Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Sep 2014
Does the timing of surgery for proximal humeral fracture affect inpatient outcomes?
Delayed surgical treatment of hip fractures is associated with adverse medical outcomes, but it is unclear whether the same is true for proximal humeral fractures. The purpose of this study was to evaluate the relationship between surgical delay for proximal humeral fracture and inpatient adverse events, in-hospital death, prolonged postoperative stay, and nonroutine discharge. ⋯ Even when comorbidities and complexity are controlled for, delaying surgery for proximal humeral fracture is likely to increase inpatient morbidity, postoperative length of stay, and nonroutine discharge. It appears that avoiding nonmedical delays is advantageous.
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J Shoulder Elbow Surg · Sep 2014
The incidence of proximal humeral fractures in New York State from 1990 through 2010 with an emphasis on operative management in patients aged 65 years or older.
Proximal humeral fractures are commonly encountered injuries. The development of locking plate technology and reverse shoulder arthroplasty may have changed the treatment patterns of these fractures. ⋯ The incidence of proximal humeral fractures in patients aged 65 or older increased by 28% between 1990 and 2010, and operative management increased by more than 40%. The use of ORIF increased between 2001 and 2010, corresponding with the use of locking plate technology. There was an associated decrease in HA. TSA increased between 2006 and 2010, corresponding to the use of reverse shoulder arthroplasty.
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J Shoulder Elbow Surg · Sep 2014
Minimally invasive plate osteosynthesis for proximal humeral fractures: clinical and radiologic outcomes according to fracture type.
This study evaluated the clinical and radiologic outcomes, according to fracture type, of proximal humeral fractures treated by the minimally invasive plate osteosynthesis (MIPO) technique. ⋯ Satisfactory clinical and radiologic outcomes were obtained by the MIPO technique in proximal humeral fractures. In addition, medial cortical support can be performed with an inferomedial screw or fibular allograft in the MIPO technique. However, the MIPO technique for 4-part fractures showed relatively inferior outcomes compared with 2- and 3-part fractures. Conversion to open plating is also considered if adequate reduction, that is, a neck-shaft angle >120°, is not able to be obtained in the MIPO technique for 4-part fractures of the proximal humerus.
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J Shoulder Elbow Surg · Aug 2014
The effect of surgeon and hospital volume on shoulder arthroplasty perioperative quality metrics.
There has been a significant increase in both the incidence of shoulder arthroplasty and the number of surgeons performing these procedures. Literature regarding the relationship between surgeon or hospital volume and the performance of modern shoulder arthroplasty is limited. This study examines the effect of surgeon or hospital shoulder arthroplasty volume on perioperative metrics related to shoulder hemiarthroplasty, total shoulder arthroplasty, and reverse shoulder arthroplasty. Blood loss, length of stay, and operative time were the main endpoints analyzed. ⋯ Higher surgeon and hospital case volumes led to improved perioperative metrics with all shoulder arthroplasty procedures, including reverse total shoulder arthroplasty, which has not been previously described in the literature. Surgeon volume had a larger effect on metrics than hospital volume did. This study supports the concept that complex shoulder procedures are, on average, performed more efficiently by higher volume surgeons in higher volume centers.
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J Shoulder Elbow Surg · Aug 2014
Long-term functional outcomes (median 10 years) after locked plating for displaced fractures of the proximal humerus.
Locked plating has become an accepted treatment for displaced fractures of the proximal humerus. However, to our knowledge, long-term outcomes have not been reported. ⋯ Ten years after locked plating of displaced proximal humeral fractures, patients show good to excellent outcomes in the majority of cases with no relevant decline compared with the shoulder function 1 year after surgery. However, poor long-term outcome is seen in 16% of patients and relates to a low CS 1 year after surgery. Thus, patients developing poor long-term outcomes may be identified at an earlier stage.