Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Sep 2007
Comparative StudyDoes delay matter? The restoration of objectively measured shoulder strength and patient-oriented outcome after immediate fixation versus delayed reconstruction of displaced midshaft fractures of the clavicle.
Outcome after surgical treatment for nonunion and malunion of midshaft displaced clavicle fractures has generally been described as favorable and equal to results of acute repair. This assumption has been based on subjective criteria, however, and no direct comparison is available in the literature. This study used objective measurements of limb function to compare outcome in patients who underwent delayed operative intervention for nonunion and malunion with the outcome of patients who underwent immediate open reduction and internal fixation after displaced clavicle fracture. ⋯ Both groups rated their satisfaction with the procedure as excellent. Late reconstruction of nonunion and malunion after displaced midshaft fractures of the clavicle is a reliable and reproducible procedure that results in restoration of objective muscle strength similar to that seen with immediate fixation; however, there are subtle decreases in endurance strength and outcome compared with acute fracture repair. This information should not be used to justify primary operative repair in isolation but is useful in decision-making when counseling patients with displaced midshaft fractures of the clavicle.
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J Shoulder Elbow Surg · Jul 2007
Case ReportsThe types and severity of complications associated with interscalene brachial plexus block anesthesia: local and national evidence.
Interscalene brachial plexus block is a commonly used anesthetic. However, substantial complications can be associated with its use. Our study included 15 years of data from a local medical center and 3 decades of records from the national American Society of Anesthesiology Closed Claims Project. ⋯ The American Society of Anesthesiology Closed Claims database had 20 peripheral neurologic injuries, 10 respiratory complications, 5 central nervous system complications, 4 deaths, 2 emotional disturbances, and 1 other unknown event. Of the complications, 19 were described as permanent. Interscalene brachial plexus block can be accompanied by substantial and disabling complications, especially when administered by less experienced anesthesiologists.
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J Shoulder Elbow Surg · Jul 2007
Indwelling interscalene catheter use in an outpatient setting for shoulder surgery: technique, efficacy, and complications.
Indwelling interscalene catheters are utilized for inpatient postoperative pain control after shoulder surgery. Improved medical equipment and advanced techniques may allow safe and efficacious outpatient use. One hundred and forty-four consecutive indwelling interscalene catheter placements were reviewed to determine adverse events, complications, and efficacy. ⋯ The average last recorded PACU pain score on a scale of 1 to 10 was 0.6. Catheter placement under real-time ultrasound guidance is accurate. Outpatient use of indwelling interscalene catheters is safe and efficacious.
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J Shoulder Elbow Surg · Jul 2007
Case ReportsAcute deep infection after surgical fixation of proximal humeral fractures.
Acute deep infection after open reduction-internal fixation of proximal humeral fractures is uncommon. Currently, there are no reported series on the outcomes of patients treated for infection after surgery for proximal humeral fractures. The purpose of this study was to review the frequency, clinical presentation, bacteriology, treatment, and outcomes of patients with such fractures complicated by acute deep infection. ⋯ At a mean final follow-up of 6.4 years, the American Shoulder and Elbow Surgeons score averaged 53 points (range, 33-75 points) and the Simple Shoulder Test score averaged 6.2 points (range, 1-10 points). Acute deep infection after open reduction-internal fixation of proximal humeral fractures is a devastating complication. Patients should be counseled that the results of treatment of deep infection are plagued with high complication rates, poor functional outcome, and a notably high nonunion rate.