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.
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J Shoulder Elbow Surg · Nov 2008
Subacromial pain pump use with arthroscopic shoulder surgery: a short-term prospective study of complications in 583 patients.
Pain pumps containing local anesthetics, with or without opioids, can be used for perioperative analgesia after arthroscopic shoulder surgery to reduce pain. Although several smaller studies have demonstrated the analgesic properties, no large series to date has reported the short-term complication rate of subacromial pain pumps. We prospectively studied (2005 to 2007) 583 patients who underwent arthroscopic shoulder surgery at a single outpatient surgery center and had intraoperative placement of a pain pump catheter into the subacromial space. ⋯ There were no cases of infection, internal catheter breakage, pump failure, or hospital admission for pain control. The only complication was external catheter breakage that occurred when a patient attempted to remove the pump without removing the tape fastening the catheter at the skin. Subacromial pain pumps used for arthroscopic shoulder procedures are safe in the short-term.
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J Shoulder Elbow Surg · Sep 2008
Hemiarthroplasty and total shoulder arthroplasty for avascular necrosis of the humeral head.
The purpose of this study was to review the outcome of patients with osteonecrosis of the humeral head, based on etiology and treatment with either hemiarthroplasty or total shoulder arthroplasty (TSA). Sixty-four shoulders, with an average age of 57 years, were evaluated at a mean of 4.8 years. Outcomes included L'Insalata and American Shoulder and Elbow Surgeons (ASES) scores, as well as range of motion (ROM). ⋯ The complication rate was significantly higher with TSA (22%) than with hemiarthroplasty (8%). Achieving ROM in patients with post-traumatic osteonecrosis remains difficult. TSA was associated with a higher complication rate and decreased mobility and should be reserved for patients with stage V osteonecrosis.