Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · May 2007
Neer Award 2005: Peripheral nerve function during shoulder arthroplasty using intraoperative nerve monitoring.
The incidence of neurologic injury after shoulder arthroplasty has been reported to be 1% to 4%. However, the true incidence may be higher, because injury is identified only clinically and examination of the post-arthroplasty shoulder is difficult. This study used intraoperative nerve monitoring to identify the incidence, pattern, and predisposing factors for nerve injury during shoulder arthroplasty. ⋯ Positioning of the arm at the extremes of motion should be minimized. Patients with decreased motion (<10 degrees passive external rotation with the arm at the side) and a history of prior open shoulder surgery are at higher risk for nerve injury and should be counseled on the increased risk. This patient population may also be considered for routine nerve monitoring.
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J Shoulder Elbow Surg · May 2007
Complications of intramedullary Hagie pin fixation for acute midshaft clavicle fractures.
The purpose of this report was to evaluate patient outcomes after treatment of acute midshaft clavicle fractures with an intramedullary Hagie pin, including clinical results and the incidence of postoperative complications. Between 1993 and 2003, 16 patients who underwent intramedullary Hagie pin fixation of a midshaft clavicle fracture were identified. The medical records of each patient were reviewed to ascertain the mechanism of injury, indication for surgical intervention, and treatment course. ⋯ In this case series, intramedullary Hagie pin fixation resulted in fracture union in 100% of cases, with a high percentage of patients regaining full range of shoulder motion and resolution of symptoms. However, there was a 50% incidence of postoperative complications associated with this treatment method. We believe that the complication rate associated with the use of the Hagie pin should preclude the use of this particular implant.
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J Shoulder Elbow Surg · May 2007
Comparative StudyA biomechanical comparison of locking plate and locking nail implants used for fractures of the proximal humerus.
The aim of this study was to determine the biomechanical behavior of 2 different implants used in the fixation of proximal humeral fractures. The 2 implants in this study are specifically designed for the fixation of proximal humeral fractures, and both are based on the concept of fixed-angle locking screws. A reproducible 3-part fracture was created in paired human cadaveric bone and then fixed via the locking screw implants. ⋯ The locking nail implant provided a significantly stiffer construct to valgus, extension, and flexion cantilever bending loads below the failure threshold. The valgus load to failure was significantly higher for the nail. The mode of failure was different between implants.
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J Shoulder Elbow Surg · May 2007
Randomized Controlled Trial Comparative StudyContinuous intralesional infusion combined with interscalene block was effective for postoperative analgesia after arthroscopic shoulder surgery.
The purpose of this study was to compare the efficacy of postoperative pain control by intravenous patient-controlled analgesia (IV) and by continuous intralesional infusion of a local anesthetic (IL) with or without an interscalene block (ISB) after arthroscopic shoulder surgery. We allocated 84 patients to 4 groups according to analgesic method: IV, ISB-IV, IL, and ISB-IL. Postoperative pain, side effects, and supplementary analgesics were recorded at 1 hour and then every 8 hours for 48 hours. ⋯ Patients in group ISB-IL had less pain at 16 and 48 hours postoperatively than those in the other groups (P < .05). Continuous intralesional infusion (groups IL and ISB-IL) was superior in reducing analgesic-related side effects (P < .05). This study suggests that a combination of an interscalene block and continuous intralesional infusion of a local anesthetic is an effective and safe method of postoperative pain control after arthroscopic shoulder surgery.
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Total claviculectomy is a rare surgical procedure that has been performed for more than 90 years for a variety of indications, such as malignancy, trauma, and infection. What are the results for the pain score, and what is the influence of a total claviculectomy on the range of motion of the shoulder? We could not find the answers in the literature and analyzed 6 cases of total claviculectomy. The pain scores are good in a chronic osteitis case and in the two malignancy cases. ⋯ All 6 patients had full range of motion. A resection of the entire clavicle did not disturb the motion of the shoulder. A tendency but no final conclusions can be drawn because of too few patients and heterogeneous indications.