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The problems involved in temporary drilling wire fixation is described with reference to fracture of the humeral head as an example. The difficulties can be resolved with a developed drill bush.
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Anterior dislocation of the shoulder is generally not associated with neurological compromise. We report three patients in whom a brachial plexus injury was caused by an anterior dislocation of the shoulder. One patient was further complicated by vascular involvement. The forces producing the injury are usually small, and the neurological trauma is likely to be neuropraxia. Conservative management is usually successful, and, in our patients, recovery took place after an average of six months.
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Electrotherapy was introduced into the aftercare programme for patients with serial rib fractures in the acute stage, shoulder injuries or fractures of the radius. Electrical stimulation was carried out with the Tenzcare Nr. 6240 apparatus. The results were significantly better in each of the three groups than in the respective control group. Patients after thorax trauma complained less of pain in the acute phase: there was less pulmonary secretion on X-ray and, on average, their blood gas values returned to normal three days earlier. None of them required assisted respiration. Patients with shoulder injuries or fractures of the radius complained less frequently of pain during physio-therapy after removal of their plaster casts. They attained their optimum range of movement on average ten and eight days earlier, respectively than the controls.
Athletic injuries in the shoulder range from a routine strain or sprain to a potentially disabling fracture or tendon rupture. The level of sports participation plays an important role in diagnosis and treatment. The nonprofessional athlete may be more likely to sustain injuries secondary to under-training or improper technique. The professional athlete may be capable of play under much higher velocities and applied loads and, therefore, may be subject to higher energy trauma than the amateur athlete. In addition to standard treatment considerations, return to play time must also be decided. Decisions regarding definitive treatment may be modulated depending on an athlete's desire to return to his or her previous level of competition.
This case report describes arthroscopic repair for the treatment of an anterior glenoid rim fracture associated with traumatic anterior shoulder dislocation.
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This clinical study was performed to analyze the midterm results and potential complications of the reverse prosthesis in different diagnosis. Forty-five consecutive patients with Grammont prosthesis were evaluated clinically and radiographically with a mean follow-up of 40 months (range, 24-72 months). The indication was a massive and irreparable cuff tear associated with arthrosis (CTA) in 21 cases, fracture sequelae (FS) with arthritis in 5 cases, and failure of a revision arthroplasty (revision) in 19 cases. Fourteen complications occurred in 11 patients. 3 dislocations, 3 deep infections (all 3 in the revision group), 1 case of aseptic humeral loosening, 2 periprosthetic humeral fractures, 1 intraoperative glenoid fracture, 1 wound hematoma, 2 late acromial fractures, and 1 axillary nerve palsy. Of the patients, 10 (22%) required further surgery: 4 reoperations, 4 prosthesis revisions, and 2 prosthesis removals. Complications were higher in revision than in CTA (47% vs. 5%). All 3 groups showed a significant increase in active elevation (from 55 degrees preoperatively to 121 degrees postoperatively) and Constant score (from 17 to 58 points) but no significant change in active external rotation (from 7 degrees to 11 degrees ) or internal rotation (S1 preoperatively and postoperatively). Of the patients, 78% were satisfied or very satisfied with the result and 67% had no or slight pain. However, the postoperative Constant score, adjusted Constant score, and American Shoulder and Elbow Surgeons shoulder score were all significantly higher in the CTA group with as compared with the revision group (P = .01, .004, and .002, respectively). Scapular notching was seen in 24 cases (68%). No glenoid loosening was observed at current follow-up, even when the notch extended beyond the inferior screw (28% of cases). Atrophy of severe fatty infiltration of the teres minor was associated with lower external rotation (15 degrees vs 0 degrees , P = .02) and lower functional results (Constant score of 46 points vs 66 points, P < .007). The Grammont reverse prosthesis can improve function and restore active elevation in patients with incongruent cuff-deficient shoulders; active rotation is usually unchanged. Results are less predictable and complication and revision rates are higher in patients undergoing revision surgery as compared with those in patients with CTA. Results of the reverse prosthesis depend on the diagnosis and on the remaining cuff muscles, specifically the teres minor. Surgeons should be vigilant with regard to low-grade infection in revision surgery.
Fracture of either clavicle or scapular neck alone are generally stable and have satisfactory results by conservative treatment. However, displaced scapular neck and ipsilateral clavicle fractures are relatively unstable. Those sequelae as drooping shoulder and limited range of motion may develop if treated conservatively. Surgical intervention either fixation of clavicle alone or fixation of clavicle and scapular neck simultaneously can achieve stable reduction of the fractures and prevent those sequelae. We present two cases of floating shoulder treated surgically with excellent results.
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In cases of shoulder injury when clinical signs suggest a possible coracoid fracture, a 20 degree posterior oblique film with 20 degrees of cephalad angulation has been shown to demonstrate coracoid fractures when other views have been inconclusive.
PURPOSE: The purpose of this study is to describe arthroscopic findings and the results of arthroscopic treatment of patients with chronic shoulder pain caused by a minimally displaced fracture of the greater tuberosity. TYPE OF STUDY: This is a retrospective case series in a consecutive sample of 23 patients with a minimally displaced or nondisplaced fracture of the greater tuberosity who underwent outcome analysis after arthroscopic treatment. MATERIALS AND METHODS: Twenty-three patients with chronic shoulder pain beyond 6 months after fracture of the greater tuberosity underwent arthroscopic treatment and were retrospectively assessed after an average of 29 months (range, 22 to 40 months). There were 18 men and 5 women with the average age of 39 years (range, 24 to 61 years). Fourteen fractures were isolated and 9 were related to acute anterior instability episode. The average displacement of the fracture was 2.3 mm (range, 0 to 4 mm) as shown on anteroposterior view plain radiographs. RESULTS: At the time of arthroscopy, all patients had partial-thickness rotator cuff tears on the articular surface. The cuff tears were located on the tuberosity fracture area and were an Ellman grade I to II in depth. After arthroscopic debridement or repair of the tear, depending on the condition of the tear itself, as well as subacromial decompression, the UCLA score results were good to excellent in 20 and fair in 3 patients. Nineteen of the patients had returned to the previous level of activities. However, the patients engaged in overhead sports activity had a lower level of return to activity (P =.034). CONCLUSIONS: A partial-thickness rotator cuff tear on the articular surface should be considered in patients with chronic shoulder pain after a minimally displaced fracture of the greater tuberosity. Arthroscopic debridement or repair is an appropriate procedure.
Twenty-two patients with marked displacement of a fracture of the proximal humeral epiphysis have been treated with closed or open reduction and fixation by Kirschner wires. At an average follow-up of 6.8 years there have been good functional results in almost all patients (91.1), with better results in patients under 13 years of age particularly with less residual displacement or angulation. Since there is a greater occurrence of residual deformity and symmetria and limitation of motion in older patients, a more aggressive approach to correct the initial displacement and angulation is warranted in those over the age of 13 years.