Techniques in Shoulder and Elbow Surgery最新文献

{"title":"Correction of Elbow Flexion Deformity in Patients Affected With Spasticity Through the Lateral Approach: Surgical Technique and Results","authors":"V. Samdanis, S. Jarvis, R. Freeman, S. Pickard","doi":"10.1097/BTE.0000000000000170","DOIUrl":"https://doi.org/10.1097/BTE.0000000000000170","url":null,"abstract":"Fixed and dynamic elbow flexion deformity due to spasticity represents a common, yet challenging, clinical entity. Several surgical options have been described in literature, the majority of which utilize the anterior approach, through the antecubital fossa to release biceps. We propose a novel technique, using the lateral approach, as a safer and simpler option that allows release of the brachialis while leaving biceps intact to act as a supinator. All patients that were referred to our institution for treatment of an elbow flexion deformity due to spasticity between 2012 and 2016 were assessed. Patients with a previous history of trauma in the affected elbow or who failed to attend their follow-up appointments were excluded from the study. The lateral approach was used and all procedures were carried out by the senior author. Minimum follow-up was 12 months with a mean follow-up time of 20 months (range, 12 to 48 mo). Overall, 18 patients were assessed. One patient was excluded due to previous elbow trauma and another 3 were lost to follow-up. The rest 14 patients were included in the study. The underlying etiology was cerebral palsy in 3 patients, head injury in 5 patients, cerebrovascular accidents in 5 patients and multiple sclerosis in 1 patient. Elbow extension was significantly improved in all patient groups. Preoperative flexed elbow contracture measured 74 degrees on average (range, 10 to 150 degrees), whereas postoperatively these figures were 21 degrees on average (range, 0 to 50 degrees). No major postoperative complications were noted, including neurovascular compromise and surgical wound healing problems. On the basis of our results, we believe that the lateral approach for elbow contracture release may be safer and technically less demanding, compared with the anterior approach, while its results are comparable to the latter. Furthermore, leaving biceps intact preserves a powerful supinator to resist overactivity in the pronator muscles. Level of Evidence: Level IV—case series.","PeriodicalId":44224,"journal":{"name":"Techniques in Shoulder and Elbow Surgery","volume":"20 1","pages":"104 - 107"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BTE.0000000000000170","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47450176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Results of Conservative Treatment of Severe Proximal Humerus Fractures Requiring Surgical Treatment in Old Patients","authors":"Gregory I. Pace, C. Zale, J. Chan, April D. Armstrong, H. Boateng, Hyun-Min Kim","doi":"10.1097/BTE.0000000000000174","DOIUrl":"https://doi.org/10.1097/BTE.0000000000000174","url":null,"abstract":"The purpose of this study was to investigate the clinical outcomes of nonsurgically treated proximal humerus fractures that would have been otherwise treated surgically had it not been for reasons precluding surgical treatment. A retrospective search for patients treated nonsurgically for a proximal humerus fracture was performed. Injury x-rays of all patients were reviewed independently by 3 orthopedic surgeons. Patients for whom at least 2 surgeons recommended surgical treatment were included. Of 96 eligible patients, 22 patients completed the data collection. There were six 2-part, seven 3-part, five 4-part fractures, and 4 head-split fractures. The mean ASES and QuickDASH scores were 82.7 and 21.9, respectively. The mean VAS pain score was 1.1. No significant effects of head-shaft angles or the presence of a head-split fracture were found. Ultimately, patients with a proximal humerus fracture that would have normally necessitated surgical treatment showed favorable outcomes following nonsurgical treatment. Fracture pattern or articular involvement had no significant effect on the outcomes. This finding suggests that nonsurgical management of proximal humerus fractures that would traditionally necessitate surgical treatment can be a viable option in certain patients whose circumstances preclude surgical treatment.","PeriodicalId":44224,"journal":{"name":"Techniques in Shoulder and Elbow Surgery","volume":"20 1","pages":"80 - 87"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BTE.0000000000000174","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49365510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Movement Patterns of the Shoulder Post Synthetic Interpositional PTFE Patch Repair for Large Rotator Cuff Tears","authors":"Thomas P Toohey, L. Hackett, P. Lam, G. Murrell","doi":"10.1097/BTE.0000000000000169","DOIUrl":"https://doi.org/10.1097/BTE.0000000000000169","url":null,"abstract":"The use of a synthetic polytetrafluoroethylene patch to repair large rotator cuff tears has resulted in good postoperative outcomes with respect to strength and range of motion. However, there is little information evaluating the movement patterns of the shoulder after patch repair. Following a reliability study of radiography to assess shoulder joint angles, radiographic assessment of shoulder kinematics was performed at 68±52 weeks (mean±SEM) postoperatively. This study compared the outcomes of polytetrafluoroethylene patch repair (n=15), suture-anchor repair (n=8), reverse total shoulder arthroplasty (n=7), and normal shoulders (n=5). The inter-rater and intrarater reliability of radiography was excellent (r=0.98, 0.96). Glenohumeral joint movement at maximal active abduction following patch repair (59±5 degrees), suture-anchor repair (57±8 degrees) and reverse total shoulder arthroplasty (52±7 degrees) was less than asymptomatic shoulders (95±3 degrees; P<0.01). Scapulothoracic motion remained similar between all cohorts. The present study demonstrated that the abnormal relationship between glenohumeral and scapulothoracic motion post rotator cuff repair is due to a decrease in glenohumeral joint movement, rather than a compensatory increase in scapulothoracic motion.","PeriodicalId":44224,"journal":{"name":"Techniques in Shoulder and Elbow Surgery","volume":"20 1","pages":"39–46"},"PeriodicalIF":0.0,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BTE.0000000000000169","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45643910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arthroscopic Technique for Transfragment Fixation of the Supraspinatus Intratendinous Footprint Avulsion","authors":"Ayman Al-Amri, P. Ahrens","doi":"10.1097/BTE.0000000000000168","DOIUrl":"https://doi.org/10.1097/BTE.0000000000000168","url":null,"abstract":"We present an arthroscopic fixation technique for a rare lesion of the rotator cuff. The lesion involves nondisplaced intratendinous avulsion of the supraspinatus footprint with an intact bridge of the supraspinatus tendon on the articular and bursal sides. The surgical technique involves the use of arthroscopic transfragment fixation with a single double-loaded suture anchor which was placed within the avulsed fragment bed. At 3 months from surgery, radiographic healing of the fracture was noted, with full recovery of daily activities and almost complete active range of motion confirmed with improvement of the Oxford Shoulder Score. This technique allows optimal reconstruction of normal footprint anatomy and creates a waterproof reduction of the fragment, protecting the fracture site from synovial fluid.","PeriodicalId":44224,"journal":{"name":"Techniques in Shoulder and Elbow Surgery","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78049142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CT-guided Navigation in Shoulder Arthroplasty","authors":"J. Wanner, Jed I. Maslow, I. Byram","doi":"10.1097/BTE.0000000000000164","DOIUrl":"https://doi.org/10.1097/BTE.0000000000000164","url":null,"abstract":"Successful anatomic and reverse total shoulder arthroplasty require a detailed understanding of each individual patient’s pathology. Advances in preoperative imaging continue to give surgeons a greater ability to customize implants to recreate native anatomy. Technological advancements have attempted to harness this information in the form of patient-specific instrumentation and more recently computed tomography-guided navigation. However, goals of shoulder arthroplasty remain the same: precise implant placement in order to maximize glenohumeral range of motion and stability while minimizing impingement to increase implant longevity. This manuscript reviews current literature with regard to importance of anatomic restoration of the glenohumeral joint and how computed tomography-guided navigation can be applied to improve accuracy and reproducibility in total shoulder arthroplasty.","PeriodicalId":44224,"journal":{"name":"Techniques in Shoulder and Elbow Surgery","volume":"20 1","pages":"68–73"},"PeriodicalIF":0.0,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BTE.0000000000000164","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41854341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shoulder Instability: Arthroscopic Capsulolabral Repair: the Gold Standard","authors":"Michael J. Chuang, W. Nottage","doi":"10.1097/BTE.0000000000000026","DOIUrl":"https://doi.org/10.1097/BTE.0000000000000026","url":null,"abstract":"There still exists some skepticism in the orthopedic community regarding the effectiveness of all-arthroscopic shoulder stabilization surgeries, mostly due to older literature, which report high failure rates when compared to open surgery. We look to present the modern indications and techniques of arthroscopic shoulder stabilization and highlight recent studies which show equivalent or superior results even in the contact athlete. There exists an abundance of literature which shows arthroscopic shoulder stabilization done with proper anchor placement, incorporating capsulolabral shifts, with the patient positioned in lateral decubitus position provides for superior outcomes. It is also critical to recognize and address concomitant lesions of instability at the time of surgery to further reduce surgical failures. We contend that there still exists a role for open stabilizations especially in the setting of significant glenoid bone loss or in the revision setting, however for the majority of stabilization procedures, arthroscopic technique is the gold standard.","PeriodicalId":44224,"journal":{"name":"Techniques in Shoulder and Elbow Surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76505214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Independent Arthroscopy-assisted Acromioclavicular Ligament Reconstruction: A Novel Technique","authors":"R. Aveledo, Daniel K Ibrahim, P. Lam, Oliver G. C. Murrell, G. Murrell","doi":"10.1097/BTE.0000000000000165","DOIUrl":"https://doi.org/10.1097/BTE.0000000000000165","url":null,"abstract":"A large number of surgical techniques have been described for acromioclavicular (AC) joint (ACJ) dislocations. Most are based on the reconstruction of the coracoclavicular ligaments. These techniques provide the ACJ with vertical stability and have a high. complication rate. Advances in material technology and implants have allowed us to develop a surgical, technique approach to treat ACJ dislocations, that provides this joint with stability in both, vertical and horizontal planes, reconstructing only the AC ligaments. Two drilled holes are made in the acromion under arthoscopic control. Then, 2 tape-type sutures are passed through these holes and fixed to the distal clavicle with anchors, in a suture bridge configuration.","PeriodicalId":44224,"journal":{"name":"Techniques in Shoulder and Elbow Surgery","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90538500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patch Reinforcement of Rotator Cuff Repairs: Current Indications","authors":"B. Morris, T. Edwards","doi":"10.1097/BTE.0000000000000068","DOIUrl":"https://doi.org/10.1097/BTE.0000000000000068","url":null,"abstract":"Patch reinforcement of rotator cuff repairs is continuing to evolve. Patches in rotator cuff repair can be used for suture reinforcement, augmentation, or interposition. We will discuss current indications for patch reinforcement of rotator cuff repairs.","PeriodicalId":44224,"journal":{"name":"Techniques in Shoulder and Elbow Surgery","volume":"20 1","pages":"64–67"},"PeriodicalIF":0.0,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BTE.0000000000000068","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44537740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When is the Reverse Shoulder Arthroplasty Indicated for Massive Rotator Cuff Tears Without Arthritis?","authors":"D. Dines, J. Dines","doi":"10.1097/BTE.0000000000000024","DOIUrl":"https://doi.org/10.1097/BTE.0000000000000024","url":null,"abstract":"","PeriodicalId":44224,"journal":{"name":"Techniques in Shoulder and Elbow Surgery","volume":"20 1","pages":"61–63"},"PeriodicalIF":0.0,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BTE.0000000000000024","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49655236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Triceps Split Approach for Total Elbow Arthroplasty","authors":"T. Kent, R. Ablove, Robert J. Duve","doi":"10.1097/BTE.0000000000000166","DOIUrl":"https://doi.org/10.1097/BTE.0000000000000166","url":null,"abstract":"Total elbow arthroplasty can be performed through a variety of surgical approaches including partial or complete triceps detachment and triceps sparing. The choice is partially influenced by surgeon preference as well as patient-related and prosthetic-related factors. Failure of triceps repair is a known complication of approaches involving triceps detachment and ulnar component malposition is a common complication of triceps sparing techniques. Our approach allows total elbow arthroplasty to be performed without compromise to the triceps insertion and ideal placement of the ulnar component. In our approach the triceps split ends distally at its insertion onto the olecranon and the creation of the trough at the base of the trochlear ridge allowing for placement of the ulnar component in line with the medullary canal. This technique preserves the triceps insertion in its entirety and allows for ideal placement of the ulnar component. These factors permit rapid advancement of the postoperative rehabilitation program without placing excessive stress on the triceps insertion.","PeriodicalId":44224,"journal":{"name":"Techniques in Shoulder and Elbow Surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82977801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}