Shoulder & Elbow Journal Scan

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Classification of postoperative acromial fractures following reverse shoulder arthroplasty.

J Bone Joint Surg Am. 2013 Aug 7;95(15):e1041-7

Authors: Levy JC, Anderson C, Samson A

Abstract
BACKGROUND: Acromial fractures following reverse shoulder arthroplasty are difficult to identify and have variable effects on outcomes. A reproducible classification system is needed to categorize these fractures before it is possible to evaluate optimal treatment. The purposes of this study were to investigate the ability of radiographs to detect acromial fractures and establish fracture union, and to assess the reliability of a new classification system of postoperative acromial fractures based on the involvement of the deltoid origin.
METHODS: Eighteen patients presenting with pain along the acromion or scapular spine following reverse shoulder arthroplasty were evaluated for acromial fractures over a period of fifty-six months. If radiographic findings were negative, computed tomography (CT) scans were performed. Sixteen acromial fractures were identified and classified into subtypes on the basis of the deltoid muscle origin: type I indicated involvement of a portion of the anterior and middle deltoid origin; type II, at least the entire middle deltoid origin with a portion but not all of the posterior deltoid origin; and type III, the entire middle and posterior deltoid origin. The average age of the patients at the time of surgery was seventy-seven years (range,

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Medium to long-term outcome of thoracoscapular arthrodesis with screw fixation for facioscapulohumeral muscular dystrophy.

J Bone Joint Surg Am. 2013 Aug 7;95(15):1404-8

Authors: Van Tongel A, Atoun E, Narvani A, Sforza G, Copeland S, Levy O

Abstract
BACKGROUND: Shoulder girdle muscle weakness is the most constant feature of facioscapulohumeral muscular dystrophy and leads to scapular winging. Mechanical fixation of the scapula to the thoracic wall provides a stable fulcrum on which the deltoid muscle can exert its action on the humerus. The aim of this study was to evaluate the medium to long-term outcome of thoracoscapular arthrodesis with screw fixation (the modified Howard-Copeland technique).
METHODS: All patients with facioscapulohumeral dystrophy who underwent thoracoscapular arthrodesis with screw fixation and bone-grafting from July 1997 to July 2010 were retrospectively reviewed. Preoperative and postoperative clinical assessment included active shoulder elevation, the Constant score, a patient satisfaction score, and cosmetic satisfaction. Union was determined both clinically and radiographically.

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Glenoid component retroversion is associated with osteolysis.

J Bone Joint Surg Am. 2013 Jun 19;95(12):e82

Authors: Ho JC, Sabesan VJ, Iannotti JP

Abstract
BACKGROUND: It has been suggested that glenoid component retroversion and eccentric loading are an important mechanism leading to glenoid component loosening, but little clinical data have been published to support this concept.
METHODS: Sixty-six shoulders underwent total shoulder replacement with an all-polyethylene press-fit pegged glenoid component designed for osseous ingrowth for treatment of osteoarthritis. These shoulders were followed clinically and with radiographs for an average (and standard deviation) of 3.8 ± 1.8 years (range, two to seven years). Preclinical radiographic loosening was defined as osteolysis around the central peg of the glenoid component.
RESULTS: Of the sixty-six shoulders, twenty (30%) had osteolysis around the center peg. The length of time after replacement (p = 0.0006), preoperative glenoid retroversion (p = 0.036), and postoperative glenoid component retroversion (p = 0.041) were correlated with osteolysis around the glenoid center peg and an increase in the Lazarus component loosening grade. Postoperative retroversion correlated with preoperative retroversion (Pearson correlation coefficient = 0.44, 95% confidence interval [CI] = 0.19 to 0.64, p = 0.0011). The presence of osteolysis around the center peg was not correlated with a worse clinical

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Published evidence demonstrating the causation of glenohumeral chondrolysis by postoperative infusion of local anesthetic via a pain pump.

J Bone Joint Surg Am. 2013 Jun 19;95(12):1126-34

Authors: Matsen FA, Papadonikolakis A

Abstract
BACKGROUND: Glenohumeral chondrolysis is the irreversible destruction of previously normal articular cartilage, occurring most commonly after shoulder surgery in young individuals. The reported incidence of this complication has risen rapidly since the early 2000s. As chondrolysis cannot be reversed, its occurrence can only be prevented by establishing and avoiding its causes.
METHODS: We analyzed all published cases of glenohumeral chondrolysis, including the relevant published laboratory data, to consolidate the available evidence on the causation of this complication by the postoperative intra-articular infusion of local anesthetic via a pain pump.
RESULTS: Analysis of the published evidence demonstrated a causal relationship between the infusion of local anesthetic and the development of glenohumeral chondrolysis. The risk of this complication in shoulders receiving intra-articular infusions via a pain pump was significantly greater with higher doses of local anesthetic: twenty of forty-eight shoulders receiving high-flow infusions developed chondrolysis, whereas only two of twenty-five shoulders receiving low-flow infusions developed this complication (p = 0.0029). Eleven of twenty-two shoulders receiving

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Allograft-prosthetic composite reconstruction for massive bone loss including catastrophic failure in total elbow arthroplasty.

J Bone Joint Surg Am. 2013 Jun 19;95(12):1117-24

Authors: Morrey ME, Sanchez-Sotelo J, Abdel MP, Morrey BF

Abstract
INTRODUCTION: Revision total elbow arthroplasty with an allograft-prosthetic composite is a difficult salvage procedure due to massive bone loss and a compromised soft-tissue envelope. High failure rates in prior studies of patients treated with allograft-prosthetic composites and an increased burden of revision total elbow arthroplasties necessitate optimized reconstructive techniques to improve incorporation of allograft-prosthetic composites. The goal of this report is to describe novel techniques for, and outcomes of, reconstructions done with an allograft-prosthetic composite.

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Medial ulnar collateral ligament reconstruction using hamstring allograft in overhead throwing athletes.

J Bone Joint Surg Am. 2013 Jun 19;95(12):1062-6

Authors: Savoie FH, Morgan C, Yaste J, Hurt J, Field L

Abstract
BACKGROUND: Currently, several graft options have been described for reconstruction of the medial ulnar collateral ligament of the elbow. Palmaris longus, gracilis, plantaris, toe extensor, and even Achilles tendon autografts have been well documented. To our knowledge, no study has investigated the clinical outcomes following the use of allograft tendon for primary medial ulnar collateral ligament reconstruction. It is our hypothesis that medial ulnar collateral ligament reconstruction with hamstring allograft provides results similar to those reported with autograft without the potential complication or risk of donor-site morbidity.
METHODS: We retrospectively reviewed the records for 123 overhead throwing athletes with medial ulnar collateral ligament injuries who had had unsuccessful nonoperative treatment. All patients were managed with reconstruction with use of a hamstring allograft and were followed for a minimum of twenty-four months. One hundred and sixteen of the 123 patients were contacted and were included in our study. Outcome measures included Conway-Jobe rating scale, the mean time to return to play, the maximum level of competition, and overall satisfaction with the reconstruction.

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The assessment of scapular radiographs: Analysis of anteroposterior radiographs of the shoulder and the effect of rotational offset on the glenopolar angle.

Bone Joint J. 2013 Aug 1;95-B(8):1114-1120

Authors: Wijdicks CA, Anavian J, Hill BW, Armitage BM, Vang S, Cole PA

Abstract

Related Articles

Reverse shoulder arthroplasty in patients with pre-operative impairment of the deltoid muscle.

Bone Joint J. 2013 Aug 1;95-B(8):1106-1113

Authors: Lädermann A, Walch G, Denard PJ, Collin P, Sirveaux F, Favard L, Edwards TB, Kherad O, Boileau P

Abstract

Related Articles

A new radiological method to detect dorsally penetrating screws when using volar locking plates in distal radial fractures: The dorsal horizon view.

Bone Joint J. 2013 Aug 1;95-B(8):1101-1105

Authors: Haug LC, Glodny B, Deml C, Lutz M, Attal R

Abstract
Penetration of the dorsal screw when treating distal radius fractures with volar locking plates is an avoidable complication that causes lesions of the extensor tendon in between 2% and 6% of patients. We examined axial fluoroscopic views of the distal end of the radius to observe small amounts of dorsal screw penetration, and determined the ideal angle of inclination of the x-ray beam to the forearm when making this radiological view. Six volar locking plates were inserted at the wrists of cadavers. The actual screw length was measured under direct vision through a dorsal approach to the distal radius. Axial radiographs were performed for different angles of inclination of the forearm at the elbow. Comparing axial radiological measurements and real screw length, a statistically significant correlation could be demonstrated at an angle of inclination between 5° and 20°. The ideal angle of inclination required to minimise the risk of implanting over-long screws in a dorsal horizon radiological view is 15°. Cite this article: Bone Joint J 2013;95-B:1101-5.

PMID: 23908427 [PubMed - as supplied by publisher]

Read more... http://www.ncbi.nlm.nih.gov/pubmed/23908427?dopt=Abstract