[Significance of osseous lesions for the prognosis of shoulder dislocation].
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Fractures, Bone↗
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Results for “SHOULDER FRACTURES”
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[Shoulder hemi-arthroplasty in proximal humeral fractures].
Most fractures of the proximal humerus with significant displacement are best treated surgically. The range of surgical treatment varies from closed reduction and pinning to hemiarthroplasty depending on the degree of displacement, age of the patient, and bone quality. Determining whether or not the individual fractured bone segments are displaced to a significant degree requires high quality x-rays which can be difficult to obtain from acutely injured patients. Indications for replacement of the humeral head in acute fractures include: head splitting fractures in elderly patients, Neer 4-part fracture dislocations, selected 3 part fractures and fracture dislocations in elderly patients with poor bone quality and a very small head fragment, selected severe impression fractures in elderly patients that involve more than 40% to 50% of the articular surface and selected anatomical neck fractures in which internal fixation is not possible. If a prosthetic replacement of the humeral head is chosen, secure repair of the tuberosities is essential to avoid tuberosity migration and malunion. The clinical results of prosthetic replacement of the proximal humerus for acute fractures are superior to those for late arthroplasty. This treatment modality has been proven to relieve pain. However, even for patients treated with primary arthroplasty, a restricted range of motion has to be expected postoperatively. Furthermore, several studies indicate that a significant number of complications can occur following early and late prosthetic replacement. Humeral head replacement as a salvage procedure after malunions or failed open reduction and internal fixation is technically demanding with a relatively high rate of complications. Newer implant designs and instruments may improve the clinical results.
Follow-Up Studies↗
Nonoperative treatment of ipsilateral fractures of the scapula and clavicle.
BACKGROUND: Internal fixation of one or both bones is the recommended treatment for floating shoulder injuries (ipsilateral fractures of the scapula and clavicle). Perceived risks of nonoperative treatment include abduction weakness, decreased range of motion, chronic pain, malunion, and nonunion. None of these problems, however, have been confirmed by clinical studies. The purpose of this retrospective study was to analyze the clinical and radiographic results of nonoperative treatment of floating shoulder injuries. METHODS: Twenty patients with a floating shoulder injury were treated with either a sling or a shoulder immobilizer. Eleven clavicular fractures were displaced ten millimeters or more, and five scapular fractures were displaced more than five millimeters. Physical therapy was begun three days to two weeks after the injury. Patients were evaluated with three separate scoring systems: those of Herscovici et al., Rowe, and Constant and Murley. Shoulder abduction and flexion were measured, and abduction strength was evaluated by clinical examination and comparison with the uninjured extremity. The duration of follow-up averaged twenty-eight months (range, nine to seventy-nine months). RESULTS: Nineteen of the twenty pairs of fractures united uneventfully. One clavicular nonunion occurred secondary to segmental bone loss from a gunshot wound. On the basis of the Herscovici rating system, seventeen patients had an excellent result and three had a good result. According to the Rowe system, eighteen patients had an excellent result, one had a good result, and one had a fair result. The average Rowe score was 95. The average Constant score was 96. In all twenty patients, the strength of the injured extremity was equal to that of the uninjured extremity. Eighteen patients had a full, symmetrical range of shoulder motion, one lost 15 degrees of flexion, and one lost 20 degrees of abduction. CONCLUSIONS: Nonoperative treatment of floating shoulder injuries, especially those with less than five millimeters of fracture displacement, can achieve satisfactory results that are probably equal or superior to those reported after operative treatment, without the risk of operative complications.
Adolescent↗
Shoulder injury caused by electric shock.
Shoulder injury and more in particular bilateral dislocation of the shoulder joint after electric shock is rare. Three patients are presented with dislocation and fracture of the shoulder and serious muscle contraction. After an accident involving electric current potential shoulder injuries should be considered. Early diagnosis improves the functional results of adequate treatment.
Adult↗
Sports injuries of the shoulder.
Much strain is placed on the shoulder joint in all sports. Sports injuries may be caused by a single, violent incident. Fractures of the clavicle, acromioclavicular and sternoclavicular traumas, isolated fractures of the greater tuberosity and shoulder dislocations are frequent clinical pictures which today can be managed by well established procedures. Other sports injuries, however, involve over-use of the shoulder which, through repetitive harmful movements, can bring about microtraumatic lesions of the rotator cuff, glenoid labrum, acromioclavicular joint and certain peripheral nerves around the suprascapularis. In all cases, a programmed, comparative, clinical examination and complementary, sequential examinations will indicate suitable curative and preventive treatment.
Acromioclavicular Joint↗
Acute fracture of the proximal humerus superimposed on a chronic posterior dislocation of the humeral head.
We have reported the case of a 73-year-old woman with a posterior shoulder dislocation and comminuted fracture of the proximal humerus occurring during a seizure. Surgery disclosed an acute humeral fracture superimposed on a chronically dislocated humeral head. Endoprosthetic replacement yielded a satisfactory clinical result. We found no similar report in the literature.
Acute Disease↗
Shoulder arthroplasty in the face of acute fracture: puzzle pieces.
Surgical management of acute 4-part humeral fracture-dislocations presents many challenges to the orthopaedic surgeon. Intraoperative surgical reconstruction requires a detailed understanding of the osseous and the muscular anatomy and physiology. The proximal humerus must be reconstructed in a way that establishes proper humeral head version and proper myofascial sleeve tension within the rotator cuff and deltoid musculature. This article reviews and discusses the salient surgical principles and techniques that allow anatomic reconstruction of the proximal humerus. Tuberosity placement and fixation techniques are emphasized, recognizing that anatomic restoration of the cuff is crucial if the patient is to achieve a pain-free and functional limb after joint arthroplasty for fracture.
Arthroplasty, Replacement↗
Dislocations of the shoulder with special reference to accompanying small fractures.
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Fractures, Bone↗
[Results of shoulder hemiarthroplasty in patients with acute and old fractures of the proximal humerus].
STUDY-DESIGN: We report on a prospective study of 22 patients after shoulder hemiarthroplasty in acute and old proximal humerus fractures. METHOD: Nine patients with an acute and 13 with an old humerus fracture, in whom a hemiarthroplasty was performed have been evaluated clinically using the Constant score as well as radiologically on average 22 months postoperatively. RESULTS: The mean Constant score improved on 28 points (27 to 55). The improvement was especially distinct in the group with acute fractures. Sixteen of the twenty examined patients were painfree. Two patients reported sleeping disturbances due to pain. The ROM was improved, especially in forward elevation and abduction. In two patients with an old fracture the results were less satisfying. Major complications could not be observed. In five cases X-ray revealed an atrophy of the fixated fragments. Dislocations did not occur. Radiological changes of the glenoid, already seen preoperatively became more obvious. Some humeral components, inserted without cement, showed "densification lines". There were no clinical signs of loosening. CONCLUSION: By performing hemiarthroplasty pain relief can be achieved, especially in old fractures. The postoperatively achieved joint function mainly depends on the type of fracture as well as ist age. In cases with a destroyed glenoid we now prefer to perform a total arthroplasty. In our opinion, general cement use for shaft fixation is not necessary.
Adult↗
Primary hemiarthroplasty for treatment of proximal humeral fractures.
BACKGROUND: Primary hemiarthroplasty of the shoulder is used to treat complex proximal humeral fractures, although the reported functional results following this method of treatment have varied widely. The aim of this study was to prospectively assess the prosthetic survival and functional outcomes in a large series of patients treated with shoulder hemiarthroplasty for a proximal humeral fracture. By determining the factors that affected the outcome, we also aimed to produce models that could be used clinically to estimate the functional outcome at one year following surgery. METHODS: A thirteen-year observational cohort study of 163 consecutive patients treated with hemiarthroplasty for a proximal humeral fracture was performed. Twenty-five patients died or were lost to follow-up in the first year after treatment, leaving 138 patients who had assessment of shoulder function with use of the modified Constant score at one year postinjury. RESULTS: The overall rate of prosthetic survival was 96.9% at one year, 95.3% at five years, and 93.9% at ten years. The overall median modified Constant score was 64 points at one year, with a typically good score for pain relief (median, 15 points) and poorer scores, with a greater scatter of values, for function (median, 12 points), range of motion (median, 24 points), and muscle power (median, 14 points). Of the factors that were assessed immediately after the injury, only patient age, the presence of a neurological deficit, tobacco usage, and alcohol consumption were significantly predictive of the one-year Constant score (p < 0.05). Of the factors that were assessed at six weeks postinjury, those that predicted the one-year Constant score included the age of the patient, the presence of a persistent neurological deficit, the need for an early reoperation, the degree of displacement of the prosthetic head from the central axis of the glenoid seen radiographically, and the degree of displacement of the tuberosities seen radiographically. CONCLUSIONS: Primary shoulder hemiarthroplasty performed for the treatment of a proximal humeral fracture in medically fit and cooperative adults is associated with satisfactory prosthetic survival at an average of 6.3 years. Although the shoulder is usually free of pain following this procedure, the overall functional result, in terms of range of motion, function, and power, at one year varies. A good functional outcome can be anticipated for a younger individual who has no preoperative neurological deficit, no postoperative complications, and a satisfactory radiographic appearance of the shoulder at six weeks. The results are poorer in the larger group of elderly patients who undergo this procedure, especially if they have a neurological deficit, a postoperative complication requiring a reoperation, or an eccentrically located prosthesis with retracted tuberosities.
Accidental Falls↗
[Bilateral fracture of the neck of the humerus in combination with luxation of the shoulder joint in electrical trauma].
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Child↗
The influence of displacement on shoulder function in patients with minimally displaced fractures of the greater tuberosity.
INTRODUCTION: There is little outcome data on functional results after non-operative treatment of greater tuberosity fractures, and no clear evidence in minimally displaced (1-5 mm) fractures of the greater tuberosity showing that the results of non-operative treatments are good enough. This study assesses the relationship between degree of displacement in non-operatively treated patients and shoulder function. MATERIALS AND METHODS: We evaluated the radiographs and function in 135 patients after non-operative treatment of minimally displaced (1-5 mm) fractures of the greater tuberosity at a mean time of 3.7 years (2-20 years) after injury. Shoulder function was assessed using the Vienna Shoulder Score (VSS), the Constant Score (CS) and the UCLA-Score. RESULTS: 97% of the evaluated patients had good or excellent results. Patients with a displacement of more than 3 mm had slightly worse results compared to those with less displacement, but this was not statistically significant. Female patients had significantly better results than male patients, and patients in the eighth and ninth decade had significantly worse results compared to younger patients. CONCLUSION: We recommend non-operative treatment in all patients with minimally displaced fractures of the greater tuberosity, as most obtain very good results. The best results followed treatment with Gilchrist bandages or Mitella slings for 3 weeks, followed by intensive rehabilitation.
Adolescent↗
Arthroscopic reduction and internal fixation of an anterior glenoid fracture.
This case report describes the use of the arthroscope for the treatment of an anterior glenoid rim fracture associated with anterior shoulder instability.
Adult↗
Vascular trauma associated with fractures and dislocations.
Vascular trauma occurs relatively infrequently in association with general orthopedic trauma but may be seen more often in injuries involving joint dislocations and areas in which vascular structures are tethered at the fracture site. The mechanisms of vascular trauma are identified, and the general principles in managing these injuries, including the operative approach to the injury itself and the options in repairing both arterial and venous injuries, are discussed. The role of fasciotomy and primary amputation are also reviewed. Several specific injuries, including pelvic fracture, knee dislocation, shoulder and upper limb injuries, complex tibial fractures, and iatrogenic injuries, are examined from diagnostic and management perspectives. Despite an ongoing evolution in the diagnosis and management of these often challenging injuries, the essential requirements for a good clinical outcome remain early recognition of the dysvascular limb and rapid institution of therapy.
Angiography↗
Current concepts of shoulder arthroplasty.
Shoulder arthroplasty is an accepted treatment for certain proximal humerus fractures and for glenohumeral arthritis. The indications for shoulder arthroplasty are fairly well defined and the outcomes are predictable and highly successful. However, it is a technically demanding surgical procedure, with which few orthopaedic surgeons gain much experience. Most of the currently available implant systems are modifications of the original unconstrained components that were introduced by Neer. Current issues of controversy include implant modularity, glenohumeral mismatch, implant fixation, and the role of glenoid replacement in outcome.
Arthritis↗
Shoulder injuries during alpine skiing.
We retrospectively reviewed alpine skiing injuries at a destination ski resort during three seasons to characterize the incidence and types of shoulder injuries. A total of 3451 injuries in 3247 patients were reviewed. The overall injury rate was 4.44 injuries per 1000 skier-days. Injuries to the upper extremity represented 29.1% (N = 1004) of all alpine ski injuries. Injuries involving the shoulder complex (393 injuries in 350 patients) accounted for 39.1% of upper extremity injuries and 11.4% of all alpine skiing injuries. The rate of shoulder injury was 0.51 injuries per 1000 skier-days. Patients with shoulder injuries had a mean age of 35.4 years, and the male-to-female ratio of these patients was 3:1. Falls represented the most common mechanism of shoulder injury (93.9%) in addition to collisions with skiers (2.8%), pole planning (2.3%), and collisions with trees (1%). The most common shoulder injuries were rotator cuff strains (24.2%), anterior glenohumeral dislocations or subluxations (21.6%), acromioclavicular separations (19.6%), and clavicle fractures (10.9%). Less common shoulder injuries included greater tuberosity fractures (6.9%), trapezius muscle strains (6.4%), proximal humeral fractures (3.3%), biceps tendon strains (2.3%), glenoid fractures (1.5%), scapular fractures (1%), humeral head fractures (1%), sternoclavicular separations (0.5%), an acromial fracture (0.3%), a posterior glenohumeral dislocation (0.3%), and a biceps tendon dislocation (0.3%).
Accidental Falls↗
Fracture due to shock from domestic electricity supply.
This report describes a fracture-dislocation of the shoulder joint due to electric shock. This is the first case reported in an English language journal of fracture due to shock from the domestic electricity supply. Other cases have been reported but not caused by such a low voltage current.
Accidents, Home↗
Mennen plate in hip and shoulder joint replacement.
Sixteen patients complicated by femoral fracture and aseptic loosening with severe bone loss and two patients complicated by humeral fracture after hip and shoulder joint replacement, respectively, were collected from the Carmel and Ichilov teaching hospitals. All patients underwent internal fixation with the Mennen plate or in conjunction with revision joint replacement, either for internal fixation or for bone graft support. The results were satisfactory in fifteen patients with respect to functional activity, pain, and the radiographic evaluation. In three patients who underwent their fourth revision, the results were unsatisfactory but were better than their preoperative status. Our conclusion is that Mennen plate fixation provides a sufficient and easy internal fixation technique for a fracture around or below the un-dislodged stem of hip and shoulder in joint replacement. In an unstable femoral fracture or in a case of aseptic loosenings with marked bone loss, we recommend Mennen plate fixation in conjunction with long stem revision total hip replacement and bone graft.
Aged↗