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Revision arthroplasty with a hip-inspired computer-assisted design/computer-assisted manufacturing implant for glenoid-deficient shoulders.

J Shoulder Elbow Surg. 2013 Jul 10;

Authors: Uri O, Beckles V, Falworth M, Higgs D, Lambert S

Abstract
BACKGROUND: Revision arthroplasty for failed post-traumatic humeral head replacement associated with rotator cuff and glenoid deficiency is challenging. Current surgical solutions are fraught with complications, and no best-practice strategy has been established. We hypothesized that the computer-assisted design/computer-assisted manufacturing (CAD/CAM) shoulder (Stanmore Implants, Elstree, UK), a total shoulder design resembling a total hip prosthesis, can offer a reliable alternative in this surgically challenging subset of patients with rotator cuff deficiency and advanced glenoid bone loss.
METHODS: Twenty-one patients with failed post-traumatic humeral head replacement associated with rotator cuff and glenoid deficiency underwent revision with CAD/CAM shoulders between 2005 and 2010. Clinical data were collected prospectively and analyzed at a mean follow-up of 3 years.

Hemiarthroplasty for Head-split Fractures of the Proximal Humerus.

Orthopedics. 2013 Jul 1;36(7):e905-11

Authors: Greiwe RM, Vargas-Ariza R, Bigliani LU, Levine WN, Ahmad CS

Abstract

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Decision-making in the treatment of diaphyseal clavicle fractures: is there agreement among surgeons? Results of a survey on surgeons' treatment preferences.

J Shoulder Elbow Surg. 2013 Jul 6;

Authors: Heuer HJ, Boykin RE, Petit CJ, Hardt J, Millett PJ

Abstract
BACKGROUND AND HYPOTHESIS: Nonoperative treatment is standard for most diaphyseal clavicle fractures, but recent studies have demonstrated improved outcomes with operative treatment of displaced fractures. The objectives of this diagnostic study were to assess agreement of orthopaedic surgeons regarding their treatment preferences for diaphyseal clavicle fractures and to compare them with recent recommendations. Interobserver and intraobserver agreement in treatment decisions were hypothesized to be only slight.
METHODS: Anonymized case vignettes of 50 acute diaphyseal clavicle fractures including medical history, physical examination findings, and radiographs were independently reviewed by 32 orthopaedic surgeons from the United States. Four treatment options were offered and decisions were compared with current treatment recommendations. Interobserver agreement was calculated using Fleiss' kappa coefficient. Average intraobserver agreement for surgeons who completed a retest review (minimum interval of 8 weeks) was calculated.
RESULTS: Thirty-two surgeons completed the first round of reviewing and 27 completed the retest (mean interval, 22 weeks). Interobserver

Superior versus anteroinferior plating of clavicle fractures.

Orthopedics. 2013 Jul 1;36(7):e898-904

Authors: Formaini N, Taylor BC, Backes J, Bramwell TJ

Abstract

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Advantages of Arthroscopic Transosseous Suture Repair of the Rotator Cuff without the Use of Anchors.

Clin Orthop Relat Res. 2013 Jul 9;

Authors: Kuroda S, Ishige N, Mikasa M

Abstract
BACKGROUND: Although arthroscopic anchor suturing is commonly used for rotator cuff repair and achieves good results, certain shortcomings remain, including difficulty with reoperation in cases of retear, anchor dislodgement, knot impingement, and financial cost. In 2005, we developed an anchorless technique for arthroscopic transosseous suture rotator cuff repair.
DESCRIPTION OF TECHNIQUE: After acromioplasty and adequate footprint decortication, three K-wires with perforated tips are inserted through the inferior margin of the greater tuberosity into the medial edge of the footprint using a customized aiming guide. After pulling the rotator cuff stump laterally with a grasper, three K-wires are threaded through the rotator cuff and skin. Thereafter, five Number 2 polyester sutures are passed through three bone tunnels using the perforated tips of the K-wires. The surgery is completed by inserting two pairs of mattress sutures and three bridging sutures.

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Prolonged incubation time does not increase sensitivity for the diagnosis of implant-related infection using samples prepared by sonication of the implants.

Bone Joint J. 2013 Jul;95-B(7):1001-6

Authors: Esteban J, Alvarez-Alvarez B, Blanco A, Fernández-Roblas R, Gadea I, Garcia-Cañete J, Sandoval E, Valdazo M

Abstract
We have designed a prospective study to evaluate the usefulness of prolonged incubation of cultures from sonicated orthopaedic implants. During the study period 124 implants from 113 patients were processed (22 osteosynthetic implants, 46 hip prostheses, 54 knee prostheses, and two shoulder prostheses). Of these, 70 patients had clinical infection; 32 had received antibiotics at least seven days before removal of the implant. A total of 54 patients had sonicated samples that produced positive cultures (including four patients without infection). All of them were positive in the first seven days of incubation. No differences were found regarding previous antibiotic treatment when analysing colony counts or days of incubation in the case of a positive result. In our experience, extending incubation of the samples to 14 days does not add more positive results for sonicated orthopaedic implants (hip and knee prosthesis and osteosynthesis implants) compared with a conventional seven-day incubation period. Cite this article: Bone Joint J 2013;95-B:1001-6.

PMID: 23814257 [PubMed - in process]

Read more... http://www.ncbi.nlm.nih.gov/pubmed/23814257?dopt=Abstract

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Durability of partial humeral head resurfacing.

J Shoulder Elbow Surg. 2013 Jul 5;

Authors: Delaney RA, Freehill MT, Higgins LD, Warner JJ

Abstract
BACKGROUND: Partial humeral head resurfacing arthroplasty uses a stemless device, which conserves bone and restores normal anatomy. We hypothesized that this does not offer a reasonable alternative to full resurfacing or total shoulder arthroplasty.
METHODS: We performed a retrospective study of 39 shoulders with focal chondral defects of the humeral head treated with partial resurfacing arthroplasty. A minimum of 2 years' follow-up was reported, unless failure and operative intervention superseded this duration. The mean follow-up period was 51.3 months. The mean age was 45.6 years (range, 27-76 years). Preoperative and postoperative evaluation included history, physical examination, radiographs, and clinical scoring with the American Shoulder and Elbow Surgeons Shoulder Score Index and Subjective Shoulder Value.
RESULTS: Of the 39 shoulders, 25 (64.1%) showed functional improvement and decreased pain. Significant mean improvements were observed in forward flexion (121° to 152°, P = .002), external rotation (37° to 58°, P = .0003), mean Subjective Shoulder Value (31% to 74%, P < .0001), and ASES score (29 to 70, P < .0001). However, at a mean of 26.6 months' follow-up, the failure group included 6 patients (15.3%) who underwent revision and another 4 (10.2%) who

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Under-coracoid-around-clavicle (UCAC) loop in type II distal clavicle fractures.

Bone Joint J. 2013 Jul;95-B(7):983-7

Authors: Soliman O, Koptan W, Zarad A

Abstract

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Analysis of arm elevation muscle activity through different movement planes and speeds during in-water and dry-land exercise.

J Shoulder Elbow Surg. 2013 Jul 5;

Authors: Castillo-Lozano R, Cuesta-Vargas A, Gabel CP

Abstract
OBJECTIVE: The objectives of this cross-sectional, analytical inference analysis were to compare shoulder muscle activation at arm elevations of 0° to 90° through different movement planes and speeds during in-water and dry-land exercise and to extrapolate this information to a clinical rehabilitation model.
METHODS: Six muscles of right-handed adult subjects (n = 16; males/females: 50%; age: 26.1 ± 4.5 years) were examined with surface electromyography during arm elevation in water and on dry land. Participants randomly performed 3 elevation movements (flexion, abduction, and scaption) through 0° to 90°. Three movement speeds were used for each movement as determined by a metronome (30°/sec, 45°/sec, and 90°/sec). Dry-land maximal voluntary contraction tests were used to determine movement normalization.