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At least 73 records · Page 4Linked to original sources
PubMed2005

Arthroscopic capsular release after hemiarthroplasty of the shoulder for fracture: a new treatment paradigm.

Four-part fracture of the proximal humerus is often an indication for hemiarthroplasty. Anatomic healing of the tuberosities is required to recover full range of motion. The authors describe their philosophy of postoperative care, which is different from the conventional wisdom. The patient is immobilized in a sling for 6 weeks until healing of the tuberosities is strong enough that motion of the shoulder will not cause the fracture fragments to displace. By prioritizing bone healing as more important than early motion, there is a possibility that arthrofibrosis may develop. However, arthroscopic release and lysis of adhesions provides a safe and reliable means to regain motion after the bone has healed. Because anatomic healing of the tuberosities is so critical to function after these fractures, we see no reason to jeopardize bone healing with ill-advised early motion because motion can virtually always be restored by means of a secondary capsular release.

Arthroplasty↗
PubMedDate not supplied

Preoperative arthroscopic assessment of fractures about the shoulder.

Soft tissue lesions in fractures about the shoulder are not completely defined by conventional imaging procedures. The purpose of the present study was to arthroscopically determine the soft-tissue pathology of the labrum, capsuloligamentous, and rotator cuff structures associated with fractures of the proximal humerus and/or scapula and to correlate them to the fracture type. In a series of 80 fractures (52 proximal humeral fractures, 20 fracture-dislocations, 8 glenoid or scapular fractures) arthroscopy was performed through a posterior approach under general anesthesia. Arthroscopy revealed significant numbers of labral, capsuloligamentous, and rotator cuff lesions, as well as cartilage damage not identified by clinical examination or preoperative imaging. Fracture dislocations (Neer type VI) and more benign fractures of the two-part variety are frequently associated with labral lesions (in 56% and 31%, respectively). This data suggest that it is important not to underestimate soft-tissue pathology in fractures that seem radiologically relatively harmless. Arthroscopic assessment in shoulder fractures is shown to be a useful tool in completely understanding the extent of the injury.

Arthroscopy↗
PubMed2002

The accuracy of self-reported fractures in older people.

Self-report is often used in large-scale studies. Therefore, it is important to determine the accuracy of self-report. In the Blue Mountains Eye Study, a population-based study of 3,654 older, community-dwelling Australians, subjects were asked about fracture history at the 5-year follow-up interview. All reported non-rib and vertebral fractures were radiologically confirmed. Hospital radiology records were searched for fracture records of people who reported no fractures in the 5-year period. Of 2,326 subjects who came to the interview, 272 subjects reported 318 fractures sustained since 1990. Overall, 34.6% of fracture reports could not be confirmed, mainly due to no record of treatment. Among self-reported fractures, false positive rates were 10.7% for all fractures and 4.8% for hip, 2.2% for wrist, 19.4% for ankle, and 6.6% for shoulder fractures. Sensitivity and specificity of fracture reports was high, with the lowest sensitivity for shoulder fractures (82.4%). Self-report of major osteoporotic fractures is reasonably accurate but may be improved by obtaining more details about treatment.

Aged↗
PubMed1997

Poor reproducibility of classification of proximal humeral fractures. Additional CT of minor value.

Fractures of the proximal humerus can be described using the Neer and AO fracture classifications. To assess the reproducibility and reliability of these classifications, we investigated 26 proximal humeral fractures with both plain radiographs and CT. 5 specialists in orthopedic surgery and 5 specialists in radiology independently classified all radiographs on 2 occasions. There was a moderate agreement between the observers when using the Neer classification, but only a fair agreement with the AO classification. The Neer system had a kappa value of 0.42 and the AO had a value of 0.31 in the first assessment. In the second assessment the kappa values were 0.45 and 0.30, respectively. Intraobserver reproducibility was slight to almost perfect agreement with Neer (kappa range 0.20-0.85) and slight to moderate agreement with AO (kappa range 0.16-0.60). The observers most familiar with shoulder fracture radiographs and shoulder fracture treatment were more consistent in their classifications. We conclude that even with CT, the fracture classifications of Neer and AO have a low consistency. Neither classification system is reproducible enough to allow comparisons of different studies.

Humans↗
PubMed2004

The effect of calcium and vitamin D3 supplementation on the healing of the proximal humerus fracture: a randomized placebo-controlled study.

The purpose of this study was to (1) quantify the healing process of the human osteoporotic proximal humerus fracture (PHF) expressed in terms of callus formation over the fracture region using BMD scanning, and (2) quantify the impact of medical intervention with vitamin D3 and calcium on the healing process of the human osteoporotic fracture. The conservatively treated PHF was chosen in order to follow the genuine fracture healing without influence of osteosynthetic materials or casts. Thirty women (mean age = 78 years; range = 58-88) with a PHF, osteoporosis or osteopenia (based on a hip scan, WHO criteria), and not taking any drugs related to bone formation, including calcium or vitamin D supplementation, were randomly assigned to either oral 800 IU vitamin D3 plus 1 g calcium or placebo, in a double-blind prospective study. We measured biochemical, radiographic, and bone mineral density effect parameters to evaluate the impact on the healing process. Scanning procedures of the fractured shoulder included use of a fixation device to obtain the highest possible precision. Double scans of the fractured shoulder revealed a coefficient of variation (CV) on BMD measurements that improved from 2.8% immediately after fracture occurrence to 1.7% at 12 weeks (P = 0.003) approaching the 1.2% levels observed over the healthy shoulder. BMD was similar in the two groups at baseline (active 0.534 g/cm2 vs. placebo 0.518 g/cm2), and both increased over the 12-week observation period, with peak levels in week 6. By week 6 BMD levels were higher in the active group (0.623 g/cm2) compared with the placebo group (0.570 g/cm2, P = 0.006). Thirty seven percent of the patients presented with vitamin D levels below 30 nmol/l, indicative of mild vitamin D insufficiency. In conclusion, we have demonstrated that it is possible to quantify callus formation of the PHF with sufficiently high precision to demonstrate the positive influence of vitamin D3 and calcium over the first 6 weeks after fracture. Whether this results in more stable fractures, extends to other fracture types, or applies to other osteogenic bone agents such as bisphosphonates remains to be examined.

Absorptiometry, Photon↗