Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Nov 2006
Articular cartilage injuries of the capitellum interposed in radial head fractures: a report of ten cases.
Ten cases of Mason type I and type II isolated radial head fractures are reported, in which an unexpected cartilaginous fragment of the capitellum trapped within the radial head fracture was identified at the time of surgery. In no case was this injury pattern identified on preoperative imaging, including computed tomography in 2 cases. Five patients did have preoperative mechanical findings with forearm rotation. ⋯ No sequelae were identified on short-term follow-up. This series highlights an injury pattern that should be considered in isolated nondisplaced and minimally displaced fractures of the radial head. The natural history of this finding, when treated conservatively, is unknown.
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J Shoulder Elbow Surg · Sep 2006
Interscalene regional anesthesia for arthroscopic shoulder surgery: a safe and effective technique.
There has been resistance to the use of interscalene regional block for arthroscopic shoulder surgery because of concerns about potential complications and failed blocks with the subsequent need for general anesthesia. The purpose of this study was to assess whether interscalene regional block is safe and effective and offers many advantages over general anesthesia for outpatient arthroscopic shoulder surgery. ⋯ There was a 1% rate of minor complications, all of which were transient sensory neuropathies that resolved within 5 weeks on average. We conclude that interscalene block can provide effective anesthesia for arthroscopic shoulder surgery.
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J Shoulder Elbow Surg · Sep 2006
Electromyographic analysis of physical examination tests for type II superior labrum anterior-posterior lesions.
Physical examination tests that place tension on the long head of the biceps may best reproduce symptoms in patients with type II superior labrum anterior-posterior (SLAP) lesions. The objective of this study is to compare the normalized electromyographic signal of the long head of the biceps for SLAP lesion physical examination tests. ⋯ We found no significant differences when comparing forearm supination and pronation within individual tests. Because the active compression and biceps tension tests maximize muscle activation on the long head of the biceps, they may be the best physical examination tests by which to identify type II SLAP lesions.
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J Shoulder Elbow Surg · Mar 2006
Bicipital groove orientation: considerations for the retroversion of a prosthesis in fractures of the proximal humerus.
The bicipital groove anatomy is well documented, and this groove is used as a landmark to guide retroversion during implantation of a shoulder prosthesis. Whereas the proximal part of the groove is used in osteoarthritis, the distal part is used in fractures. If used in 4-part fracture cases, we must assume that the bicipital groove orientation is constant from proximal to distal. ⋯ We confirmed a wide range of variation from 22 degrees to 89 degrees in the orientation of the groove. Because the values listed in the literature for lateral fin placement of a prosthesis have not been measured at the surgical neck level and because of the great variation in groove orientation, we caution surgeons about the use of the bicipital groove as a reliable landmark in shoulder replacement for fractures. Considering the risk of over- or under-retroversion of the prosthesis, we recommend the use of a fracture jig with retroversion set to 20 degrees.
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J Shoulder Elbow Surg · Jan 2006
Comparative StudyComminuted olecranon fractures: a comparison of plating methods.
The relative strength of posterior plating and dual medial-lateral plating for comminuted olecranon fractures has not been evaluated. Fifteen male cadaveric elbows with simulated highly comminuted olecranon fractures were tested to failure via cantilever bending. The strength of dual medial-lateral plates and a single posterior plate with and without an intramedullary screw was evaluated. ⋯ The mean bending moment at failure for specimens with a posterior plate and an intramedullary screw was 44.5 +/- 6.9 Nm; this was significantly greater than for dual-plated specimens (P < .05) but not for specimens with a posterior plate without an intramedullary screw. The posterior plate with an intramedullary screw was the most stable construct tested and may, therefore, be the preferred method of fixation for comminuted olecranon fractures. This construct was significantly (48%) stronger than dual medial and lateral plating.