Shoulder and Elbow

Latest journal articles about shoulder and elbow from Journal of Shoulder and Elbow Surgery, The Bone & Joint Journal, Journal of Bone and Joint Surgery, Clinical Orthopaedics and Related Research, Acta Orthopaedica, Orthopedic Clinics of North, America, Journal of Orthopaedic Surgery and Research, Orthopedics

Related Articles Reverse shoulder arthroplasty. Orthop Clin North Am. 2013 Jul;44(3):389-408 Authors: Jarrett CD, Brown BT, Schmidt CC Abstract The reverse shoulder arthroplasty is considered to be one of the most significant technological advancements in shoulder reconstructive surgery over the past 30 years. It is able to successfully decrease pain and improve function for patients with rotator cuff-deficient shoulders. The glenoid is transformed into a sphere that articulates with a humeral socket. The current reverse prosthesis shifts the center of rotation more medial and distal, improving the deltoid's mechanical advantage. This design has resulted in successful improvement in both active shoulder elevation and in quality of life. PMID: 23827841 [PubMed - in process]Read more... http://www.ncbi.nlm.nih.gov/pubmed/23827841?dopt=Abstract

Related Articles Total elbow arthroplasty for distal humerus fractures. Orthop Clin North Am. 2013 Jul;44(3):381-7 Authors: Desimone LJ, Sanchez-Sotelo J Abstract Total elbow arthroplasty has become increasingly popular for the treatment of distal humerus fractures in elderly patients with poor bone quality, comminution, and/or pre-existent elbow abnormalities. The procedure is performed without violating the extensor mechanism; the fractured fragments are exposed and resected on both sides of the triceps, and the components can be implanted through the same exposure. Early outcomes are satisfactory in most elbows and compare favorably with internal fixation in this same group of elderly patients. Advances in elbow arthroplasty for fractures will likely combine refinement of the indications and development of implants with lower rates of failure. PMID: 23827840 [PubMed - in process]Read more... http://www.ncbi.nlm.nih.gov/pubmed/23827840?dopt=Abstract

Related Articles Technical pitfalls of shoulder hemiarthroplasty for fracture management. Orthop Clin North Am. 2013 Jul;44(3):317-29 Authors: Wiesel BB, Nagda S, Williams GR Abstract Although most proximal humerus fractures can be treated nonoperatively, 4-part fractures and 3-part fractures/dislocations in elderly patients often require management with prosthetic arthroplasty. Reverse arthroplasty is gaining in popularity, but hemiarthroplasty still has a role in the management of 4-part and some 3-part fractures and dislocations. The 2 most important technical factors influencing functional outcome in hemiarthroplasty patients are the restoration of the patient's correct humeral head height and version, and healing of the greater and lesser tuberosities in an anatomic position. Hemiarthroplasty for proximal humerus fracture provides predictable pain relief, but functional recovery is much less predictable. PMID: 23827835 [PubMed - in process]Read more... http://www.ncbi.nlm.nih.gov/pubmed/23827835?dopt=Abstract

Related Articles Disorders of the proximal and distal aspects of the biceps muscle. J Bone Joint Surg Am. 2013 Jul 3;95(13):1235-45 Authors: McDonald LL, Dewing CC, Shupe LP, Provencher CM Abstract PROXIMAL ASPECT OF BICEPS  ➤ Tenodesis of the long head of the biceps may offer improved cosmesis, improved strength, and diminished activity-related pain compared with tenotomy, although comparative studies have shown similar outcomes in some patient populations. DISTAL ASPECT OF BICEPS  ➤ Operative treatment of both partial and complete distal biceps ruptures results in better outcomes compared with nonoperative care, although the optimal technique and fixation are yet to be determined. ➤ Nonoperative management is an acceptable treatment for patients willing to accept some loss of forearm supination and elbow flexion strength as well as changes in endurance and cosmesis. PMID: 23824393 [PubMed - in process]Read more... http://www.ncbi.nlm.nih.gov/pubmed/23824393?dopt=Abstract

Related Articles Volar Ligament Release and Distal Radial Dome Osteotomy for the Correction of Madelung Deformity: Long-Term Follow-up. J Bone Joint Surg Am. 2013 Jul 3;95(13):1198-204 Authors: Steinman S, Oishi S, Mills J, Bush P, Wheeler L, Ezaki M Abstract BACKGROUND: Madelung deformity is a disorder of growth of the distal aspect of the radius that is usually recognized in late adolescence near skeletal maturity. It results in a characteristic wrist deformity, decreased wrist motion, and wrist pain. The purpose of this study was to evaluate long-term results in patients treated by volar ligament release and distal radial dome osteotomy for Madelung deformity. METHODS: Patients who had undergone volar ligament release and dome osteotomy for Madelung deformity at our institution from 1990 to 2002 and who were the subjects of a previous report on this treatment were contacted for clinical and radiographic evaluation at mid-term to long-term follow-up. Forearm and wrist motion was evaluated. Posteroanterior and lateral radiographs of both forearms were assessed for radial inclination, lunate subsidence, and arthritis changes. A Disabilities of the Arm, Shoulder and Hand (DASH) survey was completed.

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Related Articles Functional and radiographic outcomes of nonoperative treatment of displaced adolescent clavicle fractures. J Bone Joint Surg Am. 2013 Jul 3;95(13):1159-65 Authors: Schulz J, Moor M, Roocroft J, Bastrom TP, Pennock AT Abstract BACKGROUND: Studies of adult patients suggest that nonoperative treatment of clavicle fractures may result in functional disability, but this has not been demonstrated in adolescents. The purpose of this study was to determine the functional outcomes after nonoperative treatment of displaced, shortened, midshaft clavicle fractures in adolescents. METHODS: Adolescents ten to eighteen years of age with an isolated, completely displaced, shortened, midshaft clavicle fracture sustained between 2009 and 2011 were recruited for this study. Injury and final radiographs were assessed for displacement, shortening, and clavicle length. Maximal and endurance strength testing was performed with the Baltimore Therapeutic Equipment (BTE) machine, with use of the uninjured shoulder as an internal control. Shoulder range of motion and clavicle length were assessed clinically, and patient-oriented outcomes were obtained. RESULTS: Sixteen patients (four of whom were female) with an average age (and standard deviation) of 14.2 ± 2 years and a mean duration of follow-up of 2 ± 1 years were included in the study. Fifteen patients were right-hand dominant and one was ambidextrous, and thirteen of the fractures occurred in the nondominant

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Related Articles Risk factors for nonunion after nonoperative treatment of displaced midshaft fractures of the clavicle. J Bone Joint Surg Am. 2013 Jul 3;95(13):1153-8 Authors: Murray IR, Foster CJ, Eros A, Robinson CM Abstract BACKGROUND: Identification of patients at higher risk of nonunion after diaphyseal clavicular fractures is desirable to improve patient counseling and enable targeted surgical treatment. METHODS: Seventy-nine percent (941 of 1196) of diaphyseal clavicular fractures were followed to union or nonunion. Demographic, injury, and radiographic characteristics associated with nonunion were determined with use of bivariate and multivariate statistical analyses.

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Related Articles Effect of Elbow Flexion on the Proximity of the PIN During 2-incision Distal Biceps Repair. Orthopedics. 2013 Jul 1;36(7):e931-5 Authors: Jones JA, Jones CM, Grossman MG Abstract The posterior interosseous nerve (PIN) is at risk for injury during surgical dissection for distal biceps repair, yet the optimal position of elbow flexion to avoid a PIN injury has never been established for the 2-incision approach. The purpose of this study was to determine the proximity of the PIN to the radial tuberosity during surgical dissection in different degrees of elbow flexion. Ten cadaveric specimens with an intact elbow and forearm were dissected in full pronation using a modified Boyd-Anderson approach. Half of the dissections were completed in 90° of flexion and the other half were completed in maximal flexion. To simulate the location of the PIN during a single-incision biceps repair, the distance of the PIN to the radial tuberosity was recorded in full extension and supination. Results from these measurements were assessed for differences using paired t tests, with differences deemed significant for P values less than .05. The PIN was not identified in any of the 2-incision surgical dissections. Based on these findings, the proximity of the PIN to the radial tuberosity is not significantly affected by the degree of elbow flexion in the muscle-splitting 2-incision approach. In addition, a safe zone exists for avoiding PIN injury in a single-incision technique for distal biceps repair because a drill bit exiting the radial tuberosity greater than 1 cm in a distal-radial direction would place the PIN at risk. PMID: 23823052 [PubMed - in process]Read more... http://www.ncbi.nlm.nih.gov/pubmed/23823052?dopt=Abstract

Related Articles Change in Quality of Life and Cost/Utility Analysis in Open Stage-related Surgical Treatment of Elbow Stiffness. Orthopedics. 2013 Jul 1;36(7):e923-30 Authors: Giannicola G, Bullitta G, Sacchetti FM, Scacchi M, Polimanti D, Citoni G, Cinotti G Abstract The goals of this study were to examine the improvement in quality of life achieved after open surgical treatment of elbow stiffness and to verify the cost/utility ratio of surgery. Thirty-three patients (22 men and 11 women) underwent surgery. The etiologies of elbow stiffness were posttraumatic conditions (n=26), primary osteoarthritis (n=5), and rheumatoid arthritis (n=2). Surgery included 14 ulnohumeral arthroplasties, 6 ulnohumeral arthroplasties associated with radiocapitellar replacement, 5 ulnohumeral arthroplasties associated with radial head replacement, and 8 total elbow arthroplasties. All patients were evaluated pre- and postoperatively with the Mayo Elbow Performance Score, the Mayo Elbow Performance Index, the modified American Shoulder and Elbow Surgeons score, the Quick Disabilities of the Arm, Shoulder and Hand score, and the Short Form 36 after a mean follow-up of 26 months. Possible variables affecting clinical outcome and quality of life improvement were assessed. The cost/utility ratio was evaluated as diagnosis-related group reimbursement per quality-adjusted life year. Mayo Elbow Performance Scores and modified American Shoulder and Elbow Surgeons scores increased, on average, by 43 and 41 points, respectively (P<.0001). Quick Disabilities of the Arm, Shoulder and Hand scores decreased, on average, by 44 points (P<.0001). The improvement in the SF-36 physical and mental component

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Related Articles Effectiveness of locking versus dynamic compression plates for diaphyseal forearm fractures. Orthopedics. 2013 Jul 1;36(7):e917-22 Authors: Azboy I, Demirtas A, Uçar BY, Bulut M, Alemdar C, Ozkul E Abstract

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