Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Oct 2012
Comparative StudyRadial head reconstruction versus replacement in the treatment of terrible triad injuries of the elbow.
Dislocation of the elbow with associated fractures of the radial head and the coronoid process of the ulna have been referred to as the terrible triad of the elbow because of the difficulties in treating this injury and the poor outcomes. ⋯ Elbow fracture-dislocations are difficult injuries to treat. Our study shows that with operative repair or replacement of the radial head to restore stability through radiocapitellar contact, coronoid, and lateral ligament repair, good range of movement and stability can be achieved at short-term follow-up.
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J Shoulder Elbow Surg · Oct 2012
Comparative StudyRotator cuff injury as a complication of portal placement for superior labrum anterior-posterior repair.
An accessory trans-rotator cuff portal is commonly used in shoulder arthroscopy, primarily in the repair of SLAP (superior labrum anterior-posterior) lesions. Improper placement of the trans-rotator cuff portal can result in damage to the rotator cuff near its attachment site. ⋯ Proper placement of a trans-rotator cuff portal should be performed cautiously, traversing the rotator cuff medial to the muscle-tendon junction. This report highlights the potential for injury to the rotator cuff tendons with improper placement of this portal. In patients with persistent pain after previous SLAP repair with a trans-rotator cuff portal technique, rotator cuff injury may be the source of symptoms. Revision surgery with rotator cuff repair can provide improvement.
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J Shoulder Elbow Surg · Oct 2012
Comparative StudyA biomechanical comparison of multidirectional nail and locking plate fixation in unstable olecranon fractures.
The main theoretic advantage of proximal olecranon fracture intramedullary fixation is decreased soft-tissue irritation and, potentially, less subsequent hardware removal. Despite this possible benefit, questions remain as to whether intramedullary devices are capable of controlling olecranon fractures to the same extent as locking plates. This study evaluates the ability of a novel multidirectional locking nail to stabilize comminuted fractures and directly compares its biomechanical performance with that of locking olecranon plates. ⋯ In simulated comminuted olecranon fractures, the multidirectional locking intramedullary nails sustained significantly higher maximum loads than the locking plates. The two implants showed no significant differences in fragment control or number of cycles survived. Surgeons can expect the multidirectional locking nails to stabilize comminuted fractures at least as well as locking plates.
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J Shoulder Elbow Surg · Oct 2012
Comparative StudyReverse total shoulder arthroplasty for cuff tear arthropathy: the clinical effect of deltoid lengthening and center of rotation medialization.
Reverse total shoulder arthroplasty (RSA) for cuff tear arthropathy improves shoulder function and reduces pain. Implant position and soft tissue balancing are important factors to optimize outcome. Tensioning the deltoid and increasing the deltoid moment arm by medializing the center of rotation are biomechanically advantageous. The purpose of this study was to correlate RSA functional outcomes with deltoid lengthening and center of rotation medialization. ⋯ Deltoid lengthening improves active forward elevation after RSA for cuff tear arthropathy.
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J Shoulder Elbow Surg · Oct 2012
Comparative StudyTemporary joint-spanning external fixation before internal fixation of open intra-articular distal humeral fractures: a staged protocol.
This study determined outcomes after temporary joint-spanning external fixation before internal fixation of open intra-articular distal humeral fractures. ⋯ Temporary joint-spanning external fixation before internal fixation of open intra-articular distal humeral fractures is a safe adjunct.