Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Jan 2008
Multicenter Study Comparative StudyThe surgical approach for locking plate osteosynthesis of displaced proximal humeral fractures influences the functional outcome.
This study evaluated the influence of the surgical approach for locking plate osteosynthesis in proximal humeral fractures during a 1-year period. We performed a comparative study in 83 patients to evaluate possible benefits for an early functional result for function, pain, activity levels, radiographic evaluation, and complications. In 39 cases, the extended anterolateral deltoid-splitting approach was used (group DS); in 44 cases, the deltopectoral approach was used (group DP). ⋯ One case of avascular necrosis was observed in group DS and 3 in group DP. We conclude that the choice of approach for exposure of the proximal humerus region may influence the functional outcome. Stable osteosynthesis is important, but the outcome of operatively treated proximal humerus fractures is dependent on soft tissue management as well.
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J Shoulder Elbow Surg · Jan 2008
Multicenter StudyA method for internal fixation of unstable distal clavicle fractures: early observations using a new technique.
Unstable distal clavicle fractures often require open reduction and internal fixation. A variety of fixation methods have been used and are currently in use. None of the current fixation methods seem to be without problems. We present a new technique and early observations using a distal radius locking T-plate normally used for fixation of distal radius fractures.
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J Shoulder Elbow Surg · Jan 2008
Randomized Controlled TrialExtracorporeal shock wave therapy for calcifying tendinitis of the shoulder.
We prospectively studied extracorporeal shock wave therapy (ESWT) for calcific tendinitis of the shoulder in 46 consecutive patients. All patients were randomly divided into 2 groups: treatment and control. The 33 patients in the treatment group received 2 courses of ESWT at the energy density of 0.55 mJ/mm(2) (1000 impulses). ⋯ In contrast, elimination was partial in 2 control patients (15.3%) and unchanged in 11 (84.7%). There was no significant difference between Gärtner type I and type II groups in the Constant score (P > .05). ESWT shows promise for pain relief and functional restoration of calcific tendinitis with negligible complications.
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J Shoulder Elbow Surg · Nov 2007
Transfer of segmentally split pectoralis major for the treatment of irreparable rupture of the subscapularis tendon.
Irreparable ruptures of the subscapularis tendon represent a difficult surgical problem. An accepted treatment has been to utilize the pectoralis major as a transfer, using the superior half of the tendon, which involves parts of both the sternal and clavicular heads of the muscle. ⋯ From 22 dissected cadaveric shoulders, it was possible in all cases to obtain a segmentally split tendon suitable for transfer. We describe the morphology of the pectoralis major musculotendinous unit and neurovascular structures pertinent to the performance of a safe and effective transfer.
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J Shoulder Elbow Surg · Nov 2007
Total shoulder arthroplasty versus hemiarthroplasty for rheumatoid arthritis of the shoulder: results of 303 consecutive cases.
Between January 1, 1976 and December 31, 1991, 195 total shoulder arthroplasties and 108 hemiarthroplasties were performed in 247 patients in patients with rheumatoid arthritis. One hundred and eighty-seven total shoulder arthroplasties and 95 hemiarthroplasties with complete preoperative evaluation, operative records, and minimum 2-year follow-up (mean, 11.6 years) or follow-up until revision were included in the clinical analysis. Twenty patients had died and 1 was lost to follow-up. ⋯ Glenoid periprosthetic lucency was present in 110 of 152 total shoulder arthroplasties (72%). The data from this study indicate that there is marked long-term pain relief and improvement in motion with shoulder arthroplasty. Among patients with an intact rotator cuff, TSA appears to be the preferred procedure for pain relief, improvement in abduction, and lower risk of revision surgery.