Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · May 2017
Computed tomography-based prediction of the straight antegrade humeral nail's entry point and exposure of "critical types": truth or fiction?
Straight antegrade intramedullary nailing of proximal humerus fractures has shown promising clinical results. However, up to 36% of all humeri seem to be "critical types" in terms of the potential violation of the supraspinatus (SSP) tendon footprint by the nail's insertion zone. The aims of this study were to evaluate if a computed tomography (CT) scan could reliably predict the nail's entry point on the humeral head and if it would be possible to preoperatively estimate the individual risk of iatrogenic violation of the SSP tendon footprint by evaluating the uninjured contralateral humerus. ⋯ Assessing the uninjured contralateral side, CT can reliably predict the entry point in antegrade humeral nailing and preoperatively identify critical types of humeral heads at risk of iatrogenic implantation damage to the SSP tendon footprint. This study may help surgeons in the decision-making processon which surgical technique should be used without putting the patient at risk for iatrogenic, implant-related damage to the rotator cuff.
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J Shoulder Elbow Surg · May 2017
Treatment of comminuted proximal humeral fractures using locking plate with strut allograft.
This study compared the radiologic outcome of fixation using locking plate only with fixation using locking plate with an endosteal strut allograft in the treatment of comminuted proximal humeral fracture. ⋯ Fixation using a locking plate with an endosteal strut allograft can be considered a reasonable option to maintain the anatomic reduction in elderly patients with comminuted proximal humeral fracture.
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Shoulder arthroscopic arthrodesis is an uncommon and non-standardized procedure. Results are poorly evaluated. We describe the findings in 8 patients who underwent shoulder arthroscopic arthrodesis for brachial plexus injury. ⋯ Arthroscopic arthrodesis of the shoulder can be a reliable procedure and associated with a low rate of complications.
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J Shoulder Elbow Surg · Apr 2017
Local injection of liposomal bupivacaine combined with intravenous dexamethasone reduces postoperative pain and hospital stay after shoulder arthroplasty.
Alternative techniques have been developed to address pain after shoulder arthroplasty and are well documented. We evaluated the effect of adding intraoperative liposomal bupivacaine and intravenous dexamethasone during shoulder arthroplasty. ⋯ These changes to the perioperative shoulder arthroplasty protocol decreased hospitalization length of stay, narcotic requirement, and pain.
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J Shoulder Elbow Surg · Apr 2017
Comparative StudyContinuous versus single shot brachial plexus block and their relationship to discharge barriers and length of stay.
Brachial plexus block has been associated with improved pain control and decreased length of stay in patients undergoing upper extremity arthroplasty. Continuous delivery is associated with a shorter length of stay; however, comparisons to single-shot delivery in this setting are scarce. As the paradigm shifts to outpatient arthroplasty in the era of bundled payments, there exists a strong impetus to identify the most effective mode of analgesia associated with the least risk to patients. ⋯ There was no demonstrated disparity in the rate of complications associated with single-shot vs. continuous brachial plexus block. However, the continuous indwelling catheter was associated with an increased incidence of potential barriers to discharge and an increased length of stay compared with patients receiving single-shot regional anesthesia.