PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “SHOULDER FRACTURES”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,567 records · Page 87Linked to original sources
PubMed1993

Operative treatment of displaced intra-articular glenoid fractures.

Operative treatment is indicated in displaced intra-articular glenoid fractures. We report the results of treating 14 such fractures with open reduction and stable internal fixation. With an average follow-up period of 30.5 months, all fractures healed. All shoulders are rated good according to Rowe's scoring system. Complication was minimal, apart from those which resulted from the concomitant chest injuries. We therefore conclude that the operative treatment for these fractures gives good and predictable results. Special attention should be paid to treat the complications resulting from the common association of chest injuries in these patients.

Adult↗
PubMed2000

Operative results of the inferior capsular shift procedure for multidirectional instability of the shoulder.

BACKGROUND: Neer and Foster previously described the inferior capsular shift procedure for treating multidirectional instability of the shoulder and reported preliminary results that were quite satisfactory. The purpose of our study was to perform a longer-term follow-up evaluation of the efficacy of the inferior capsular shift procedure for treating multidirectional instability of the shoulder. METHODS: An inferior capsular shift procedure was used to treat multidirectional instability of the shoulder in forty-nine patients (fifty-two shoulders). All patients had failed to respond to an exercise program. In this series, the operative approach (anterior or posterior) was based on the major direction of the instability, as determined by the preoperative history and physical examination and as verified by examination with the patient under anesthesia. In all of the patients, the inferior capsular shift was the primary attempt at operative stabilization. The repair consisted of a lateral-side (or humeral-side) shift of the capsule to reduce capsular redundancy and, when necessary, a reattachment of the avulsed labrum to the anteroinferior aspect of the glenoid. RESULTS: A redundant capsular pouch was seen in all of the shoulders in this series. In addition, detachment of the anteroinferior aspect of the labrum was found in ten shoulders and an anterior fracture of the glenoid rim was seen in two shoulders. At an average of sixty-one months (range, twenty-four to 132 months), results were available for forty-nine shoulders (forty-six patients). Thirty shoulders (61 percent) had an excellent overall result, sixteen (33 percent) had a good result, one (2 percent) had a fair result, and two (4 percent) had a poor result. Forty-seven (96 percent) of the forty-nine shoulders remained stable at the time of follow-up. Two of the thirty-four shoulders that had been repaired through an anterior approach began to subluxate anteroinferiorly again. None of the fifteen shoulders that had been repaired through a posterior approach had recurrent instability. Full function, including the ability to perform strenuous manual tasks, was restored to forty-five shoulders (92 percent). A return to sports was possible after thirty-one (86 percent) of the thirty-six procedures done in athletes; however, a return to the premorbid level of participation was possible after only twenty-five (69 percent) of the thirty-six procedures. CONCLUSIONS: The results in this series demonstrate the efficacy and the durability of the results of the inferior capsular shift procedure for the treatment of shoulders with multidirectional instability. The procedure directly addresses the major pathological feature - a redundant joint capsule. Similar results were seen with either an anterior or a posterior approach, and we continue to approach shoulders with multidirectional instability on the side of greatest instability. A postoperative brace was reserved for patients in whom a posterior approach had been used or in whom an anterior approach had involved extensive posterior capsular dissection (ten of the thirty-four shoulders treated with the anterior approach).

Adolescent↗
PubMed1997

Diagnosis of Hill-Sachs lesion of the shoulder. Comparison between ultrasonography and arthro-CT.

AIM: The Hill-Sachs lesion is a compression fracture caused by impact on the trabeculae of the humeral head during anterior glenohumeral dislocation. The early and accurate identification of patients who risk recurrence of shoulder dislocation requires a suitable screening method. This should be characterized by high sensitivity and specificity, low cost, and repeatability. MATERIAL AND METHODS: The results of ultrasound examination as a screening method were evaluated, the indicator being the identification of the Hill-Sachs lesion. Using ultrasonography and conventional radiological techniques, and double contrast CT (arthro-CT), we studied 60 patients with posttraumatic instability of the shoulder. RESULTS: Against arthro-CT as the true standard, ultrasonography showed a sensitivity of 95.6%, specificity of 92.8%, and diagnostic accuracy of 95%. CONCLUSION: Ultrasonography is an acceptable screening examination for recurrent scapulohumeral dislocation and should be applied prior to other techniques of investigation such as arthro-CT or MR imaging.

Adult↗
PubMed1989

Fracture of the coracoid process of the scapula with acromioclavicular separation. Case report and review of the literature.

A case report of a coracoid fracture of the scapula with acromioclavicular separation is presented. The treatment consisted of surgical reduction and fixation of the acriomioclavicular separation and of the coracoid fracture. After healing of the acromioclavicular separation and the coracoid fracture the left shoulder was asymptomatic with a full range of motion.

Acromioclavicular Joint↗
PubMed1996

[Shoulder problems in leisure athletes: physical examination, diagnosis and therapy. Sensible procedures in daily practice].

At first sight the anatomy of the shoulder may seem simple (see Fig. 1). However, for the physician treating a patient suffering from shoulder pain, the scapulo-thoracal interplay of 5 joints and 19 muscles, providing a wide and varied range of motion, may constitute an obstacle difficult to overcome. In the leisure athlete acute injuries must be distinguished from degenerative disease. Contact sports in particular tend to involve risks of falling on the shoulder, injuring the shoulder girdle or the elbow and wrist, sometimes with major consequences: complex fractures, dislocations, ligament and tendon lesions or joint instabilities. Thorough, rapid and cost-effective diagnostic evaluation of the athlete, involving clinical examination (function tests), radiographic imaging (shoulder a.p., y-view) and in selected cases ultrasonography (compared with the other side) may be necessary in starting early and effective therapy.

Acromioclavicular Joint↗
PubMed1995

[Hemi-arthroplasty of the shoulder: radiological, functional and dynamic studies].

From September 1973 to October 1992, forty-three shoulder arthroplasties were performed in forty-one patients with complicated fractures or degenerative disease. Radiological and functional assessment with a mean follow-up time of forty-five months permitted us to review twenty patients with fifteen Neer II prosthesis, three isoelastic prosthesis and two total shoulder replacements. Of these, eleven presented with traumatic injuries and four with degenerative disease. The mean age at operative time was 61 years. Radiological evaluation showed that all cases had a retroversion of about 30 degrees. Normal humeral length and lateral shifting were not achieved in most patients; in fact only one had a restored length and lateral shifting. The mean scapulothoracic range of motion was found to be half that of a normal gliding shoulder (angle 30 degrees instead of 60 degrees). The subacromial space was diminished by one third in all cases. Relief of shoulder pain was the most significant finding. Mobility was restored to a level of about 75% of normal according to Constant's Scale. Dynamometric measures showed an important loss of force (47% of normal) despite a normal external rotation force. Recent improvements in implant conception (modular prosthesis) and a better understanding of physiological shoulder mechanisms should improve the functional results of this arthroplasty in the future.

Adult↗
PubMedDate not supplied

Outcomes of hemiarthroplasty for fractures of the proximal humerus.

We reviewed 80 shoulders (72 shoulders in 71 patients) treated with hemiarthroplasty. At follow-up, 66 patients (93%) were pain-free and satisfied with their results; the mean American Shoulder and Elbow Surgeons score was 76.6, the mean Simple Shoulder Test score was 7.5, the average forward flexion was 128 degrees, external rotation was 43 degrees, and internal rotation was to L2. Radiographic analyses revealed nearly anatomic tuberosity reconstruction in 58 shoulders, heterotopic ossification in 18, pseudosubluxation in 10, and superior migration in 15. Patients with superior migration had statistically lower mean American Shoulder and Elbow Surgeons scores, mean Simple Shoulder Test scores, and decreased forward flexion. Tuberosity complications occurred in 16 shoulders. Malunion of the greater tuberosity was the most common complication. Healing of the greater tuberosity more than 2 cm below the humeral head correlated with a worse functional result. Hemiarthroplasty for indicated fractures of the proximal humerus results in shoulder-level function and reproducible pain relief.

Adult↗
PubMed2001

Antegrade locked intramedullary nailing in humeral shaft fractures.

Thirty-three humeral nailings were carried out using the Russell-Taylor nail. Twenty-two acute fractures and one non-union united, gave an overall union rate of 70%. Eighteen patients (56%) experienced pain in the shoulder or at the fracture site. Thirteen patients (41%) had poor shoulder function. Only 17 (51%) of the patients were satisfied with the outcome. Fourteen patients (42%) needed further surgery. We conclude that antegrade intamedullary nailing of humeral shaft fractures leads to a substantial risk of non-union and impairment of shoulder function. There was no significant correlation between fracture comminution and fracture healing in our study.

Adult↗
PubMed1990

[Clinical examination of the traumatized shoulder].

In emergencies clinical examination and straight radiography are enough to make a diagnosis and indicate the kind of treatment required. When radiography gives normal results, slight and brief immobilization prevents the occurrence of retractile capsulitis. A second clinical examination, performed a fortnight later, provides a better evaluation of the severity of soft tissue lesions.

Fracture Fixation, Internal↗
PubMed2006

The reverse shoulder prosthesis: A review of imaging features and complications.

BACKGROUND: The reverse shoulder prosthesis is a prosthesis that has been in clinical use in Europe since 1985 and was approved for use in the United States in 2004. This unique prosthesis has a baseplate attached to the glenoid, which holds a spherical component, while the humeral component includes a polyethylene insert that is flat. This design is the "reverse" configuration of that seen with a conventional arthroplasty, in which the spherical component is part of the humeral component. The indications for the reverse prosthesis are: (1) painful arthritis associated with irreparable rotator cuff tears (cuff tear arthropathy), (2) failed hemiarthroplasty with irreparable rotator cuff tears, (3) pseudoparalysis due to massive, irreparable rotator cuff tears, (4) some reconstructions after tumor resection, and (5) some fractures of the shoulder not repairable or reconstructable with other techniques. This prosthesis can produce a significant reduction in pain and some improvement in function for most of the indications mentioned. However, the unique configuration and the challenge of its insertion can result in a high incidence of a wide variety of unusual complications. Some of these complications, such as dislocation of the components, are similar to conventional shoulder replacement. Other complications, such as notching of the scapula and acromial stress fractures, are unique to this prosthesis. CONCLUSION: The configuration of the reverse prosthesis, its normal radiographic appearance and potential complications associated with its use are reviewed.

Arthroplasty, Replacement↗
PubMed2000

Shoulder dislocations in patients older than 40 years of age.

Shoulder dislocations in patients over 40 years of age are common and are frequently associated with serious injuries to adjacent structures. Associated injuries such as brachial plexus injury, rotator cuff tear, axillary artery injury, fractures about the shoulder, and recurrent dislocation can make shoulder dislocations challenging problems for the clinician. Early diagnosis and treatment of associated injuries and treatment complications are the mainstays in prevention of morbidity and, even, mortality.

Adult↗
PubMed1999

Plate fixation of proximal humeral fractures with indirect reduction: surgical technique and results utilizing three shoulder scores.

To determine the outcome after indirect reduction and buttress plate fixation of displaced and unstable proximal humeral fractures, we retrospectively evaluated 98 patients, an average of 34 months (range 24-72 months) after fracture fixation. The patients were reviewed and results were evaluated clinically according to the Neer, UCLA and Constant score. A radiographic evaluation of fracture healing, avascular necrosis and degenerative changes of the shoulder joint was performed in all patients. Any complications of treatment were assessed. Results were, according to the UCLA-rating system, good to excellent in 76% of fractures. According to the Constant-score and the Neer score, good to excellent results were obtained in 69 and 59% of fractures, respectively. Poor results were mainly due to secondary malunion. The avascular necrosis rate was 4%. Non-union was seen in one case. Secondary varus deformity and retroversion of the humeral head as a result of lack of rotational and angular stability of the plate developed in twelve (12%) and eight (8%) cases, respectively. Plate fixation is an adequate procedure for treating unstable and displaced two- to four-part fractures of the proximal humerus, enabling early functional after-treatment. The incidence of avascular necrosis and nonunion are low, when fracture reduction is performed indirectly. Poor rotational and angular instability can lead to a loss of reduction.

Adult↗
PubMedDate not supplied

Shoulder arthroplasty for proximal humeral nonunions.

Between 1980 and 1997, 27 patients underwent shoulder arthroplasty because of pain or functional impairment due to a proximal humeral nonunion. Twenty-five of the 27 shoulders with a mean 6-year follow-up period (range, 2-15 years) were included in the study. There were 19 women and 6 men, with a mean age of 65 years. The most frequent original fracture types were 2-part surgical neck (64%) and 3-part greater tuberosity fractures (28%). Twenty-one shoulders underwent hemiarthroplasty, and 4 underwent total shoulder arthroplasty. Shoulder arthroplasty resulted in significant pain relief, with mean pain scores decreasing from 4.6 to 1.8 points (P <.05). Mean active elevation improved from 41 degrees preoperatively to 88 degrees postoperatively (P <.05), and mean external rotation from 22 degrees to 38 degrees (P =.045). In 11 shoulders the greater tuberosity resorbed or was nonunited. Two of the 25 shoulders required another operation after the arthroplasty: one for periprosthetic humeral fracture and one for instability. Twenty shoulders were much better or better, and 5 were the same or worse. On the basis of a modified Neer result rating system, there was 1 excellent result, 11 satisfactory results, and 13 unsatisfactory results. Patients who have significant functional impairment from a nonunion of the humeral surgical neck with failed internal fixation, severe osteoporosis, cavitation of the humeral head, or secondary osteoarthritis may benefit from shoulder arthroplasty. Although function is not completely restored, pain relief and high levels of subjective satisfaction can be achieved.

Aged↗
PubMed2002

Strength and motion after hemiarthroplasty in displaced four-fragment fracture of the proximal humerus: 27 patients followed for 1-6 years.

We evaluated 27 patients with shoulder hemiarthroplasty after displaced four-fragment fracture of the proximal humerus after mean 4 (1-6) years. Isometric strength measurements (Kintrex) and three-dimensional motion analysis (Elite-System) were performed on the operated and unoperated shoulders. Clinical assessment was based on Constant's score and Neer's scoring system. The isometric strength of the operated and unoperated sides were 22 (SD 8.6) Nm and 24 (SD 5.9) Nm in abduction and 48 (SD 14) Nm and 65 (SD 21) Nm, respectively in adduction (the latter was statistically significant). Motion analyses at follow-up showed a mean reduction in glenohumeral movement. Increases in acceleration and deceleration of the acromion at the operated side were noted, indicating a change in glenohumeral rhythm during maximal abduction. The Constant score was 45 (SD 15) points with a significant reduction in the range of motion. 15 patients had some degree of heterotopic ossification. On the basis of our findings, the impaired function seems to be caused by reduced glenohumeral mobility rather than muscle strength. We also found a better outcome after early than late hemiarthroplasty.

Adult↗
PubMed1992

[Osteosynthesis in dislocated fractures of the humerus head].

The operative treatment of displaced fractures of the proximal humerus has changed during the last few years. Minimal osteosynthesis takes into consideration to a great extent the biological aspects of these fractures and provides sufficient stability for early functional therapy. Neer's classification has proved very useful for both the indication for and the choice of an operative procedure. The high necrosis rate of the operatively stabilized humeral head has considerably influenced the operative strategy. This is shown in two separately controlled patient groups. From 1970 to 1980, 65 patients and from 1983 to 1987, 30 patients with displaced fractures of the proximal humerus were treated operatively. Within the first group, in more than half the cases a T-plate osteosynthesis was performed, a minimal osteosynthesis being performed in only 1 out of 5 patients. In the second group, we exclusively performed minimal osteosynthesis. More favourable results were achieved in fractures with two or three fragments, in younger patients and in isolated shoulder injuries than with four-fragment fractures or luxated fractures, in older and in polytraumatized patients. Using minimal osteosynthesis instead of plate osteosynthesis in four-fragment fractures, functional results were achieved which, in 75%, were satisfactory or better. The necrosis rate of the humeral head also declined. We conclude that head-preserving methods seem advisable in these severe forms of humeral fractures.

Adolescent↗