Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Aug 2013
Comparative StudyClinical and radiographic comparisons of two different radial head implant designs.
There is little comparative data to guide implant choice for radial head replacements. The purpose of this study was to evaluate the clinical and radiographic results between patients who received a smooth-stemmed bipolar radial head implant and patients who received an in-growth monopolar prosthesis. ⋯ Outcomes at short- to mid-term follow-up were similar with either implant design. Loosening of a press-fit prosthesis may lead to extensive osteolysis, but of undetermined clinical consequence.
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J Shoulder Elbow Surg · Aug 2013
Review Meta AnalysisEffectiveness of bracing in the treatment of nonosseous restriction of elbow mobility: a systematic review and meta-analysis of 13 studies.
Restriction of elbow mobility is a very frequent complaint after trauma or surgery. The objective of this study was to assess and compare the effectiveness of dynamic, static, or static-progressive bracing in patients with elbow stiffness of traumatic or postoperative origin and without evidence of ossification. For the purpose of this study, effectiveness was measured as the increase in total range of motion, as well as extension and flexion. ⋯ The current evidence strongly supports the use of static-progressive stretching 3 times 30 minutes per day in each direction as a first line of treatment in patients with post-traumatic and postsurgical elbow stiffness. If this treatment fails or if reasons for stiffness other than soft-tissue incompliance are identified, further surgical interventions should be considered.
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J Shoulder Elbow Surg · Aug 2013
Comparative StudyShoulder hemiarthroplasty for proximal humeral fractures: comparisons between the deltopectoral and anterolateral deltoid-splitting approaches.
Shoulder hemiarthroplasty is a widely accepted method for treating complex proximal humeral fractures, and the deltopectoral approach is the most popular route for this procedure. The purpose of the current study was to define and compare outcomes of shoulder hemiarthroplasty when using deltopectoral or anterolateral deltoid-splitting approaches. ⋯ When performing shoulder hemiarthroplasty for complex proximal humeral fractures, we found that the anterolateral deltoid-splitting approach provides an easier route for assessing posterior fracture fragments and managing rotator cuff tissue. The anterolateral deltoid-splitting approach was shown to be an acceptable alternative route for shoulder hemiarthroplasty than the standard deltopectoral approach.
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J Shoulder Elbow Surg · Jul 2013
Comparative StudyThe "bicipital aponeurosis flex test": evaluating the integrity of the bicipital aponeurosis and its implications for treatment of distal biceps tendon ruptures.
One mitigating factor in the accurate diagnosis of complete distal biceps tendon ruptures (DBTR) is the integrity of the bicipital aponeurosis (BA). Current orthopedic literature lacks a descriptive means of evaluating the integrity of the BA in the presence of distal biceps injury. ⋯ Evaluating the integrity of the BA can help to inform evaluation and treatment of DBTR, especially when visible or palpable alterations in biceps contour and proximal tendon migration are absent or equivocal.
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The purpose of this study was to evaluate wear debris in periprosthetic tissues at the time of revision total elbow arthroplasty. Polyethylene, metallic, and bone cement debris were characterized, and the tissue response was quantified. ⋯ We have shown that periprosthetic tissues of total elbow patients who have undergone revision for loosening and osteolysis contain polyethylene, cement, and metal debris. Although the polyethylene particles were of a size and shape that have been previously shown to result in activation of phagocytic cells, osteolysis after total elbow arthroplasty is a multimodal process. Because of the presence of multiple wear particle sources, a cause-and-effect relationship between polyethylene debris and osteolysis cannot be established with certainty.