Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Oct 2015
Reverse shoulder arthroplasty versus hemiarthroplasty for treatment of proximal humerus fractures.
Whereas most proximal humerus fractures are treated nonoperatively, complex 3- and 4-part fractures may require shoulder arthroplasty. Hemi-shoulder arthroplasty (HSA) has been the standard treatment, but recently there has been discussion and utilization of reverse total shoulder arthroplasty (RTSA) as a viable treatment option. This study evaluated the national utilization of RTSA and HSA for proximal humerus fractures and compared patient and hospital characteristics associated with each procedure. ⋯ Although HSA remains the most common arthroplasty choice for proximal humerus fractures, RTSA is becoming widely used. Patient characteristics and complications were similar between the 2 procedures, and as clinical evidence appears to show improved outcomes with RTSA, it is likely that acceptance of RTSA will continue to grow.
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J Shoulder Elbow Surg · Sep 2015
Outcome and value of reverse shoulder arthroplasty for treatment of glenohumeral osteoarthritis: a matched cohort.
Total shoulder arthroplasty (TSA) is commonly used to treat glenohumeral osteoarthritis (GHOA) with an intact rotator cuff. Recently, reverse shoulder arthroplasty (RSA) has been used for GHOA patients who are elderly or have eccentric glenoid wear. We evaluated patients with GHOA scheduled to have TSA but who were changed to RSA because of intraoperative difficulties with the glenoid component or instability and compared them with a cohort that underwent TSA to determine if the groups had similar outcomes. ⋯ Patients with GHOA who were converted intraoperatively to RSA because of improper seating of the glenoid trial or persistent posterior subluxation had outcomes comparable to those of a similar group of patients in whom TSA was performed. At midterm follow-up, TSA is associated with lower cost than RSA. The higher rate of radiographic loosening in the TSA group warrants longer follow-up to assess revision costs. In cases in which a TSA cannot be performed with confidence, RSA is a reasonable alternative.
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J Shoulder Elbow Surg · Aug 2015
Infection after primary anatomic versus primary reverse total shoulder arthroplasty.
Deep periprosthetic infection is a serious complication after total shoulder arthroplasty (TSA) and is associated with suboptimal clinical results. This retrospective study aimed to determine whether a difference in infection rate existed after primary anatomic TSA (aTSA) and primary reverse TSA (rTSA). ⋯ There is no difference in infection rate after primary aTSA and primary rTSA in shoulders that have not undergone previous operative interventions. Infection is more likely to develop in shoulders undergoing primary rTSA that have had one or more nonarthroplasty operative procedures.
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J Shoulder Elbow Surg · Aug 2015
Treatment of proximal humerus fractures with a CFR-PEEK plate: 2-year results of a prospective study and comparison to fixation with a conventional locking plate.
A radiolucent carbon fiber-reinforced polyetheretherketone (CFR-PEEK) plate was recently introduced for fixation of proximal humerus fractures. Prospective clinical and radiographic results of patients treated with a CFR-PEEK plate are compared with those of patients treated with a conventional locking plate. ⋯ Fixation of proximal humerus fractures with a CFR-PEEK plate provides satisfying clinical and radiographic results after 2 years of follow-up. The results are comparable to those achieved with conventional locking plates.
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The two most commonly used approaches to expose medial elbow structures are the flexor carpi ulnaris split and the Hotchkiss over-the-top approach. The aim of this study was to define the extended medial approach to the elbow, featuring advantages of over-the-top (proximal exposure) and additional complete exposure of the coronoid and proximal medial ulna, while respecting the internervous plane between the flexor pronator mass and flexor carpi ulnaris muscle. ⋯ The extended medial elbow approach is a single approach allowing full exposure of the medial elbow and combining the advantages of the over-the-top approach with a safe distal extension to the medial ulna. In contrast to the flexor carpi ulnaris split, our approach respects the internervous plane.