Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Dec 2012
Comparative StudyThe influence of ultrasound guidance in the rate of success of acromioclavicular joint injection: an experimental study on human cadavers.
Injections of the acromioclavicular joint (ACJ) are performed routinely in patients with ACJ arthritis, both diagnostically and therapeutically. The aim of this prospective controlled study was to estimate the frequency of successful intra-articular ACJ injections with the aid of sonographic guidance versus non-guided ACJ injections. ⋯ The use of ultrasound significantly improves the accuracy of ACJ injection.
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J Shoulder Elbow Surg · Dec 2012
Comparative StudyClosed reduction techniques in acute anterior shoulder dislocation: modified Milch technique compared with traction-countertraction technique.
To perform closed manual reduction of acute anterior shoulder dislocation using the traction-countertraction technique requires sedation (TCTS) and the participation of 2 people. We studied the modified Milch (MM) technique, a positional reductive maneuver that requires 1 operator, without patient sedation or analgesia. ⋯ The results showed that the Milch technique was effective, safe, shortened hospital stay, and was well tolerated. We recommend the modified Milch technique as a first-line maneuver for acute anterior shoulder dislocations without associated fractures.
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J Shoulder Elbow Surg · Dec 2012
ReviewEvaluation of the osteoporotic proximal humeral fracture and strategies for structural augmentation during surgical treatment.
Fractures of the proximal humerus are relatively common injuries in the elderly population. Given the association between proximal humeral fractures and osteoporosis, elderly patients who sustain these injuries should always undergo a fragility fracture workup. ⋯ Optimal management of osteoporotic proximal humeral fractures has evolved and may now includes use of locking plates and augmentation with intramedullary fibular grafts, calcium phosphate or sulfate cement, and iliac crest bone graft. This article reviews the demographics of patients who sustain proximal humerus fractures, the appropriate postinjury fragility fracture workup, modalities for quantifying osteoporosis in the proximal humerus, techniques for augmenting fixation of proximal humerus fractures, and the authors' preferred approach to the treatment of these injuries.
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The number of times an article has been cited has been used as a marker of its influence in a medical specialty. The purpose of this study was to determine the 50 most cited articles in shoulder surgery and their characteristics. ⋯ Articles that introduced instruments for outcome evaluation or that introduced classification systems (methodologic) were highly cited regardless of the date of publication. The top 50 list presented provides residency and fellowship directors with a group of "classic" articles in the subspecialty of orthopedic shoulder surgery that can be included in reading curriculums for their trainees.
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J Shoulder Elbow Surg · Dec 2012
Comparative StudyChange in labrum height after arthroscopic Bankart repair: correlation with preoperative tissue quality and clinical outcome.
Arthroscopic factors, such as labral and capsular tissue quality or anterior labral periosteal sleeve avulsion (ALPSA) lesion, affect postoperative labral height stability. Labral height stability has a correlation with clinical outcome. ⋯ The patients with less labral height decrease between 3 months and 1 year or higher labral height at 1 year postoperatively showed higher Rowe scores at 1 year postoperatively. Shoulders with ALPSA lesions, Hill-Sachs lesions, and a poor labrum with poor capsular tissue quality correlated more strongly with postoperative labral height decrease.