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PubMed1987

Skiing-related injuries to the shoulder.

An analysis of 135 consecutive shoulder injuries seen in one clinic during a single ski season revealed anterior dislocation to be the most common ailment, constituting 52% of the total. Rotator cuff tears accounted for 20% of the total, followed by acromioclavicular (AC) separations (18%) and a miscellaneous group of contusions and isolated fractures comprising the other 10%. All of the shoulder dislocations were anterior, most were primary (81%) and men (83%) were involved more frequently. Twenty-four percent of the dislocations were thought to be equipment related. At follow-up examination three to four years after injury, a significant number (41%) were still symptomatic either from a recurrence (18%) or pain and weakness (23%). Patients with rotator cuff tears tended to be about ten years older than the average skier. Their injuries were usually a result of a fall on ipsilateral arm and were not equipment related. Of the 13 patients responding after a three-year follow-up period, most (10/13) were asymptomatic. There were 24 AC separations. All resulted from a direct fall on the shoulder. Sixty percent were first degree, 22% were second degree, and 18% were third degree. About one-third of the respondents with first and second degree injuries were still having significant pain at three-year follow-up examination. The most frequent isolated fracture was a minimally displaced fracture of the greater tuberosity (only three cases in 135 injuries), but this same fracture occurred in 10% of the shoulder dislocations.

Acromioclavicular Joint↗
PubMed1990

[Treatment of pseudarthroses of the humerus after gunshot wound].

The report is based on the analysis of the treatment of 32 patients with false joints of the humerus after gunshot injuries. All of them were operated and had supraosseous osteosynthesis with an AO plate (6 cases) and osteosynthesis after Ilizarov (26 cases). When the false joint of the shoulder was associated with the radial nerve paralysis, the tendons were transplanted after Chaklin in 9 cases. The indications for each method of treatment are presented. The causes of the complications after the operations are analysed. In 23 cases (72%) the results of the treatment were good and in 7 cases (22%) satisfactory.

Adolescent↗
PubMed2006

[Elastic, stable intramedullary nailing in midclavicular fractures--a change in treatment strategies?].

Midshaft fractures of the clavicle are mostly treated conservatively. For the few cases in which stabilisation is needed, open reduction and plate fixation is the standard procedure. We report a minimally invasive technique of intramedullary stabilisation using a titanium nail carried out in 35 markedly displaced midclavicular fractures. Twelve fractures were simple and 23 consisted of more than two fragments. A total of 62.9% (22/35) of the patients presented additional injuries; 37.1% (13/35) with additional fractures. There were four ipsilateral scapular neck fractures. In 74.3% (26/35) of patients closed reduction was possible, whereas nine fractures required open reduction before the nail inserted from the sternal end of the clavicle could be introduced into the peripheral fragment. All fractures healed clinically and radiologically within 6 weeks. In contrast to conservatively treated fractures, length discrepancies of 1 cm or more, mainly shortening, could be avoided. Using a visual analog scale, significant pain relief (8.4-2.4 points) was already recorded on the first day after surgery. Patients with an isolated fracture of the clavicle showed a nearly normal range of motion only 1 week after surgery, whereas patients with associated scapular or rib fractures needed up to 3 weeks to reach normal shoulder function. No patient complications requiring interventional procedures occurred. Minimally invasive, elastic, stable intramedullary nailing of midshaft fractures of the clavicle should be recommended as an alternative to conservative treatment because of early pain relief, associated rapid functional recovery and anatomical restoration of the clavicle.

Adult↗
PubMed1998

Revision of failed total shoulder arthroplasty.

The complexity of revision shoulder surgery remains a supreme challenge for the experienced shoulder surgeon. The difficulty of surgery is often accompanied by unpredictable patient cooperation during the postoperative rehabilitation program. Recognition of the problems associated with the failed shoulder arthroplasty is necessary for successful revision surgery. Numerous reconstructive techniques are necessary for restoration of soft tissue and bony deficiencies. Component revision is often necessary in treating component loosening or glenohumeral instability. Glenoid component removal may be necessary in the presence of severe rotator cuff insufficiency or marked glenoid bone deficiency. Humeral revision is most predictably treated with methylmethacrylate fixation. Humeral fractures associated with humeral arthroplasty are most successfully treated surgically, except in those instances where a long oblique or spiral fracture is not associated with prosthetic loosening. Deep infection is most predictably treated by extensive debridement, parenteral antibiotics, and delayed exchange of the components. The success of revision shoulder arthroplasty is often unpredictable, with 60% of revisions offering satisfactory pain relief and restoration of function. Critical to the success of revision arthroplasty is the status of the soft tissues, particularly the anterior deltoid and rotator cuff.

Anti-Bacterial Agents↗
PubMedDate not supplied

[A case of a fracture of the clavicle associated with an acromio-clavicular luxation].

The study reports a rate case of a girl with associated clavicular fracture and acromioclavicular dislocation following a care accident. The pathogenetic mechanism may be attributed to a trauma on the medial shoulder stump which having fractured the clavicle then provoked the acromioclavicular dislocation by continued pressure on that point. It is important to observe that the patient fully recovered, virtually without therapy.

Acromioclavicular Joint↗
PubMed1980

Surgical treatment of the difficult humeral neck fracture: acromial shortening anterolateral approach.

A surgical approach to the shoulder joint for the difficult humeral neck fracture is described with illustration of a case. Resection of a middle portion of the acromial process in addition to the detachment of the anterior origin of the deltoid using an anterolateral approach is presented. This provides an unrestricted exposure to the shoulder joint and eliminates the possible complications arising from acromionectomy.

Acromion↗
PubMed2005

Osteochondral allograft transplantation for treatment of glenohumeral instability.

The intimate contact between articular surfaces of the humeral head and glenoid labrum contribute to glenohumeral stability. When the articular surface area of these 2 surfaces is decreased, as with the presence of a bony Bankart lesion or an engaging Hill-Sachs lesion, the shoulder is more prone to dislocation. Although osteochondral allograft transplantation has become widely popular for the treatment of osteochondral defects of the knee, it is less used for treating bony defects of the humeral head. We present a case in which a 16-year-old male athlete with multiple anterior shoulder dislocations underwent arthroscopic repair of a Bankart lesion. His arthroscopic repair ultimately failed and on subsequent magnetic resonance imaging he was found to have a large, engaging Hill-Sachs defect. He underwent arthroscopic osteochondral allograft transplantation to correct the humeral head bony deformity. As of the 1-year follow-up, the patient has had no recurrences and had returned to his normal level of activity.

Adolescent↗
PubMed1991

[The value of Sowinski coracoid-plasty for recurrent dislocation of the shoulder].

The value of Sowiński coracoplasty for recurrent, trauma related dislocation of the shoulder was evaluated on the basis of multidirectional clinical, Xray, CT and ultrasound examinations in 15 patients operated on between 18 and 40 years of age. Good results were achieved in 14 cases after 2-14 years follow up. In one case of epileptic patient 4.5 years after surgery traumatic dislocation of the shoulder occurred with a fracture of incorporated bony graft. The authors have proved the coracoplasty performed to be efficient in preventing recurrent dislocation of the shoulder by means of creating new biomedical conditions around the joint. The bony graft by elongation of the coracoid process of ca 35 mm and change in its alignment imposes strong mechanical support for the head of the humerus and indirectly makes the acetabulum deeper. The graft located above anterior rim of the acetabulum increases the tension of subscapular muscle and stabilizes the capsule thus aiding to the stability of the joint. In 4 cases some adhesions between the graft and subscapularis muscle have slightly restricted external sotation of the shoulder.

Adolescent↗
PubMed2001

Clavicle fracture in labor: risk factors and associated morbidities.

OBJECTIVE: Neonatal clavicle fracture has been previously reported to occur in association with shoulder dystocia, suggesting liability on behalf of the obstetrician. However, clavicle fracture is often inconsistently diagnosed, and shoulder dystocia commonly subjectively defined. Using a formal pediatric diagnosis protocol and an objective definition of shoulder dystocia, we sought to determine the incidence, antecedents, and associated morbidities of clavicle fracture and the potential association with shoulder dystocia. STUDY DESIGN: All deliveries at Harbor-UCLA Medical Center complicated by clavicle fracture from January 1996 to March 1999 were studied. Deliveries with clavicle fracture were compared to all vaginal deliveries during this period. RESULTS: Among 4297 deliveries, twenty-six were complicated by clavicle fracture (0.5%). Clavicle fracture was significantly associated with increased maternal age and birth weight greater than 4 kg, though not associated with shoulder dystocia or operative vaginal delivery. Clavicle fracture was associated with meconium passage and with neonatal orthopedic abnormalities. CONCLUSION: Neonatal clavicle fracture is associated with infant birth weight greater than 4 kg, but not with the occurrence of objectively defined shoulder dystocia. However, infants with clavicle fracture may be at increased risk for additional complications.

Birth Injuries↗
PubMed2004

[Shoulder arthroplasty in traumatological indications, long-term results].

PURPOSE OF THE STUDY: To evaluate the long-term results of shoulder arthroplasty in trauma cases, using ProSpon and MMS-M.I.L. novel systems. MATERIAL AND METHODS: The shoulder endorosthesis designed by the authors, and manufactured as two products by ProSpon (Czech Republic) and MIL (France) companies, was used in surgical treatment of 43 cases of acute fractures and 33 cases of post-traumatic conditions. The Constant score was used to evaluate the clinical outcome. RESULT: In patients with acute trauma, the average Constant score was 59 points (range, 23-82). The average maximal elevation was 88 degrees (range, 40-140). No postoperative pain, mild pain at strain and arm activity-limiting pain were recorded in 25%, 72% and 3% of the patients, respectively. In patients with post-traumatic destruction of the shoulder, the average Constant score was 53.5 points (range, 20-88) and the average maximal elevation was 85 degrees (range, 30-130). No pain, mild pain and activity-limiting pain were present in 36%, 52% and 12% of the patients, respectively. The patients in whom the reconstruction of the proximal humerus and rotator cuff was performed with the use of a special toothed plate and screws, as designed by the authors, the overall average Constant score was higher by 12 and 11 points for acute trauma and post-traumatic destruction, respectively, when compared with the conventional technique of reconstruction by suture. Two serious complications were recorded, namely, a failure of the reconstruction due to splitting of the greater tubercle fragment at the site of plate fixation and an instability of the shoulder. In patients who were indicated for shoulder arthroplasty due to post-traumatic destruction, the average increase in the Constant score was 12 points in comparison with the pre-operative status. DISCUSSION: Our results of shoulder arthroplasty in acute injury to the proximal humerus are in agreement with the results published in the literature. In reconstruction of the tubercles, there was a considerable difference in results between our screws-and-plate technique and the conventional suture method. With the former, the average Constant score was higher by 12 and 11 points and the average active elevation was better by 15 and 10 degrees for acute trauma and post-traumatic destruction, respectively. Clinical observations also show that osteosynthesis of the tubercle, particularly of the greater one, has better stability with the use of screws and plate, rehabilitation is associated with less pain and shoulder motion improves more rapidly. CONCLUSIONS: The results presented here are comparable with those reported in the literature. In the group treated by the technique designed by the authors, the outcomes are markedly better. This technique of shoulder reconstruction provides better stability for attachment fixation of the rotator cuff, facilitates reconstruction of the proximal humerus in acute trauma and restoration of biomechanical properties of the shoulder joint.

Adult↗
PubMed1998

Non-operative treatment of comminuted fractures of the proximal humerus in elderly patients.

The purpose of this retrospective study was to assess the clinical and radiographical results of non-operative treatment of displaced multifragmental fractures of the proximal humerus with a minimum follow-up of 10 years. Fifteen patients (one man, 14 women) with 17 injured shoulders were examined. The Neer classification system was used to classify the fractures, and the functional outcome was assessed using the Constant score. At the 10 year review, the mean Constant score for the patients in the three-part fracture group was 59, and 47 in the four-part fracture group. The range of motion was satisfactory with a mean flexion and abduction over 90 degrees. Only four patients reported pain and it was graded as mild. In spite of low functional scoring and poor fracture reduction in many shoulders, the patient's contentment with their injured shoulder after 10 years with high. Radiographical examination revealed severe osteoarthrosis in one shoulder, and humeral head osteonecrosis in two shoulders. Results from this study suggests that non-operative treatment of displaced three-part fractures of the proximal humerus should be considered.

Activities of Daily Living↗
PubMed1995

Isolated avulsion fracture of the lesser tuberosity of the humerus.

Six cases of isolated avulsions of the lesser tuberosity of the humerus were encountered within a short period of time. Although it seldom has been described in the literature, it might be a more common fracture than suspected. Physical examination revealed a painful shoulder with limited function in all six patients. In retrospect, all diagnoses could have been made on the primary plain roentgenograms. However, the fragment of the lesser tuberosity was easily misdiagnosed. An axillary view showed the fragment clearly in all cases. Computed tomography is useful for making an accurate diagnosis because it establishes the size and displacement of the fragment and determines additional injuries, such as a ruptured biceps tendon. Five patients with displacement of the lesser tuberosity were operated on after several weeks or months. The lesser tuberosity was reattached in all cases. After 6 months three patients had slight impairment of elevation and external rotation, and one of them suffered from pain during movements of the arm. The patient with no fracture displacement was treated conservatively with a good result. In conclusion, we recommended an axillary roentgenogram as part of the posttrauma radiologic series of the shoulder. A nondisplaced avulsion fracture of the lesser tuberosity of the humerus can be treated conservatively. We recommend reattachment of displaced fractures.

Accidental Falls↗
PubMed2004

[Marburg shoulder radiography splint (MSR splint) for standardized and high quality plain film radiography in fractures of the proximal humerus].

To ensure safe, quick, pain-relieving, standardized, and reproducible high quality plain film radiography in fractures of the proximal humerus, the MSR splint was introduced into clinical practice. With the rectangular and completely radiolucent splint the shoulder radiographs are obtained in supine position by a sole radiographer. Two radiographs are taken in projection at 90 degrees to one another: the true anteroposterior and axillary views, the most important views for fracture visualization and assessment. The smooth flat bottom part of the splint glides easily across the X-ray table below the injured shoulder. The arm lying on the chest is carefully rotated externally up to the neutral position and placed in the splint, then fixed with Velcro fastening with the forearm supinated. The splint is adjusted to the patient for the anteroposterior view which is taken with the central ray directed at the coracoid process and perpendicularly on the film cassette. For the axillary view the MSR splint holding the upper extremity is carefully swiveled into a 80-90 degrees abduction position. Even in cases of comminuted fractures this maneuver is not painful for the patients. The X-ray tube is put into a horizontal position with the central ray pointing to the humeral head in an angle about 25 degrees to the long body axis. The cassette is placed upright in touch with the shoulder girdle. In our institution the MSR splint is not only routinely used for diagnosing fractures of the proximal humerus but also for radiological follow-up controls.

Equipment Design↗
PubMed1996

[Imaging methods in traumatology of the shoulder- and elbow joint].

Radiological diagnostics (diagnostic imaging) of the traumatised shoulder and elbow joint has expanded considerably and has become increasingly meaningful in recent years. The introduction of computed tomography and magnetic resonance imaging has enabled a significantly better assessment of soft parts and of the inner spatial structure of the joints. Hence, focus of diagnosis has now shifted from the assessment of the bones (which was previously the main aspect of diagnosis) to a different analysis of the joint as a functional unit of bone and soft part structures, an analysis that can also detect subtle changes such as additive micro-traumas. The article reviews the conventional imaging methods and the present state of the art in tomographic imaging technique, and illustrates this by means of several representative examples of diagnostic imaging.

Elbow Joint↗
PubMed1998

The use of radiographs to evaluate shoulder pain in the ED.

This study was conducted to describe the utilization of plain radiography in the initial evaluation of shoulder pain in the emergency department (ED) and assess the feasibility of developing guidelines for the selective use of shoulder radiographs by determining whether clinical variables are able to discriminate between subjects having therapeutically informative versus uninformative X-rays. The study was a chart review of all adult ED patients presenting to the Boston University Medical Center Hospital (Boston, MA) between January 1994 and January 1996 with a chief complaint that included shoulder pain. Subjects with X-rays were classified into two groups, those with therapeutically informative X-rays (ie, identified conditions requiring specific therapy) and those with therapeutically uninformative X-rays (ie, did not result in specific therapy). Recursive partitioning techniques were then used to identify clinical variables that best distinguished between therapeutically informative and uninformative radiographs. Three hundred twelve patients were included in the analysis, of whom 185 (59%) had shoulder X-rays performed. Thirty-seven (20%) radiographs were therapeutically informative, including 13 glenohumeral dislocations, 3 acromioclavicular joint separations, and 21 fractures. Deformity present on shoulder examination was the strongest discriminating variable and correctly classified 21 of 23 subjects as having informative X-rays. Of the remaining patients (n = 162), only those older than 43.5 years with a history of a precipitating fall (n = 40) had a high likelihood of having therapeutically informative X-rays. No patients without a deformity or precipitating fall (n = 90) had an informative X-ray. These data show that X-rays for the initial evaluation of shoulder pain in the ED are overutilized. This preliminary model suggests that clinical variables are able to distinguish between patients with informative versus uninformative X-rays. Prospective studies are needed to derive valid decision rules for selective use of shoulder radiographs in the ED.

Adolescent↗
PubMedDate not supplied

[Shoulder arthroplasty - Clinical results in 171 patients].

AIM: Review and critical evaluation of 181 shoulder arthroplasties performed on 171 patients between December 1992 and January 1997. METHOD: We performed 118 hemiarthroplasties and 63 total shoulder replacements in 171 patients with an average age of 56.5 years. The patients were examined clinically and radiologically before surgery and followed-up for an average of two years. The Constant score was used for postoperative functional assessment. RESULTS: 46 % of the patients were very satisfied and 31 % were satisfied with the outcome. We found a significant pain reduction and an improvement of active joint function. The average Constant score was 34.9 preoperatively and 65.2 postoperatively. Overall, we found the best results after joint replacement in patients treated for avascular necrosis or fracture sequelae of the humeral head. A revision surgery had to be performed in 16 patients (8.8 %). CONCLUSION: The results of this study are encouraging and underline the growing importance of shoulder arthroplasty. The preoperative limited range of motion, previous surgeries, and the status of the rotator cuff are preoperative indicators for a favourable postoperative outcome. Preoperative planning, anatomical reconstruction, and an optimal rehabilitation programme are the keys for successful shoulder arthroplasty.

Adult↗