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Cureus May 2024The patient, a 69-year-old female, presented one year after receiving a total elbow arthroplasty with a nonunion periprosthetic fracture of the humerus. Due to the...
The patient, a 69-year-old female, presented one year after receiving a total elbow arthroplasty with a nonunion periprosthetic fracture of the humerus. Due to the patient's severe osteoarthritis of the ipsilateral shoulder and significant humeral deformity, a procedure linking the total elbow arthroplasty to the reverse shoulder implant via a cemented allograft-composite linkage sleeve was performed. Previous literature suggests upper extremity salvage surgery using large-scale allografts is successful in treating large tumor or infection-derived defects, though data is lacking as to whether this treatment is effective in periprosthetic fractures in patients with significant comorbidities. This patient's success in the postoperative year supports the use of allograft-composite reconstruction followed by linkage to a reverse shoulder implant as a salvage treatment for periprosthetic fractures under certain conditions, such as multiple adjacent implants, bone deformity, and severe osteoarthritis.
PubMed: 38883071
DOI: 10.7759/cureus.60491 -
Cureus May 2024Neglected shoulder dislocation is a relatively rare occurrence characterized by structural changes in bone and soft tissue. Surgical intervention is often necessary, yet...
Neglected shoulder dislocation is a relatively rare occurrence characterized by structural changes in bone and soft tissue. Surgical intervention is often necessary, yet no universally accepted treatment approach exists, presenting a challenging clinical scenario. A 45-year-old female presented with an eight-month-old neglected anterior shoulder dislocation, compounded by a Hill-Sachs lesion from a previous fall. Treatment comprised open reduction in conjunction with the Latarjet procedure. Regular follow-up evaluations were conducted over three years post-surgery, revealing satisfactory outcomes including good range of motion, bony union, and absence of dislocation episodes. Managing neglected shoulder dislocations, particularly those with significant bone defects, poses unique challenges involving soft tissue contracture, bone loss, and associated fractures. Despite these complexities, open reduction combined with the Latarjet procedure demonstrated a high success rate in preventing further shoulder dislocation, albeit with a persistent risk of shoulder joint osteoarthritis.
PubMed: 38883054
DOI: 10.7759/cureus.60333 -
Cureus May 2024Road traffic accidents lead to extensive damage to superficial as well as deep components in the body. Neurological structures that are affected due to open injuries...
Road traffic accidents lead to extensive damage to superficial as well as deep components in the body. Neurological structures that are affected due to open injuries have major impairments in the day-to-day life of an individual. High trauma incidents lead to nerve injuries, which are a common occurrence secondary to fractures after such falls. Nerve entrapment, nerve compression, nerve denervation, or demyelination usually result in the wasting of muscles supplied by it, which eventually causes muscle atrophy. Muscle atrophy limits the ability of an individual to move the extremities to achieve functional activities. Sensory neuropathy, in addition to motor neuropathy, is an associated complication. Physical therapy interventions are observed to play a significant role in nerve and muscle injury rehabilitation courses, thus improving quality of life. This report presents a case of a 43-year-old male who came to the hospital with complaints of pain and inability to move the shoulder after his bike was hit by a truck from behind and he experienced a fall. The patient presented to an orthopedic surgeon who took X-ray, electromyography (EMG), and nerve conduction velocity (NCV) investigations and confirmed fracture of greater tuberosity of the humerus and motor neuropathy of the suprascapular nerve. He was surgically treated and was referred to the physiotherapy outpatient department for postoperative management. A well-planned physical therapy program aimed to improve the range of motion and strength of the affected shoulder joint while preventing atrophy, thus improving quality of life.
PubMed: 38882973
DOI: 10.7759/cureus.60509 -
Orthopaedics & Traumatology, Surgery &... Jun 2024The Latarjet procedure is a frequently used stabilization procedure in case of anterior shoulder instability with critical glenoid bone loss and/or off-track Hill Sachs...
The Latarjet procedure is a frequently used stabilization procedure in case of anterior shoulder instability with critical glenoid bone loss and/or off-track Hill Sachs lesions. Although uncommon, intra-operative graft fractures do occur. When confronted with this potentially challenging intra-operative complication, having a secondary solution is paramount to achieve a successful outcome. This technical note provides a treatment algorithm that may function as a useful guideline to assist surgeons that experience this potentially complex unintended event during a Latarjet procedure. Level of evidence: Level IV, therapeutic case series.
PubMed: 38879002
DOI: 10.1016/j.otsr.2024.103919 -
Injury Jun 2024Although varus posteromedial rotatory instability (VPMRI) is a subtle elbow injury that involves anteromedial coronoid facet (AMCF) fracture and ligamentous injuries,...
INTRODUCTION
Although varus posteromedial rotatory instability (VPMRI) is a subtle elbow injury that involves anteromedial coronoid facet (AMCF) fracture and ligamentous injuries, treatment options and outcomes of VPMRI remains controversial. The aim of this study was to investigate radiographic findings, treatments, and outcomes of a large series of VPMRI.
METHODS
We retrospectively reviewed 91 pure VPMRI cases with AMCF fracture (O'Driscoll classification anteromedial type) which were treated at 6 hospitals. Clinical and radiographic outcomes were investigated with a mean follow-up period of 46.8 months using the Mayo elbow performance score (MEPS), and the Quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) score, and serial plain radiographs.
RESULTS
In AMCF fracture, there were 4 cases of subtype 1, 67 cases of subtype 2, and 20 cases of subtype 3. On MRI, complete tears of lateral collateral ligament and medial collateral ligament were observed in 83.1 % (59/71 cases) and 33.8 % (24/71 cases). Operative treatment was performed in 68 cases (74.7 %) including both side fixation in 40 cases (58.8 %), medial side fixation only in 17 cases (25.0 %), and lateral side fixation only in 11 cases (16.2 %). Nonoperative treatment was performed in 23 cases (25.3 %). The mean final MEPS and Quick-DASH scores were 93.7 and 7.9. The overall complication and reoperation rates were 22.0 % and 15.4 %. No significant differences regarding final clinical scores and range of motions were observed between the operative group and the nonoperative group, but significant differences were observed regarding number (p = 0.019) and displacement (p = 0.002) of coronoid fragment, and complication rate (p < 0.001) between the two groups.
CONCLUSION
Depending on the pattern of coronoid fragment and the degree of ligamentous injuries, operative treatment of unstable VPMRI using various fixation techniques including coronoid fixation and ligament repair yielded satisfactory final clinical outcomes. However, surgeons should be aware of the high complication and reoperation rates after operative treatment. Stable VPMRI with AMCF fracture involving minimal displacement or small number of fragments can be treated nonoperatively.
PubMed: 38878382
DOI: 10.1016/j.injury.2024.111628 -
European Journal of Orthopaedic Surgery... Jun 2024
Correction to: Converting to reverse shoulder arthroplasty from primary anatomic shoulder arthroplasty and fracture hemiarthroplasty: a radiographic and clinical outcome analysis at 8‑years.
PubMed: 38878065
DOI: 10.1007/s00590-024-04005-6 -
Journal of Orthopaedics and... Jun 2024The aim of this study was to explore the efficacy of a novel intramedullary fixation technique using the ortho-bridge system (OBS) for midshaft clavicle fractures.
BACKGROUND
The aim of this study was to explore the efficacy of a novel intramedullary fixation technique using the ortho-bridge system (OBS) for midshaft clavicle fractures.
METHODS
A total of 63 patients were included in this study: 35 underwent plate internal fixation (LP group) and 28 underwent OBS intramedullary fixation (OBS group). Surgical time, intraoperative blood loss, incision length, fracture healing time, removal of the internal fixation agent, visual analog scale (VAS) score for shoulder pain, Constant-Murley shoulder score and complication occurrence were compared between the two groups.
RESULTS
Preoperative general data, such as sex, age and fracture type, were not significantly different between the two groups (P > 0.05). However, the OBS group exhibited better outcomes than the LP group exhibited in terms of surgical time, intraoperative blood loss and total incision length (P < 0.05). Additionally, the OBS group exhibited a significantly shorter fracture healing time and internal-fixation removal time than the LP group exhibited (P < 0.05). The VAS scores on postoperative day 1, week 1, month 1 and month 3 were lower in the OBS group than in the LP group (P < 0.05). Furthermore, the Constant-Murley shoulder scores at 1, 3, and 6 months postoperatively were higher in the OBS group than in the LP group (P < 0.05), with no significant difference at 1 year after surgery (P > 0.05). None of the patients in the OBS group experienced scarring of the surgical incision, and 6 patients in the LP group experienced scarring of the surgical incision. Finally, the complication incidence in the OBS group was lower than that in the LP group.
CONCLUSION
For midshaft clavicle fractures, OBS intramedullary fixation is better than locking-plate internal fixation because it led to less trauma, a faster recovery, better efficacy, and better esthetic outcomes and comfort. Therefore, this technique may have potential as a novel treatment for midshaft clavicle fractures.
LEVEL OF EVIDENCE
III, retrospective observational study.
Topics: Humans; Clavicle; Male; Female; Retrospective Studies; Fractures, Bone; Adult; Fracture Fixation, Intramedullary; Middle Aged; Fracture Healing; Bone Plates; Treatment Outcome; Operative Time; Pain Measurement; Blood Loss, Surgical; Fracture Fixation, Internal
PubMed: 38864994
DOI: 10.1186/s10195-024-00771-5 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Jun 2024This study compares the efficacy and safety of lateral approach surgery with and without radial nerve dissection in treating humeral diaphyseal fractures. It assesses...
BACKGROUND
This study compares the efficacy and safety of lateral approach surgery with and without radial nerve dissection in treating humeral diaphyseal fractures. It assesses clinical, radiological, and complication outcomes, providing a description of the surgical methods and perioperative benefits.
METHODS
We retrospectively analyzed data from 71 patients admitted between May 2015 and December 2022 who underwent lateral approach surgery for humeral diaphyseal fractures. Group 1, consisting of 34 patients without radial nerve dissection, and Group 2, comprising 37 patients with radial nerve dissection, were compared. Parameters such as age, gender, fracture side (right/left), fracture type, follow-up time, surgical duration, blood loss, radiological and clinical evaluations (including Shoulder-Elbow range of motion [ROM] and Quick Disabilities of the Arm, Shoulder, and Hand score [Q-DASH]), and complications were examined. Surgical techniques and outcomes were documented.
RESULTS
Both groups exhibited comparable distributions in age, gender, fracture types, and follow-up times (p>0.05). Group 1 demonstrated significantly lower surgical duration and blood loss compared to Group 2 (p<0.05 for both). Clinical assessment revealed satisfactory shoulder and elbow ROM within functional limits for all patients, with no instances of infection. Q-DASH scores were similar between groups. Postoperative radial nerve palsy occurred in one patient in Group 1 and three patients in Group 2, with all cases resolving uneventfully during outpatient follow-ups. Radiological assessment confirmed uneventful union in all patients.
CONCLUSION
Lateral approach surgery without radial nerve dissection for humeral diaphyseal fractures offers comparable effectiveness and safety to conventional surgery, with potential perioperative advantages such as reduced operation time and blood loss.
Topics: Humans; Male; Female; Humeral Fractures; Retrospective Studies; Adult; Radial Nerve; Middle Aged; Fracture Fixation, Internal; Range of Motion, Articular; Treatment Outcome; Diaphyses; Young Adult
PubMed: 38863290
DOI: 10.14744/tjtes.2024.49500 -
Scientific Reports Jun 2024In conservative treatment for proximal humerus fractures (PHFs), the immobilization position of the affected arm should not be determined uniformly. The aim of this...
In conservative treatment for proximal humerus fractures (PHFs), the immobilization position of the affected arm should not be determined uniformly. The aim of this study is to investigate the optimal immobilization position for conservative treatment of different types of PHFs. We hypothesized that the optimal position minimizing the deforming force in PHFs depends on the fracture components involved. PHF models involving either the surgical neck (SN) or greater tuberosity (GT) were created using 12 fresh-frozen cadaveric shoulders. In the SN model, the deforming forces on the pectoralis major muscle were measured in full adduction by increasing external rotation. In the GT model, the deforming force of the supraspinatus muscle was measured in neutral rotation by decreasing abduction, and the deforming force of the infraspinatus muscle was measured in full adduction by increasing internal rotation, respectively. In the SN model, the deforming force of the pectoralis major muscle increased significantly with external rotation from full internal rotation to neutral rotation (P = 0.006), indicating that the arm should be placed in full internal rotation. In the GT model, the deforming force of the supraspinatus muscle increased significantly with adduction from 45° of abduction to full adduction (P = 0.006); the deforming force of the infraspinatus muscle increased significantly with internal rotation from neutral rotation to full internal rotation (P = 0.006). These findings should be considered when placing the arm in abduction and neutral rotation so as to minimize the deforming force by either the supra or infraspinatus muscle. In conservative treatment for PHFs, the affected arm should be placed in a position that minimizes the deforming force on the fracture components involved.
Topics: Humans; Shoulder Fractures; Cadaver; Biomechanical Phenomena; Aged; Male; Female; Conservative Treatment; Aged, 80 and over; Immobilization; Middle Aged; Range of Motion, Articular
PubMed: 38862648
DOI: 10.1038/s41598-024-64326-8 -
Acta Ortopedica Mexicana 2024shoulder plain is a common cause of complain, however a precise diagnosis is hard to achieve. This is why finding factors associated to a good prognosis could help to...
INTRODUCTION
shoulder plain is a common cause of complain, however a precise diagnosis is hard to achieve. This is why finding factors associated to a good prognosis could help to improve our clinical practice.
OBJECTIVE
to identify demographic and clinical characteristics from the initial assessment associated with substantial clinical benefit (SCB) in patients with shoulder pain one month after treatment or at patient's discharge.
MATERIAL AND METHODS
this was a secondary analysis of a prospective cohort of patients with shoulder pain. Demographic and clinical (self-reported scales) factors associated with SCB at discharge or four weeks after the initial assessment, were analyzed. SCB was defined as a score +5 on a Global Rating of Change. A logistic regression model was made in order to identify predictors of SCB. The area under the curve ROC was used to assess the performance of the model with its independent variables.
RESULTS
101 patients of 138 were analyzed. The median age was 55 (RIQ 37-61) years old, there were 55 (54.5%) women in the sample. The variables independently associated to SCB were fracture as a reason for admission [adjusted OR 11.8 (95% CI 1.4-101.8); p = 0.024], and durations of shoulder symptoms shorter than seven months [adjusted OR 4.63 (95% CI 1.9-11.1); p = 0.001].
CONCLUSION
the diagnosis of fracture and durations of shoulder symptoms shorter than seven months were independently associated with a SCB after one month of treatment or at the patient's discharge.
Topics: Humans; Female; Male; Middle Aged; Prospective Studies; Prognosis; Adult; Shoulder Pain; Logistic Models
PubMed: 38862143
DOI: 10.35366/115808