Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Jan 2009
Randomized Controlled Trial Multicenter StudyA multicenter, prospective, randomized, controlled trial of open reduction--internal fixation versus total elbow arthroplasty for displaced intra-articular distal humeral fractures in elderly patients.
We conducted a prospective, randomized, controlled trial to compare functional outcomes, complications, and reoperation rates in elderly patients with displaced intra-articular, distal humeral fractures treated with open reduction-internal fixation (ORIF) or primary semiconstrained total elbow arthroplasty (TEA). Forty-two patients were randomized by sealed envelope. Inclusion criteria were age greater than 65 years; displaced, comminuted, intra-articular fractures of the distal humerus (Orthopaedic Trauma Association type 13C); and closed or Gustilo grade I open fractures treated within 12 hours of injury. ⋯ TEA may result in decreased reoperation rates, considering that 25% of fractures randomized to ORIF were not amenable to internal fixation. TEA is a preferred alternative for ORIF in elderly patients with complex distal humeral fractures that are not amenable to stable fixation. Elderly patients have an increased baseline DASH score and appear to accommodate to objective limitations in function with time.
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J Shoulder Elbow Surg · Jan 2009
Comparative StudyTotal shoulder arthroplasty in patients with Parkinson's disease.
Currently, there is little information available on the results of total shoulder arthroplasty (TSA) in patients with Parkinson's disease. The purpose of the current study was to determine the results, risk factors for an unsatisfactory outcome, and rates of failure of TSA in patients with Parkinson's disease. Between 1978 and 2005, 49 total shoulder arthroplasties were performed in patients with Parkinson's disease for osteoarthritis of the shoulder. ⋯ Total shoulder arthroplasty is associated with significant long-term improvement in pain, external rotation, and abduction in patients with Parkinson's disease. However, early postoperative instability appears to be higher in this patient population. The results of TSA in our patients with Parkinson's disease were marginal, with 20 (47%) achieving unsatisfactory results.