Journal of shoulder and elbow surgery
-
J Shoulder Elbow Surg · Jul 2013
Comparative StudyDoes cubitus varus cause morphologic and alignment changes in the elbow joint?
In cubitus varus after pediatric supracondylar fracture, late development of trochlear deformity causing additional varus angulation and joint misalignment relating to late complications of the tardy ulnar nerve palsy or posterolateral rotatory instability have been suggested. However, it is unclear whether these morphologic and alignment changes of the elbow joint occur in cubitus varus. The object of this study was to investigate morphologic changes of the bones and alignment changes of the elbow joint in longstanding cubitus varus using 3-dimensional computer bone models created from computed tomography data. ⋯ In longstanding cubitus varus, the morphology and alignment of the elbow joint are observed to differ from those of the normal side.
-
Clavicle fractures are common injuries of the shoulder girdle and occasionally result in nonunion or symptomatic malunion. When present, these chronic injuries can result in considerable shoulder dysfunction. A number of surgical techniques have been described for the management of these injuries. Current literature suggests that supplemental bone grafting may not be necessary in all cases but should be considered in the setting of atrophic nonunion. However, optimal treatment is controversial, as discussed in the literature. This article highlights the current treatment options based on the existing literature and describes our preferred techniques. ⋯ Nonunion and malunion of the clavicle remain challenging problems. Reliable bony union and improved shoulder function can be expected with thoughtful surgical planning, appropriate implant choice, and meticulous surgical technique.
-
J Shoulder Elbow Surg · Jun 2013
Comparative StudyDistal-third clavicle fracture fixation: a biomechanical evaluation of fixation.
Approximately 25% of distal clavicle fractures are unstable. Unstable patterns have longer times to union and higher nonunion rates. Stable restoration of the distal clavicle is important in decreasing the nonunion rate in distal clavicle fractures. The purpose of this study was to biomechanically compare operative constructs for the treatment of unstable, comminuted distal-third clavicle fractures in a cadaveric model using a locking plate and coracoclavicular reconstruction. We hypothesized that the combination of coracoclavicular reconstruction and a distal clavicle locking plate is biomechanically superior to either construct used individually. ⋯ Greater fracture stability was achieved with the combination of the AC TightRope and locking clavicle plate construct than with either alone, suggesting a possibility for increased fracture-healing rates.
-
J Shoulder Elbow Surg · Jun 2013
Proximal humerus cortical bone thickness correlates with bone mineral density and can clinically rule out osteoporosis.
Bone mineral density measurements with dual-energy x-ray absorptiometry (DXA) are commonly used to diagnose osteoporosis and assess fracture risk. This study describes the association between radiographic measures of proximal humeral cortical bone thickness and bone mineral density measured by DXA. The study also assesses the discriminative capability of clinical cortical bone thickness measurements at the proximal humerus to differentiate patients with osteoporosis. ⋯ Average cortical bone thickness measurements obtained from standard anteroposterior shoulder radiographs are correlated with DXA. Furthermore, they provide a clinically relevant, rapid, sensitive, and inexpensive method for ruling out osteoporosis.