Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Jan 2002
Single-strand reconstruction of the lateral ulnar collateral ligament restores varus and posterolateral rotatory stability of the elbow.
Because of a lack of biomechanical studies of lateral elbow ligament reconstruction in the literature, the initial stability afforded by 3 different techniques of lateral ulnar collateral ligament reconstruction was evaluated in 8 cadaveric elbows. The arm was mounted in a testing apparatus, and passive flexion was performed with the arm in varus and valgus orientations. A pivot shift test was performed with the arm in the vertical orientation. ⋯ Reconstruction of the lateral ulnar collateral ligament restored elbow stability to that of the intact state. There was no significant difference in stability between the single- and double-strand repair techniques (P >.05). This study demonstrates that both single- and double-strand reconstructions restore varus and posterolateral elbow stability and may be considered appropriate reconstructive procedures in patients with symptomatic insufficiency of the lateral ligaments of the elbow.
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J Shoulder Elbow Surg · Nov 2001
Computed tomography measurement of humeral head retroversion: influence of patient positioning.
For accurate humeral head arthroplasty, the surgeon needs to know some geometric data, such as, for example, the retroversion angle of the humeral head. Only a few reports have described and evaluated the use of computed tomography (CT) to measure humeral head retroversion. The humerus position relative to the roentgen beam is variable from one subject to another depending on the patients' morphology. ⋯ Our study tries to clarify technical problems that occur during CT examination. Geometric considerations that can modify the measurements are presented. A reliable method of humeral head retroversion angle measurement is recommended, which could be useful to the shoulder surgeon.
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J Shoulder Elbow Surg · Nov 2001
The use of a blade plate and autogenous cancellous bone graft in the treatment of ununited fractures of the proximal humerus.
Stable internal fixation is essential to obtain healing of an ununited fracture of the proximal humerus. Standard plate and screw fixation may be inadequate to secure a small, osteopenic proximal fragment. We used blade plates and autogenous cancellous bone graft to repair ununited fractures of the proximal humerus in 25 patients (19 women and 6 men) with a mean age of 61 years. ⋯ Objective and subjective instruments documented substantial functional improvement in patients with healed fractures. The results were classified as good or excellent in 20 of 25 patients, and few complications were encountered. Blade plate fixation facilitates successful treatment of ununited fractures of the proximal humerus.
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J Shoulder Elbow Surg · Sep 2001
The effect of articular malposition after total shoulder arthroplasty on glenohumeral translations, range of motion, and subacromial impingement.
The articular surface of the normal humeral head has a variable posterior and medial offset with respect to the central axis of the humeral shaft. Recreation of the normal humeral head shaft offset is postulated to be an important consideration during shoulder arthroplasty. However, the effect of humeral head malposition is unknown. ⋯ Humeral articular malposition of 4 mm or less during prosthetic arthroplasty of the glenohumeral joint may lead to small alterations in humeral translations and range of motion. Inferior malposition of greater than 4 mm can lead to increased subacromial contact; offset of 8 mm in any direction results in significant decreases in passive range of motion. Therefore if subacromial contact is to be minimized and glenohumeral motion maximized after shoulder replacement, anatomic reconstruction of the humeral head-humeral shaft offset to within 4 mm is desirable.