Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Jan 2013
Multicenter StudyCurrent strategies for the treatment of proximal humeral fractures: an analysis of a survey carried out at 348 hospitals in Germany, Austria, and Switzerland.
The therapeutic spectrum for the treatment of displaced proximal humeral fractures ranges from conservative therapy to head-preserving surgical interventions and joint replacement. This study initiated a survey on the current treatment options with regard to diagnostics, choice of therapy, and complications that are encountered at trauma surgeries and orthopedic hospitals in Germany, Austria, and Switzerland. ⋯ A preference for surgical treatment of proximal humeral fractures was found, with stabilization predominantly being attempted by the use of angle-stable implants. The 2 most common complications were "nonanatomic reduction of fractures" and the more specific problem of "implant perforation" when fixed-angle implants were used for treatment.
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J Shoulder Elbow Surg · Jan 2013
Comparative StudyFunctional outcomes of reverse shoulder arthroplasty compared with hemiarthroplasty for acute proximal humeral fractures.
Complex acute proximal humeral fractures may require prosthetic replacement of the proximal humerus. Reverse shoulder arthroplasty (RSA) has been suggested as an alternative to hemiarthroplasty in the management of such fractures. This study compared the functional outcomes of RSA with hemiarthroplasty in patients with acute proximal humeral fractures. ⋯ Patients with acute proximal humeral fractures who undergo RSA appear to achieve superior 5-year functional outcomes compared with patients who undergo hemiarthroplasty.
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Safely permitting early range of motion after a destabilizing injury to the elbow is believed to optimize return of function. However, the range-of-motion exercises must be balanced against the risk of re-dislocation or subluxation. The goal of this study was to describe the position of the upper limb that permitted the greatest motion while minimizing the risk of re-dislocation or subluxation. ⋯ The overhead motion protocol is a safe protocol for unstable elbows. The supine position results in the least amount of ulnohumeral distraction across flexion angles from 10° to 90°. The upright protocols, especially with the hinged elbow brace, exhibited ulnohumeral distraction that may result in dislocation.
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J Shoulder Elbow Surg · Dec 2012
Comparative StudyThe influence of ultrasound guidance in the rate of success of acromioclavicular joint injection: an experimental study on human cadavers.
Injections of the acromioclavicular joint (ACJ) are performed routinely in patients with ACJ arthritis, both diagnostically and therapeutically. The aim of this prospective controlled study was to estimate the frequency of successful intra-articular ACJ injections with the aid of sonographic guidance versus non-guided ACJ injections. ⋯ The use of ultrasound significantly improves the accuracy of ACJ injection.
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J Shoulder Elbow Surg · Dec 2012
Comparative StudyClosed reduction techniques in acute anterior shoulder dislocation: modified Milch technique compared with traction-countertraction technique.
To perform closed manual reduction of acute anterior shoulder dislocation using the traction-countertraction technique requires sedation (TCTS) and the participation of 2 people. We studied the modified Milch (MM) technique, a positional reductive maneuver that requires 1 operator, without patient sedation or analgesia. ⋯ The results showed that the Milch technique was effective, safe, shortened hospital stay, and was well tolerated. We recommend the modified Milch technique as a first-line maneuver for acute anterior shoulder dislocations without associated fractures.