Journal of shoulder and elbow surgery
-
J Shoulder Elbow Surg · Aug 2014
The effect of surgeon and hospital volume on shoulder arthroplasty perioperative quality metrics.
There has been a significant increase in both the incidence of shoulder arthroplasty and the number of surgeons performing these procedures. Literature regarding the relationship between surgeon or hospital volume and the performance of modern shoulder arthroplasty is limited. This study examines the effect of surgeon or hospital shoulder arthroplasty volume on perioperative metrics related to shoulder hemiarthroplasty, total shoulder arthroplasty, and reverse shoulder arthroplasty. Blood loss, length of stay, and operative time were the main endpoints analyzed. ⋯ Higher surgeon and hospital case volumes led to improved perioperative metrics with all shoulder arthroplasty procedures, including reverse total shoulder arthroplasty, which has not been previously described in the literature. Surgeon volume had a larger effect on metrics than hospital volume did. This study supports the concept that complex shoulder procedures are, on average, performed more efficiently by higher volume surgeons in higher volume centers.
-
J Shoulder Elbow Surg · Aug 2014
Long-term functional outcomes (median 10 years) after locked plating for displaced fractures of the proximal humerus.
Locked plating has become an accepted treatment for displaced fractures of the proximal humerus. However, to our knowledge, long-term outcomes have not been reported. ⋯ Ten years after locked plating of displaced proximal humeral fractures, patients show good to excellent outcomes in the majority of cases with no relevant decline compared with the shoulder function 1 year after surgery. However, poor long-term outcome is seen in 16% of patients and relates to a low CS 1 year after surgery. Thus, patients developing poor long-term outcomes may be identified at an earlier stage.
-
J Shoulder Elbow Surg · Aug 2014
Factors influencing K-wire migration in tension-band wiring of olecranon fractures.
Tension-band wiring is a popular method of internal fixation for simple olecranon fractures. Although fracture union rates and clinical outcomes are good, up to 80% of patients require removal because of prominent/symptomatic metalwork. The current literature remains unclear as to the best orientation of the longitudinal wires to minimize hardware failure. The aim of this study was to determine the surgically modifiable factors related to spontaneous wire pullout. ⋯ To minimize postoperative pullout of wires, we suggest anatomic reduction and transcortical wire orientation, without bending, in the subchondral bone close to the articular surface.
-
J Shoulder Elbow Surg · Aug 2014
Biomechanical effects of humeral neck-shaft angle and subscapularis integrity in reverse total shoulder arthroplasty.
The variability in functional outcomes and the occurrence of scapular notching and instability after reverse total shoulder arthroplasty remain problems. The objectives of this study were to measure the effect of reverse humeral component neck-shaft angle on impingement-free range of motion, abduction moment, and anterior dislocation force and to evaluate the effect of subscapularis loading on dislocation force. ⋯ The 155° neck-shaft angle was more prone to scapular bone contact during adduction but was more stable at the internally rotated position, which was the least stable humeral rotation position. Subscapularis loading gave further anterior stability with all neck-shaft angles at all positions.