary nerve lesion (onset unknown). The average age- and gender-related Constant Score (n = 35) was 76.Conclusions
The NCB PH® combines conventional plating technique with polyaxial screw placement and angular stability. Although the complication rate was 19%, with a reoperation rate of 12%, the early results show that the NCB PH® is a safe implant for the treatment of proximal humeral fractures.14.
Luisa Marilena Schäck Jan-Dierk Clausen Sandra Noack Afif Harb Christian Krettek Claudia Neunaber 《Der Unfallchirurg》2017,120(11):918-926
Background
The clinical outcome of fresh allogeneic osteochondral allografts (OCA) is greatly dependent on the number of viable chondrocytes at the time of implantation. The selection and preparation of a suitable recipient can be very time-consuming and the number of tissue donors is greatly limited; therefore, the preservation of high allograft viability before transplantation is a focal point of current research.Objective
The objective of this review is to give an overview of established storage strategies for OCA and to serve as a decision-making aid for German clinics in the choice of a suitable storage strategy.Material and methods
A search of the literature published between January 2002 and May 2017 was independently performed by two persons with respect to original works on storage strategies of OCA with a focus on storage medium, use of fetal bovine serum, storage temperature and change of medium. A total of 20 suitable studies were selected for this review.Results
Based on the current studies a clearly superior storage solution could not be identified; however, storage at 4?°C seems to give better results with respect to cell viability than storage at 37?°C. High chondrocyte viability rates after 28 days of storage were also achieved using media without the addition of fetal bovine serum.Conclusion
A major difficulty in comparing the relevant studies on storage solutions is that multiple aspects in the study design varied between the studies. Due to this no definite conclusion on what the ideal storage strategy should look like could be drawn. Further studies are needed to conclusively show whether cell culture medium-based storage solutions are truly superior to those based on Ringer-lactate solutions.15.
Background
Reverse total shoulder arthroplasty (RTSA) provides reconstructive options in patients previously not candidates for total shoulder arthroplasty (TSA) or who have failed previous anatomic TSA. Revision from anatomic TSA to RTSA previously required removal of all components, a difficult and extensive procedure. Modular humeral components permit conversion from anatomic TSA to RTSA without removal of well-fixed humeral components.Questions/Purposes
Our purpose is to present a case series of patients treated for the unique and not previously reported complication of humeral tray-taper failure following modular RTSA. Challenges in diagnosis and treatment are described, including the use of dynamic fluoroscopy and manufacturer-specific instruments for component revision.Methods
Five patients with a total of six humeral tray-taper failures were identified from 300 patients with first-generation (titanium) humeral trays over a 7-year period. Dynamic fluoroscopic evaluation aided in diagnosis in a majority of the cases. All cases have been revised to second-generation (cobalt chrome) humeral trays.Results
Average follow-up was 22?±?23 months (range 3–60 months). One individual required a second revision for the same complication, but otherwise, no additional procedures were required. Symptom relief was obtained in all patients.Conclusions
This case series illustrates a previously unpublished complication of humeral tray-taper junction failure following modular RTSA. Clinical and radiographic diagnosis is challenging; however, dynamic fluoroscopic evaluation permits identification of the component failure, and revision surgery results in good outcomes. We must, however, continue to evaluate what activities are recommend for patients following shoulder arthroplasty, specifically reverse total shoulder arthroplasty.16.
Florian Dussing Fabian Plachel Teresa Grossauer Thomas Hoffelner Eva Schulz Arvind von Keudell Alexander Auffarth Philipp Moroder 《Obere Extremit?t》2018,13(3):211-217
Background
Recurrence rates after primary traumatic shoulder dislocation are distinctly high. We hypothesized that concomitant isolated fractures of the greater tuberosity are associated with low rates of persistent instability but decreased range of motion.Methods
Between 2007 and 2013, 66 consecutive shoulders in 64 patients were treated for primary shoulder dislocation combined with an isolated fracture of the greater tuberosity with either a nonsurgical (48 shoulders, 72.7%) or surgical (18 shoulders, 27.3%) treatment approach. In all, 55 cases (83.3%) were available for clinical follow-up examination after an average of 59.0?± 20.7 months (range: 25–96 months) and of these, 48 (72.7%) patients consented to radiological evaluation to determine healing and position of the greater tuberosity.Results
The mean range of motion of the affected shoulder was significantly decreased by 9° of elevation (p?=?0.016), 11° of abduction (p?=?0.048), 9° of external rotation in 0° of abduction (p?=?0.005), and 10° of external rotation in 90° of abduction (p?=?0.001), compared with the unaffected shoulder. The mean WOSI score was 373?± 486 points, the mean Constant and Murley score was 75.1?± 19.4 points, and the mean Rowe score was 83?± 20 points. Three cases (5.5%) of re-dislocation were reported among the cohort, all of them were due to a relevant trauma. Radiological evaluation revealed anatomically healed fragments in 31 shoulders (65%), dislocation of the fragment in ten shoulders (21%), impaction into the humeral head in four shoulders (8%), and absorption in three shoulders (6%).Conclusion
A concomitant isolated fracture of the greater tuberosity leads to low recurrence rates along with a significant decrease in range of motion after primary traumatic anterior shoulder dislocation.17.
Background
The treatment of patients with distal humeral fractures and reduced bone quality or complex fracture patterns is still complicated. Using angular stable implants should lead to better functional results.Objective
The clinical and functional results were analyzed as well as the complications after treatment of patients with distal humeral fractures using angular stable plate osteosynthesis.Material and methods
A questionnaire was sent to patients treated in our hospital for distal humeral fractures and they were invited for a follow-up examination. We investigated the DASH (Disability of the Arm, Shoulder and Head) score, Mayo Elbow Performance Score (MEPS) and EQ-5D-3?L for evaluation of functional results, as well as the VAS (“visuelle Analogskala”) score for evaluation of pain. Using radiographs the fracture patterns were classified and interpreted for complications.Results
A total of 28 patients returned the questionnaire after a minimum of 6 months following the operation and 10 attended a follow-up examination in our clinic. The DASH score was 38.40 and the MEPS 72.31. The results for 15 patients were good to excellent. The EQ-5D-3?L was 0.790 and the VAS 2.76. We found a significant correlation between the DASH score and patient age (p = 0.028), as well as an inverse correlation of the DASH score and the EQ-5D-3?L (p < 0.001). The complication rate was 53.6%. The three biggest groups of complications were neuronal complications, healing disorders and problems with the osteosynthesis material.Discussion
The treatment results showing that unsatisfactory results are possible even if angular stable plates are used. An inferior functional result as assessed by the DASH score reduces the quality of life measured by EQ-5D-3?L. A follow-up after 6 months appears to be sufficient to assess the outcome after complicated distal humeral fractures.18.
C. K. Spies B. Hohendorff L. P. Müller W. F. Neiss P. Hahn F. Unglaub 《Operative Orthopadie und Traumatologie》2016,28(3):204-217
Objective
Resection of the proximal carpal row, termed proximal row carpectomy (PRC), is performed in order to treat pathologies of the proximal carpal row or radiocarpal joint between the scaphoid and scaphoid facet. It entails the articulation of the capitate and the lunate facet.Indications
Lunate necrosis, carpal collapse, joint infection with concomitant intercarpal ligament lesions.Contraindications
Severe cartilage lesions of the lunate facet and the capitate, wrist capsule laxity, rheumatoid arthritis, neuromuscular dysbalance of the wrist-covering soft tissue structures.Surgical technique
Dorsal approach to the wrist, incision of the third and fourth extensor compartments, resection and coagulation of the dorsal interosseous nerve, usage of a ligament-sparing capsule incision, identification of the proximal carpal row and inspection of cartilage of the lunate facet and capitate, mobilization and excision of the lunate, scaphoid and triquetrum, articulation of lunate facet and capitate is controlled clinically and fluoroscopically, wound closure, application of plaster slabs.Postoperative management
Immobilization of the wrist on plaster slabs for 2 weeks, removal of sutures after 14 days.Results
PRC is a surgical procedure with few complications. Satisfactory range of motion and grip strength could be preserved without limiting function of the upper extremity. Postoperative osteoarthritis of capitate and lunate facet did not correlate with the good clinical outcome.19.
Objective
The aim of this systematic review is to show the feasibility and efficacy of operatively treated posttraumatic shoulder stiffness and to report on the implementation of a standardized treatment algorithm.Materials and methods
In January 2016, a systematic literature search of Medline (www.pubmed.com) was performed to identify studies with cohorts of patients with operatively treated posttraumatic shoulder stiffness. Studies were included according to predefined inclusion and exclusion criteria.Results
In total, nine studies with 191 patients were included. After a mean of 7 months (range: 3.7–12) of conservative treatment with pain medication and physiotherapy, surgery was performed. The mean follow-up was 24 months (range: 6–46). All studies showed an improvement in clinical scores or range of motion (ROM) on follow-up.Conclusion
To our knowledge, no previous systematic review of operatively treated posttraumatic shoulder stiffness has been published. Based on this systematic review, arthroscopic-guided or arthroscopic release of posttraumatic shoulder stiffness is an effective method to relieve pain and gain ROM. A clearly defined time until surgery does not exist and must be determined individually.20.
C. Neuerburg S. Mehaffey M. Gosch W. Böcker M. Blauth C. Kammerlander 《Operative Orthopadie und Traumatologie》2016,28(3):164-176