Pub Date : 2020-05-08DOI: 10.1097/BTE.0000000000000192
H. Namazi, Keramat Askari, Mohammad T Karimi, M. Fereidooni
The incidence of acromioclavicular joint (ACJ) injuries is high in daily activities and sports. Various surgical procedures have been used to restore the performance of the shoulder complex in ACJ injuries. This study was aimed to introduce a new implant designed to fix ACJ and to evaluate its efficiency on the basis of biomechanical modeling and finite element analysis approaches. Computerized tomography scan images of 12 normal shoulders were selected to create a 3d model of shoulder joints. The dimensions of the implant were obtained from the models of shoulder joints and then were evaluated on 5 fresh cadavers. The stress developed in the implant and shoulder articular surfaces were evaluated by finite element analysis on the basis of the models obtained from computerized tomography scan images. The designed implant can be used to fix ACJ for both right and left sides. The stress developed in the implant varied between 1.88 and 2.1 MPa. The newly designed implant can be used for most of the subjects to fix ACJ for both rights and left sides. The stress developed in the implant in the abduction of the shoulder joint was significantly less than the yield strength of the material used for the implant. Therefore, it can be used without failure for most of the daily activities.
{"title":"A Pilot Biomechanical Study to Evaluate the Efficiency of New Implant to Fix Acromioclavicular Joint","authors":"H. Namazi, Keramat Askari, Mohammad T Karimi, M. Fereidooni","doi":"10.1097/BTE.0000000000000192","DOIUrl":"https://doi.org/10.1097/BTE.0000000000000192","url":null,"abstract":"The incidence of acromioclavicular joint (ACJ) injuries is high in daily activities and sports. Various surgical procedures have been used to restore the performance of the shoulder complex in ACJ injuries. This study was aimed to introduce a new implant designed to fix ACJ and to evaluate its efficiency on the basis of biomechanical modeling and finite element analysis approaches. Computerized tomography scan images of 12 normal shoulders were selected to create a 3d model of shoulder joints. The dimensions of the implant were obtained from the models of shoulder joints and then were evaluated on 5 fresh cadavers. The stress developed in the implant and shoulder articular surfaces were evaluated by finite element analysis on the basis of the models obtained from computerized tomography scan images. The designed implant can be used to fix ACJ for both right and left sides. The stress developed in the implant varied between 1.88 and 2.1 MPa. The newly designed implant can be used for most of the subjects to fix ACJ for both rights and left sides. The stress developed in the implant in the abduction of the shoulder joint was significantly less than the yield strength of the material used for the implant. Therefore, it can be used without failure for most of the daily activities.","PeriodicalId":44224,"journal":{"name":"Techniques in Shoulder and Elbow Surgery","volume":"21 1","pages":"33 - 36"},"PeriodicalIF":0.0,"publicationDate":"2020-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BTE.0000000000000192","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44406584","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}
Pub Date : 2020-05-08DOI: 10.1097/BTE.0000000000000189
Kelsey A. Rebehn, Lisa K. Cannada, J. Watson
The most utilized approach for minimally invasive plate osteosynthesis (MIPO) of humeral fractures has been an anterior percutaneous approach. Other approaches include posterior, which places the radial nerve at risk. We performed a cadaveric study to evaluate safe intervals for screw placement using a posterior approach. MIPO fixation of the humeral shaft was performed on 11 fresh frozen cadaveric specimens following a standard protocol using a 10-hole 4.5 locking compression plate (LCP) plate and cortical screws. After fixation, anatomic dissection of the radial nerve was performed and location of the nerve delineated with regards to radiographic landmarks and the fixation construct. A 10-hole LCP plate centered on the humerus will position a screw in the third hole from top of plate only 3.08 cm (±SD 1.05 cm) from the radial nerve. The distal screws in the LCP plate construct do not the place the radial nerve at risk. The literature reports rates of iatrogenic radial nerve injury during formal open reduction and internal fixation approaching 20%, and during MIPO between 0% and 5%. With a posterior MIPO approach the radial nerve is most at risk with screw placement in the fifth and sixth holes from the top of a 10-hole plate.
{"title":"Posterior Minimally Invasive Plate Osteosynthesis of Humeral Shaft Fractures: An Anatomic Study of “Danger Zones”","authors":"Kelsey A. Rebehn, Lisa K. Cannada, J. Watson","doi":"10.1097/BTE.0000000000000189","DOIUrl":"https://doi.org/10.1097/BTE.0000000000000189","url":null,"abstract":"The most utilized approach for minimally invasive plate osteosynthesis (MIPO) of humeral fractures has been an anterior percutaneous approach. Other approaches include posterior, which places the radial nerve at risk. We performed a cadaveric study to evaluate safe intervals for screw placement using a posterior approach. MIPO fixation of the humeral shaft was performed on 11 fresh frozen cadaveric specimens following a standard protocol using a 10-hole 4.5 locking compression plate (LCP) plate and cortical screws. After fixation, anatomic dissection of the radial nerve was performed and location of the nerve delineated with regards to radiographic landmarks and the fixation construct. A 10-hole LCP plate centered on the humerus will position a screw in the third hole from top of plate only 3.08 cm (±SD 1.05 cm) from the radial nerve. The distal screws in the LCP plate construct do not the place the radial nerve at risk. The literature reports rates of iatrogenic radial nerve injury during formal open reduction and internal fixation approaching 20%, and during MIPO between 0% and 5%. With a posterior MIPO approach the radial nerve is most at risk with screw placement in the fifth and sixth holes from the top of a 10-hole plate.","PeriodicalId":44224,"journal":{"name":"Techniques in Shoulder and Elbow Surgery","volume":"21 1","pages":"50 - 53"},"PeriodicalIF":0.0,"publicationDate":"2020-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BTE.0000000000000189","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44116194","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}
Pub Date : 2020-05-08DOI: 10.1097/BTE.0000000000000190
P. Robinson, S. Kanthasamy, L. Funk
There is no “gold standard” technique for the surgical stabilization of acromioclavicular joint (ACJ) disruptions and each of the described techniques has a failure rate. The management of failed ACJ stabilizations is a difficult problem and salvage procedures may often be constrained by the original procedure and the resultant anatomy. Reliable anatomic and biomechanically robust revision procedures for failed ACJ stabilization are therefore required. We describe a technique for revision stabilization of the ACJ that utilizes a synthetic ligament in combination with augmentation from the coracoacromial ligament and biceps short head aponeurosis (“biceps flip” procedure).
{"title":"A Surgical Technique for Revision of Failed Acromioclavicular Joint Reconstruction","authors":"P. Robinson, S. Kanthasamy, L. Funk","doi":"10.1097/BTE.0000000000000190","DOIUrl":"https://doi.org/10.1097/BTE.0000000000000190","url":null,"abstract":"There is no “gold standard” technique for the surgical stabilization of acromioclavicular joint (ACJ) disruptions and each of the described techniques has a failure rate. The management of failed ACJ stabilizations is a difficult problem and salvage procedures may often be constrained by the original procedure and the resultant anatomy. Reliable anatomic and biomechanically robust revision procedures for failed ACJ stabilization are therefore required. We describe a technique for revision stabilization of the ACJ that utilizes a synthetic ligament in combination with augmentation from the coracoacromial ligament and biceps short head aponeurosis (“biceps flip” procedure).","PeriodicalId":44224,"journal":{"name":"Techniques in Shoulder and Elbow Surgery","volume":"21 1","pages":"37 - 41"},"PeriodicalIF":0.0,"publicationDate":"2020-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BTE.0000000000000190","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47689079","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}
Pub Date : 2020-03-01DOI: 10.1097/BTE.0000000000000182
P. Chan, C. Yan, K. Chiu
Infection after total elbow arthroplasty can be a devastating problem. Eradication of the infection can often be difficult and may compromise the already tenuous bone and soft tissue, particularly the elbow extensor mechanism. Resection arthroplasty with the complete removal of all foreign material is often necessary to adequately treat the infection. Components may be well fixed and removal may further compromise bone and soft tissue. The authors present a technique of ulnar cortical window that facilitates the removal of a well-fixed ulnar component and the associated cement mantle. An illustrative surgical case is also included with pertinent intraoperative and radiographic images. This technique provides reliable, atraumatic access to the ulnar canal, cement mantle, and component for safe extraction of a well-fixed implant. When comparing with other techniques in the removal of the ulnar component, such as transverse ulnar osteotomy, and extended olecranon osteotomy, our technique did not breach the bony integrity of ulna, and it did not require wiring for rigid fixation of the bony fragment. This may be more applicable in excisional arthroplasty for the management of infected total elbow arthroplasty.
{"title":"Ulnar Cortical Window for Removal of a Well-Fixed Ulnar Component in Total Elbow Arthroplasty: Surgical Technique and Case Report","authors":"P. Chan, C. Yan, K. Chiu","doi":"10.1097/BTE.0000000000000182","DOIUrl":"https://doi.org/10.1097/BTE.0000000000000182","url":null,"abstract":"Infection after total elbow arthroplasty can be a devastating problem. Eradication of the infection can often be difficult and may compromise the already tenuous bone and soft tissue, particularly the elbow extensor mechanism. Resection arthroplasty with the complete removal of all foreign material is often necessary to adequately treat the infection. Components may be well fixed and removal may further compromise bone and soft tissue. The authors present a technique of ulnar cortical window that facilitates the removal of a well-fixed ulnar component and the associated cement mantle. An illustrative surgical case is also included with pertinent intraoperative and radiographic images. This technique provides reliable, atraumatic access to the ulnar canal, cement mantle, and component for safe extraction of a well-fixed implant. When comparing with other techniques in the removal of the ulnar component, such as transverse ulnar osteotomy, and extended olecranon osteotomy, our technique did not breach the bony integrity of ulna, and it did not require wiring for rigid fixation of the bony fragment. This may be more applicable in excisional arthroplasty for the management of infected total elbow arthroplasty.","PeriodicalId":44224,"journal":{"name":"Techniques in Shoulder and Elbow Surgery","volume":"352 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76595192","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}
Pub Date : 2020-03-01DOI: 10.1097/BTE.0000000000000183
Raymond Skunda, Joshua Wilson, Kenton Panas, S. P. Kelly, C. White
Suprascapular neuropathy is a well-known cause of shoulder pain and dysfunction. Common locations for suprascapular nerve (SSN) entrapment are the suprascapular notch and the spinoglenoid notch. Multiple authors have described both open and arthroscopic approaches for SSN decompression; however, to our knowledge, there is no description of decompression of the SSN at the suprascapular notch using a hybrid endoscopic approach to maximize the advantages of both. The patient was a 27-year-old, white male laborer, who presented with a 6-month history of left shoulder pain and decreased function without a history of trauma. A standard course of conservative treatment including nonsteroidal antiinflammatory drugs, activity modification, and physical therapy was attempted but failed to result in symptomatic improvement. Magnetic resonance imaging and electromyography were subsequently ordered and demonstrated a subacute muscle denervation pattern indicating the SSN as the most probable site of compression. Given the patient’s clinical examination, failure of nonoperative management, age, and his activity level, he was offered surgical intervention. The technique described in this report utilizes a novel, safe, effective, and facile approach for the release of the transverse scapular ligament. We present our hybrid endoscopic technique along with a case report demonstrating a good patient outcome to emphasize the successful application of our technique following appropriate utilization of history, physical examination, and diagnostic tests when deciding to operatively treat a patient with isolated suprascapular neuropathy.
{"title":"A Novel Technique for Endoscopic Release of the Transverse Scapular Ligament in the Setting of Suprascapular Neuropathy: Case Report and Technique","authors":"Raymond Skunda, Joshua Wilson, Kenton Panas, S. P. Kelly, C. White","doi":"10.1097/BTE.0000000000000183","DOIUrl":"https://doi.org/10.1097/BTE.0000000000000183","url":null,"abstract":"Suprascapular neuropathy is a well-known cause of shoulder pain and dysfunction. Common locations for suprascapular nerve (SSN) entrapment are the suprascapular notch and the spinoglenoid notch. Multiple authors have described both open and arthroscopic approaches for SSN decompression; however, to our knowledge, there is no description of decompression of the SSN at the suprascapular notch using a hybrid endoscopic approach to maximize the advantages of both. The patient was a 27-year-old, white male laborer, who presented with a 6-month history of left shoulder pain and decreased function without a history of trauma. A standard course of conservative treatment including nonsteroidal antiinflammatory drugs, activity modification, and physical therapy was attempted but failed to result in symptomatic improvement. Magnetic resonance imaging and electromyography were subsequently ordered and demonstrated a subacute muscle denervation pattern indicating the SSN as the most probable site of compression. Given the patient’s clinical examination, failure of nonoperative management, age, and his activity level, he was offered surgical intervention. The technique described in this report utilizes a novel, safe, effective, and facile approach for the release of the transverse scapular ligament. We present our hybrid endoscopic technique along with a case report demonstrating a good patient outcome to emphasize the successful application of our technique following appropriate utilization of history, physical examination, and diagnostic tests when deciding to operatively treat a patient with isolated suprascapular neuropathy.","PeriodicalId":44224,"journal":{"name":"Techniques in Shoulder and Elbow Surgery","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81537834","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}
Pub Date : 2020-03-01DOI: 10.1097/BTE.0000000000000184
Heta Lukjanov, J. Ikonen, T. Niemi, M. Pääkkönen
Despite the self-limiting nature of lateral epicondylitis (LE) the disease has a prolonged course in some patients. Currently there is no optimal treatment of choice for these patients. We treated 6 elbows in 5 patients with LE with free fat grafting. All patients had symptomatic LE (symptom duration >2 y) and magnetic resonance imaging scan consistent with LE, and no finding of osteoarthrosis of the elbow joint, ligament injury, or other condition causing palpable lateral elbow pain. The fat graft was harvested from the abdomen, centrifuged or decanted and 10 mL was injected in and around the lateral epicondyle. All patients recovered without complications. Pain in visual analogue scale decreased in 5 of the 6 elbows (83%). The routine follow-up was 3 months. Regarding the final results 3 patients were satisfied, 1 was uncertain and 1 was dissatisfied and underwent open surgery 10 months after the fat transfer. Lipomatosis was still visible in the lateral epicondyle. Free adipose transfer is an option in the treatment of LE. Patients undergoing the procedure will have a small bump in the lateral elbow. Level of Evidence: Level IV.
{"title":"Treatment of Chronic Lateral Epicondylitis With Autologous Fat Grafting","authors":"Heta Lukjanov, J. Ikonen, T. Niemi, M. Pääkkönen","doi":"10.1097/BTE.0000000000000184","DOIUrl":"https://doi.org/10.1097/BTE.0000000000000184","url":null,"abstract":"Despite the self-limiting nature of lateral epicondylitis (LE) the disease has a prolonged course in some patients. Currently there is no optimal treatment of choice for these patients. We treated 6 elbows in 5 patients with LE with free fat grafting. All patients had symptomatic LE (symptom duration >2 y) and magnetic resonance imaging scan consistent with LE, and no finding of osteoarthrosis of the elbow joint, ligament injury, or other condition causing palpable lateral elbow pain. The fat graft was harvested from the abdomen, centrifuged or decanted and 10 mL was injected in and around the lateral epicondyle. All patients recovered without complications. Pain in visual analogue scale decreased in 5 of the 6 elbows (83%). The routine follow-up was 3 months. Regarding the final results 3 patients were satisfied, 1 was uncertain and 1 was dissatisfied and underwent open surgery 10 months after the fat transfer. Lipomatosis was still visible in the lateral epicondyle. Free adipose transfer is an option in the treatment of LE. Patients undergoing the procedure will have a small bump in the lateral elbow. Level of Evidence: Level IV.","PeriodicalId":44224,"journal":{"name":"Techniques in Shoulder and Elbow Surgery","volume":"21 1","pages":"22 - 24"},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BTE.0000000000000184","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47802689","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}
Pub Date : 2020-02-14DOI: 10.1097/BTE.0000000000000181
Ameya U. Kulkarni, Umesh M. Kulkarni
Proximal humerus fractures account for 4% to 5% of all fractures. These fractures have been conventionally treated either conservatively in a shoulder immobilizer or by open reduction and internal fixation with a locking plate. Conservative treatment often leads to a stiff shoulder, and operative management requires extensive soft tissue dissection. In this study, we have chosen a middle path for treating proximal humerus fractures in the form of closed reduction and Joshi external stabilizing system (JESS) with early mobilization, thus overcoming the problem of shoulder stiffness associated with conservative management and excessive soft tissue dissection associated with the open procedure. We conducted a study on 25 patients with proximal humerus fractures with Neer types 2 and 3 fractures. The mean age was 49.6 years with a female preponderance of 64%. JESS was applied after closed reduction in all cases. Mobilization was started on days 1 or 2 of surgery. All patients were followed up at 2, 4, 6, and 8 weeks and at 6 months after surgery. All cases were evaluated functionally using the constant shoulder scoring system. In our study, the mean constant shoulder score was 75.7 at 6 months. All fractures united in 6 to 8 weeks. In our study, we had 2 cases of pin-tract infection and 1 case of shoulder stiffness. The JESS fixator is a good modality of treatment for Neer types 2 and 3 proximal humerus fractures, facilitating early mobilization without compromising on fracture stability and union rates.
{"title":"Proximal Humerus Fractures Managed With Joshi External Stabilizing System","authors":"Ameya U. Kulkarni, Umesh M. Kulkarni","doi":"10.1097/BTE.0000000000000181","DOIUrl":"https://doi.org/10.1097/BTE.0000000000000181","url":null,"abstract":"Proximal humerus fractures account for 4% to 5% of all fractures. These fractures have been conventionally treated either conservatively in a shoulder immobilizer or by open reduction and internal fixation with a locking plate. Conservative treatment often leads to a stiff shoulder, and operative management requires extensive soft tissue dissection. In this study, we have chosen a middle path for treating proximal humerus fractures in the form of closed reduction and Joshi external stabilizing system (JESS) with early mobilization, thus overcoming the problem of shoulder stiffness associated with conservative management and excessive soft tissue dissection associated with the open procedure. We conducted a study on 25 patients with proximal humerus fractures with Neer types 2 and 3 fractures. The mean age was 49.6 years with a female preponderance of 64%. JESS was applied after closed reduction in all cases. Mobilization was started on days 1 or 2 of surgery. All patients were followed up at 2, 4, 6, and 8 weeks and at 6 months after surgery. All cases were evaluated functionally using the constant shoulder scoring system. In our study, the mean constant shoulder score was 75.7 at 6 months. All fractures united in 6 to 8 weeks. In our study, we had 2 cases of pin-tract infection and 1 case of shoulder stiffness. The JESS fixator is a good modality of treatment for Neer types 2 and 3 proximal humerus fractures, facilitating early mobilization without compromising on fracture stability and union rates.","PeriodicalId":44224,"journal":{"name":"Techniques in Shoulder and Elbow Surgery","volume":"21 1","pages":"30 - 32"},"PeriodicalIF":0.0,"publicationDate":"2020-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BTE.0000000000000181","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42935153","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}
Pub Date : 2020-02-14DOI: 10.1097/BTE.0000000000000187
H. Çevi̇k, S. Gümüştaş, S. Kayahan
Clavicular malignancies are very rare, and few papers which reported that primary tumors are predominant, have been published about the functional and oncological outcomes after surgical treatment. The main purpose of the present study was to report the functional and oncological outcomes of 14 patients with clavicular malignancy, who were managed with total/partial claviculectomy without reconstruction, or followed up without surgical intervention. Of the total patients, 26.7% presented with clavicular cancer of unknown primary, and 42.9% with pathologic fractures of the clavicle. Claviculectomy without reconstruction was applied to 57.1% patients, as partial resection in 42.9% and total in 14.3%. The similarity of the clavicle to flat bones rather than long bones, that the surgical decision for partial or total resection of the clavicle because of malignancy is simpler to make than for other long bones because there is no requirement for reconstruction. Level of Evidence: Level IV.
{"title":"Surgical Management of Clavicular Malignancies With Resection of the Clavicle Without Reconstruction","authors":"H. Çevi̇k, S. Gümüştaş, S. Kayahan","doi":"10.1097/BTE.0000000000000187","DOIUrl":"https://doi.org/10.1097/BTE.0000000000000187","url":null,"abstract":"Clavicular malignancies are very rare, and few papers which reported that primary tumors are predominant, have been published about the functional and oncological outcomes after surgical treatment. The main purpose of the present study was to report the functional and oncological outcomes of 14 patients with clavicular malignancy, who were managed with total/partial claviculectomy without reconstruction, or followed up without surgical intervention. Of the total patients, 26.7% presented with clavicular cancer of unknown primary, and 42.9% with pathologic fractures of the clavicle. Claviculectomy without reconstruction was applied to 57.1% patients, as partial resection in 42.9% and total in 14.3%. The similarity of the clavicle to flat bones rather than long bones, that the surgical decision for partial or total resection of the clavicle because of malignancy is simpler to make than for other long bones because there is no requirement for reconstruction. Level of Evidence: Level IV.","PeriodicalId":44224,"journal":{"name":"Techniques in Shoulder and Elbow Surgery","volume":"21 1","pages":"25 - 29"},"PeriodicalIF":0.0,"publicationDate":"2020-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BTE.0000000000000187","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47952910","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}
Pub Date : 2020-02-14DOI: 10.1097/BTE.0000000000000186
Jae H.T. Lee, N. Vivekanandamoorthy, P. Lam, G. Murrell
Outcomes of arthroscopic instability repairs vary depending on repair techniques and anchor materials. The purpose of this study is to determine the short to mid-term redislocation, resubluxation rate and clinical outcomes following arthroscopic stabilization of nonabsorbable, biologically inert polymer polyether ether ketone (PEEK) suture anchors. This is a retrospective study with 140 patients who underwent arthroscopic anterior stabilization surgery using PEEK (Pushlock) anchors with a mean follow-up of 40 months. Patient ranked pain scores, clinically assessed range of motion and strength testing were collected preoperatively and at 1, 6, 12, and 24 weeks after surgery with the final follow-up carried out as a phone interview. After surgery, the redislocation rate increased over time to 18% until it stabilized at 3.8 years. Resubluxation rate increased to 20% until 2.8 years. At 24 weeks, forward flexion, as well as shoulder strength in abduction, adduction, external rotation, internal rotation, and lift-off, improved compared with preoperative levels. Patient ranked pain scores and overall shoulder rating improved significantly at the most recent follow-up compared with before surgery. Arthroscopic stabilization of glenohumeral instability using PEEK knotless anchors results in good short-term to mid-term stability with improved function and reduced pain. Level of Evidence: Level III.
{"title":"Short-Term to Mid-Term Outcomes of Arthroscopic Stabilization Using PEEK Knotless Anchors","authors":"Jae H.T. Lee, N. Vivekanandamoorthy, P. Lam, G. Murrell","doi":"10.1097/BTE.0000000000000186","DOIUrl":"https://doi.org/10.1097/BTE.0000000000000186","url":null,"abstract":"Outcomes of arthroscopic instability repairs vary depending on repair techniques and anchor materials. The purpose of this study is to determine the short to mid-term redislocation, resubluxation rate and clinical outcomes following arthroscopic stabilization of nonabsorbable, biologically inert polymer polyether ether ketone (PEEK) suture anchors. This is a retrospective study with 140 patients who underwent arthroscopic anterior stabilization surgery using PEEK (Pushlock) anchors with a mean follow-up of 40 months. Patient ranked pain scores, clinically assessed range of motion and strength testing were collected preoperatively and at 1, 6, 12, and 24 weeks after surgery with the final follow-up carried out as a phone interview. After surgery, the redislocation rate increased over time to 18% until it stabilized at 3.8 years. Resubluxation rate increased to 20% until 2.8 years. At 24 weeks, forward flexion, as well as shoulder strength in abduction, adduction, external rotation, internal rotation, and lift-off, improved compared with preoperative levels. Patient ranked pain scores and overall shoulder rating improved significantly at the most recent follow-up compared with before surgery. Arthroscopic stabilization of glenohumeral instability using PEEK knotless anchors results in good short-term to mid-term stability with improved function and reduced pain. Level of Evidence: Level III.","PeriodicalId":44224,"journal":{"name":"Techniques in Shoulder and Elbow Surgery","volume":"21 1","pages":"15 - 21"},"PeriodicalIF":0.0,"publicationDate":"2020-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BTE.0000000000000186","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49055400","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}
Pub Date : 2020-02-14DOI: 10.1097/BTE.0000000000000185
F. Luceri, J. Lesman, D. Cucchi, M. Domzalski, P. Randelli, P. Arrigoni
The coronoid process (CP) is important for stabilizing the elbow joint. The elbow’s joint fracture is considered the most common factor in several cases of complex elbow dislocations. The surgical indications for recommending the CP in fractures are prolonged instabilities of the elbow. The open fixation of the CP is a demanding procedure, owing to many complications after the surgeries. Arthroscopic reduction and internal fixation have been proposed to overcome the limitations of open approaches. The aim of our study is to describe, step by step, a new surgical procedure for arthroscopically assisted fracture reduction and insertion of an antegrade guidewire for internal fixation of coronoid fractures. To perform this surgery, the knowledge of the portals in elbow arthroscopy is essential. The final stabilization is achieved by accurate positioning of the Kirschner-wire under arthroscopic control and stabilizing by the cannulated screw. The proposed technique is a safe and appealing procedure in the treatment of coronoid fractures.
{"title":"Antegrade Reduction and Fixation of Coronoid Fractures: A New Arthroscopic Technique","authors":"F. Luceri, J. Lesman, D. Cucchi, M. Domzalski, P. Randelli, P. Arrigoni","doi":"10.1097/BTE.0000000000000185","DOIUrl":"https://doi.org/10.1097/BTE.0000000000000185","url":null,"abstract":"The coronoid process (CP) is important for stabilizing the elbow joint. The elbow’s joint fracture is considered the most common factor in several cases of complex elbow dislocations. The surgical indications for recommending the CP in fractures are prolonged instabilities of the elbow. The open fixation of the CP is a demanding procedure, owing to many complications after the surgeries. Arthroscopic reduction and internal fixation have been proposed to overcome the limitations of open approaches. The aim of our study is to describe, step by step, a new surgical procedure for arthroscopically assisted fracture reduction and insertion of an antegrade guidewire for internal fixation of coronoid fractures. To perform this surgery, the knowledge of the portals in elbow arthroscopy is essential. The final stabilization is achieved by accurate positioning of the Kirschner-wire under arthroscopic control and stabilizing by the cannulated screw. The proposed technique is a safe and appealing procedure in the treatment of coronoid fractures.","PeriodicalId":44224,"journal":{"name":"Techniques in Shoulder and Elbow Surgery","volume":"21 1","pages":"1 - 5"},"PeriodicalIF":0.0,"publicationDate":"2020-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BTE.0000000000000185","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45837650","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}
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