Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Jul 2001
Multicenter StudyShoulder arthroplasty for the treatment of the sequelae of fractures of the proximal humerus.
The purpose of this multicenter study was to analyze the results of shoulder arthroplasty for the treatment of the sequelae of proximal humerus fractures and establish an updated classification system and treatment guidelines for these complex situations. Seventy-one sequelae of proximal humerus fractures were treated with shoulder replacement with the use of the same nonconstrained, modular, and adaptable prosthesis: the Aequalis prosthesis (Tornier Inc, St Ismier, France). The average time between initial fracture and shoulder arthroplasty was 5 years and 5 months. ⋯ Shoulder arthroplasty for the treatment of the sequelae of fractures of the proximal humerus should be performed without an osteotomy of the greater tuberosity when possible. If prosthetic replacement is possible without an osteotomy, surgeons should accept the distorted anatomy of the proximal humerus and adapt the prosthesis and their technique to the modified anatomy. A modular and adaptable prosthesis with both adjustable offsets and inclination may allow surgeons to adapt to a large number of malunions and may help to avoid the troublesome greater tuberosity osteotomy in a higher proportion of cases.
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J Shoulder Elbow Surg · Jul 2001
Injury of the suprascapular nerve in shoulder surgery: an anatomic study.
Fifty-two shoulders in 26 cadavers were dissected to evaluate the safe zone for avoiding injury of the suprascapular nerve during open surgical procedures and arthroscopic Bankart repairs requiring blind drilling. The course of the suprascapular nerve was given as the shortest distance between the suprascapular nerve and the glenoid rim. A Kirschner wire was inserted from the anterior glenoid rim toward the suprascapular nerve. ⋯ The insertion angle toward the bifurcation of the infraspinatus motor branch in the transverse plane averaged 44.3 degrees and in the sagittal plane averaged 27.7 degrees. On the basis of the results of the anatomic evaluation, the safe zone was described. An appreciation of this safe zone may help shoulder surgeons avoid iatrogenic injury to the suprascapular nerve.
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J Shoulder Elbow Surg · Jul 2000
Indwelling interscalene catheter anesthesia in the surgical management of stiff shoulder: a report of 100 consecutive cases.
One hundred consecutive stiff shoulders in 93 patients resistant to conservative therapy were treated with surgery and intermittent regional anesthesia via indwelling interscalene catheter. Each patient underwent manipulation and one of several operative treatments to release any additional contracture. The indwelling interscalene catheter remained in place and functioned well for an average of 3 days in 87 shoulders. ⋯ The best results were obtained in those shoulders with idiopathic stiffness (88% excellent or satisfactory results); the worst results were in the postsurgical shoulders (47% excellent or satisfactory results). There were no catheter-related complications. The use of an indwelling interscalene catheter for postoperative pain control is a safe technique that facilitates early physical therapy in a patient population with a high risk of developing recurrent stiffness.