Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Mar 2014
Clinical outcomes of reverse total shoulder arthroplasty in patients aged younger than 60 years.
Reverse total shoulder arthroplasty (RTSA) has been indicated primarily for patients aged older than 65 years with symptomatic rotator cuff deficiency, poor function, and pain. However, conditions that benefit from RTSA are not restricted to an elderly population. This study evaluates a consecutive series of RTSA patients aged younger than 60 years. ⋯ RTSA can improve shoulder function in a younger, complex patient population with poor preoperative functional ability. This study's success rate was 75% at 2.8 years. This is a limited-goals procedure, and longer-term studies are required to determine whether similar results are maintained over time.
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J Shoulder Elbow Surg · Mar 2014
A new "virtual" patient pathway for the management of radial head and neck fractures.
Minimally displaced radial head and neck fractures are common and the outcome with conservative treatment is generally excellent. A new protocol was introduced to manage patients with these suspected fractures at a major urban hospital. Simple, undisplaced fractures without other associated injuries or instability were discharged with structured advice but no further face-to-face review. Patients with more complex injuries were reviewed at a "virtual clinic." The aim of this study was to examine the outcome of this process in terms of patient flow, satisfaction, reattendance, and reintervention. ⋯ In this study, patients with suspected Mason I or II fractures were managed with limited face-to-face follow-up with high satisfaction rates. The reintervention rate was extremely low. This process has significant benefits to patients, who have fewer hospital visits, and to orthopaedic departments, which have more time to devote to complex cases.
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J Shoulder Elbow Surg · Mar 2014
Acute lateral dislocated clavicular fractures: arthroscopic stabilization with TightRope.
Type IIA, IIB, and V lateral clavicular fractures (Craig modification of the Neer classification) are characterized by a constant displacement and are associated with a high rate of nonunion. The aim of this study is to verify whether the reduction and arthroscopic stabilization of these clavicular fractures with coracoclavicular cerclage provide stable fixation to allow for bone healing. To date, the treatment of these fractures is still controversial in young active patients in whom functional requirements are to be met. ⋯ The arthroscopic procedure with the TightRope allows for fracture healing with no loss of reduction in the acromioclavicular joint and full return to everyday activities.
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J Shoulder Elbow Surg · Mar 2014
Randomized Controlled TrialEfficacy of axillary nerve block in elbow arthroscopic surgery: a randomized trial.
The purpose of this study was to evaluate postoperative pain levels after arthroscopic elbow surgery under general anesthesia and to determine whether an axillary nerve block provides additional pain management benefits compared with a portal site injection of local anesthetic. ⋯ Postoperative pain levels after arthroscopic elbow surgery could be well managed with oral analgesics and local anesthetic. An axillary nerve block was not found to provide any postoperative pain control benefits.
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J Shoulder Elbow Surg · Mar 2014
Randomized Controlled Trial Comparative StudyProximal humerus nailing: a randomized clinical trial between curvilinear and straight nails.
Intramedullary nailing of displaced proximal humerus fractures is an attractive option in the elderly patient. However, in recent reports, some existing intramedullary nails have shown high rate of complications, so new designs are being developed. The objective of the present study is to report on outcomes and complications when comparing a straight to a curvilinear nail design. ⋯ Straight intramedullary nails had a comparable union rate to an accepted curvilinear design, with a much lower incidence of complications. Rotator cuff pain and dysfunction can be minimized with the use of newer generation straight nails.