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ISSN 2457-0338
Acta of Shoulder and Elbow Surgery by http://asesjournal.com/ is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
ISSN 2457-0338
Outcomes Following Open Reduction Internal Fixation of Extra Articular or Simple Articular Distal Humerus Fractures in Patients over 75 Years of Age
/0 Comments/in Vol 4 | Issue 1| Jan-June 2020 /by ASESADMIN2016Acta of Shoulder and Elbow Surgery | Volume 4 | Issue 1 | January-June 2020 | Page 2-6 | Benjamin W. Sears, Mitchell J. Sungelo, Jacqueline E. Bader, Armodios M. Hatzidakis, Charles L. Getz
Authors: Benjamin W. Sears [1], Mitchell J. Sungelo [2], Jacqueline E. Bader [1], Armodios M. Hatzidakis [1], Charles L. Getz [3]
[1] Western Orthopaedics, 1830 Franklin St Ste 450 Denver, CO 80218
[2] University of Colorado School of Medicine, 13001 E. 17th Place Aurora, CO 80045
[3] Rothman Institute, 925 Chestnut St Philadelphia, PA 19107
Address of Correspondence
Dr. Benjamin W. Sears,
Western Orthopaedics, 1830 Franklin St Ste 450 Denver, CO 80218
E-mail: bwsears@gmail.com
Abstract
Introduction: Treatment of distal humerus fractures in the aged population remains controversial due to concerns for bone quality, healing capacity, and integrity of the surrounding soft tissue envelope. We evaluated outcomes of open reduction internal fixation (ORIF) in patients aged ≥75 years with extra articular or simple articular distal humerus fractures (AO Type A or B).
Methods: Between 2011 to 2016, 13 patients 75 years of age or older identified in the last five years at two tertiary elbow centers as having undergone ORIF for AO Type A or B distal humerus fractures were retrospectively reviewed.
Results: The final average Mayo Elbow Performance Scores (MEPS) was 83.1 (range, 50-100). Average range of motion included lack of extension to 15° (range, 0-40°), and an average flexion to 128° (range, 115-140°). Average time to union was 12.2 weeks; however, two patients treated with percutaneous pinning resulted in nonunion. One required conversion to total elbow arthroplasty for pain with osseous collapse. There were no triceps or ulnar nerve issues, and no associated perioperative medical complications.
Conclusions: ORIF for AO Type A or B distal humerus fractures in the elderly population provides for immediate/early, functional use of the extremity, predictable union, limited perioperative complications and no long-term weight bearing restrictions. Conversion to total elbow arthroplasty can be utilized as a salvage procedure.
Level of evidence: Level IV.
Keywords: Distal humerus fracture, Elderly, ORIF, Arthroplasty, Fixation, Osteoporosis, Percutaneous pinning, Locked plates.
References
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16. Frankle MA, Herscovici D Jr, DiPasquale TG, Vasey MB, Sanders RW. A comparison of open reduction and internal fixation and primary total elbow arthroplasty in the treatment of intraarticular distal humerus fractures in women older than age 65. J Orthop Trauma 2003;17(7):473-80. DOI: 10.1097/00005131-200308000-00001
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18. Charissoux JL, Vergnenegre G, Pelissier M, Fabre T, Mansat P. Epidemiology of distal humerus fractures in the elderly. Orthop Traumatol Surg Res 2013;99(7):765-9. DOI: 10.1016/j.otsr.2013.08.002
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Derotational humerus osteotomy and teres major tenotomy for recurrent posterior shoulder instability: A case report
/0 Comments/in Vol 3 | Issue 2| July-Dec 2019 /by ASESADMIN2016Acta of Shoulder and Elbow Surgery | Volume 3 | Issue 2 | July-December 2019 | Page 6-10 | Jad Chbib Abi Raad, Denis Bouttens, Simon Lebbos, Christophe Obry
Authors: Jad Chbib Abi Raad [1], Denis Bouttens [1], Simon Lebbos [1], Christophe Obry [1].
[1] Department of Orthopaedics, Fondation Hopale – Institut Calot (France)
Address of Correspondence
Dr. Jad Chbib Abi Raad ,
Fondation Hopale – Institut Calot (France)
E-mail: jadabiraad@gmail.com
jad.chbib-abi-raad@hopale.com
Abstract
Posterior instability represents about 10 percent of shoulder instabilities. It enclose dislocation or more frequently posterior sub luxation. Posterior instability can be also associated with constitutional laxity and multidirectional instability. The factors related to this instability depends of the etiology (traumatic, atraumatic), bony factors (glenoid and humeral head, defects, ante and retroversions) and the soft tissues. We describe a case of 28 year old lady, with recurrent posterior shoulder instability despite 3 previous interventions (2 posterior bone blocks and a glenoid osteotomy). For the treatment we combined two techniques: Derotational humerus osteotomy and Teres major tenotomy. We found that Derotational humerus osteotomy can be used as an alternative for glenoid osteotomy, or after failed glenoid osteotomy, to treat the instability. It can be associated with teres major tenotomy which was previously described mainly for voluntary posterior dislocation.
Keywords: Posterior instability, Posterior subluxation , Laxity, Derotational osteotomy, Teres major tenotomy, voluntary, involuntary.
References
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knowledge and literature review. World J Orthop 2018 N o v e m b e r 1 8 ; 9 ( 1 1 ) : 2 4 5 – 2 5 4 , D O I : 10.5312/wjo.v9.i11.245
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osteotomy and teres major tenotomy for recurrent posterior shoulder instability: A Case report. Acta of Shoulder and Elbow Surgery July – Dec 2019; 3(2): 6-10.
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Randomized controlled trial comparing local autologous bloodinjection and polidocanol injection for treatment of lateral epicondylosis of elbow
/0 Comments/in Vol 3 | Issue 2| July-Dec 2019 /by ASESADMIN2016Acta of Shoulder and Elbow Surgery | Volume 3 | Issue 2 | July – Dec 2019 | Page 2-5 | Rajendra Didel, Saurabh Kumar
Authors: Rajendra Didel [1], Saurabh Kumar [2].
[1] Department of Orthopaedics, Govt Medical College, Pali, Rajasthan, India.
[2] Department of Orthopaedics, U.C.M.S & G.T.B Hospital, Delhi, India.
Address of Correspondence
Dr. Saurabh Kumar,
U.C.M.S & G.T.B Hospital, Delhi, India.
E-mail: srbrai@gmail.com
Abstract
Background: Lateral epicondylosis has been found to occur in approximately 2% of general population. It’s etiology and management still remains controversial. Various studies have shown benefits with local injection of autologous blood and polidocanol individually. However, there is paucity of studies comparing the results between these both, hence we envisage to compare the clinical and functional outcomes of local autologous blood versus polidocanol injection for the treatment of lateral epicondylosis of elbow.
Materials and methods: 60 patients (age group- 18 to 60 years)with clinically diagnosed lateral epicondylosis of elbow were enrolled for the study. They were randomized into 2 groups. Group I (n = 30) was treated with autologous blood injection and Group II (n = 30) with polidocanol injection after Nirschl staging. Patients were evaluated clinically at 6& 12 weeks after the injection and were again staged by Nirschl staging on both the visits.
Results: 34 patients successfully completed 12 weeks follow-up and were included in the analysis. It was observed that clinical outcomes in terms of Nirschl score at 6 and 12 weeks was better in Group I as compared to Group II. Statistical comparison between the two groups revealed that mean values of Nirschl score were lower in group I (4.41+1.004 and 3.71+1.532 at 6 weeks and 12 weeks of follow-up respectively) as compared to group II (4.76+1.300 and 4.47+1.281at 6 weeks and 12 weeks follow-up respectively). Down staging of disease symptom was clinically better in group I (16/17) as compared to group II (11/17). However the difference in the mean values of Nirschl score between the groups was not statistically significant (p=0.342).
Conclusion: Although autologous blood injection showed a better clinical improvement as compared to polidocanol injection, the difference was not statistically significant between these both.
Keywords: Lateral epicondylosis, Autologous blood injection, Polidocanol injection
References
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7. Calfee RP, Patel A, DaSilva MF, Akelman E. Management of lateral epicondylitis: current concepts. J Am AcadOrthop Surg. 2008 Jan;16(1):19- 29.
8. Zeisig E, Fahlström M, Ohberg L, Alfredson H. Pain relief after intratendinousinjections in patients with tennis elbow: results of a randomised study. Br JSports Med. 2008 Apr;42(4):267-71.
9. Jindal N, Gaury Y, Banshiwal RC, Lamoria R, Bachhal V. Comparison of shortterm results of single injection of autologous blood and steroid injection in tennis elbow: a prospective study. J OrthopSurg Res. 2013 Apr 27;8:10.
10. Wolf JM, Ozer K, Scott F, Gordon MJ, Williams AE. Comparison of autologousblood, corticosteroid, and saline injection in the treatment of lateralepicondylitis: a prospective, randomized, controlled multicenter
study. J HandSurg Am. 2011 Aug;36(8):1269-72.
11. Edwards SG, Calandruccio JH. Autologous blood injections for refractorylateral epicondylitis. J Hand Surg Am. 2003 Mar;28(2):272-8.
12. Ozturan KE, Yucel I, Cakici H, Guven M, Sungur I. Autologous blood and corticosteroid injection and extracoporeal shock wave therapy in the treatment oflateral epicondylitis. Orthopedics. 2010 Feb;33(2):84-91.
13. Kazemi M, Azma K, Tavana B, RezaieeMoghaddam F, Panahi A. Autologous bloodversus corticosteroid local injection in the short-term treatment of lateralelbow tendinopathy: a randomized clinical trial of efficacy. Am J Phys
MedRehabil. 2010 Aug;89(8):660-7.
14. Zeisig E, Ohberg L, Alfredson H. Sclerosingpolidocanol injections in chronic painful tennis elbow-promising results in a pilot study. Knee Surg Sports TraumatolArthrosc. 2006 Nov;14(11):1218-24.
15. Connell DA, Ali KE, Ahmad M, Lambert S, Corbett S, Curtis M. Ultrasoundguidedautologous blood injection for tennis elbow. Skeletal Radiol. 2006Jun;35(6):371-7.
16. Gani NU, Butt MF, Dhar SA, et al. Autologous blood injection in the treatment of Refractory Tennis Elbow. The Internet Journal of Orthopaedic Surgery 2007.
17. Creaney L, Wallace A, Curtis M, Connell D. Growth factor-based therapies provide additional benefit beyond physical therapy in resistant elbow tendinopathy: a prospective, single-blind, randomised trial of autologous blood injections versus platelet-rich plasma injections. Br J Sports Med. 2011Sep;45(12):966-71.
18. Raeissadat SA, Sedighipour L, Rayegani SM, Bahrami MH, Bayat M, Rahimi R.Effect of Platelet-Rich Plasma (PRP) versus Autologous Whole Blood on Pain andFunction Improvement in Tennis Elbow: A Randomized Clinical Trial. Pain ResTreat. 2014;2014:191525.
blood injection and polidocanol injection for treatment of lateral epicondylosis
of elbow. Acta of Shoulder and Elbow Surgery July – Dec 2019; 3(2): 2-5.
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Case Report: A rare case of Giant Cell Tumor of Distal Ulna
/0 Comments/in Vol 3 | Issue 1| Jan-June 2019 /by ASESADMIN2016Acta of Shoulder and Elbow Surgery | Volume 3 | Issue 1 | Jan- June 2019 | Page 19-20 | Soham R Chachcha, Ramavtar Saini, Anand Yadav
Authors: Soham R Chachcha [1], Ramavtar Saini [1], Anand Yadav [1].
[1] Dept. Of Orthopaedics, Geetanjali Medical College and Hospital Udaipur.
Address of Correspondence
Dr. Soham R Chachcha,
Dept. Of Orthopaedics, Geetanjali Medical College and Hospital Udaipur.
E-mail: chacha_soham@yahoo.co.in , chachasoham@gmail.com
Abstract
Background: Giant Cell tumor has a reported incidence of 30% in Indian population out of which only 10% cases occur in adults more than 65 years of age. Distal Femur and proximal Tibia are the most common sites followed by distal Radius . Distal Ulna Giant cell tumor is a rare presentation.
Methods: There are no clear-cut guidelines for treatment of Giant Cell Tumor. The treatment of choice in case of Giant Cell Tumor usually is wide block resection of tumor, and to prevent recurrence adjuvant procedures can be used such as cryotheryapy, phenol, cementing and bone grafting and burring. We used the en bloc resection method.
Result: After the en bloc resection of the tumor, the patient had relief in pain and the range of motion at wrist joint was restored.
Conclusion: Giant Cell tumor of distal Ulna is a rare entity and it is even rarer in Geriatric population. It can be treated with en bloc resection.
Keywords: Distal, Ulna, Giant Cell, Tumor, Geriatric.
References
1. Dr Ajay Puri, Dr. M. G. Agarwal and Dr. DinshawPardiwala in ‘Current concepts in bone and soft tissue tumors’ Chapter 6 Giant Cell Tumor Of Bone Page: 53-63.
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3. D. J. McDonald, F. H. Sim, R. A. McLeod, and D. C. Dahlin, “Giant-cell tumor of bone,” Journal of Bone and Joint Surgery. Series A, vol. 68, no. 2, pp. 235–242, 1986.
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Suprascapular neuropathy in a young male handball player: case report
/0 Comments/in Vol 3 | Issue 1| Jan-June 2019 /by ASESADMIN2016Acta of Shoulder and Elbow Surgery | Volume 3 | Issue 1 | Jan- June 2019 | Page 16-18 | Luís Henrique Barros, Claudia Rodrigues, Rui Claro
Authors: Luís Henrique Barros [1], Claudia Rodrigues [1], Rui Claro [1].
[1] Centro Hospitalar do Porto
Address of Correspondence
Dr. Luís Henrique Barros,
Avenida da República, 855, 1º direito, Vila Nova de Gaia, 4430-201, Portugal
Centro Hospitalar do Porto
E-mail: luisbarros8@gmail.com
Abstract
Background: Suprascapular neuropathy is an uncommon but a very disabling condition. If not diagnosed early, it can lead to irreversible changes. Their prevalence is higher among males and active population, mainly in overhead athletes.
Methods: A 22-year-old male, who is a handball player, reported right shoulder pain, fatigue, and discomfort after one month holding a backpack during hiking in his vacations. He did not remember any trauma to the right shoulder. Clinically, he had a normal active and passive range of motion but the moderate weakness of the right shoulder external rotator muscles. At inspection, he had marked atrophy of supraspinatus and infraspinatus muscles. MRI demonstrated a superior labrum from anterior to the posterior lesion with large multiloculated Paralabral cyst and electromyography was consistent with compression of the suprascapular nerve.
Results: The patient was submitted to arthroscopic labral repair and decompression of the suprascapular nerve. Six months after surgery he has no pain and limitation and is recovering strength
Conclusions: Paralabral cysts are described in the literature as causing compression on spinoglenoid notch and thus coursing with infraspinatus atrophy. This case demonstrates an unusual presentation with both supra and infraspinatus muscles atrophy. Early recognition of these injuries is crucial because complication and morbidity rates are high with delayed diagnosis, mainly in the athlete population.
Keywords: suprascapular neuropathy, SLAP lesion, paralabral cyst, overhead athletes lesions, supraspinatus muscle atrophy, infraspinatus muscle atrophy.
References
1. Schroeder AJ, Bedeir YH, Schumaier AP, Desai VS, Grawe BM. Arthroscopic Management of SLAP Lesions With Concomitant Spinoglenoid Notch Ganglion Cysts: A Systematic Review Comparing Repair Alone to Repair With Decompression. Arthroscopy. 2018. Epub 2018/03/05. doi: 10.1016/j.arthro.2018.01.031. PubMed PMID: 29501216.
2. Zehetgruber H, Noske H, Lang T, Wurnig C. Suprascapular nerve entrapment. A meta-analysis. International orthopaedics. 2002;26(6):339-43. Epub 2002/12/06. doi: 10.1007/s00264-002-0392-y. PubMed PMID: 12466865; PubMed Central PMCID: PMCPMC3620977.
3. Schroder CP, Lundgreen K, Kvakestad R. Paralabral cysts of the shoulder treated with isolated labral repair: effect on pain and radiologic findings. J Shoulder Elbow Surg. 2018;27(7):1283-9. Epub 2018/02/17. doi: 10.1016/j.jse.2017.12.022. PubMed PMID: 29449084.
4. Romeo AA, Rotenberg DD, Bach BR, Jr. Suprascapular neuropathy. J Am Acad Orthop Surg. 1999;7(6):358-67. Epub 2001/08/11. PubMed PMID: 11497489.
5. Pillai G, Baynes JR, Gladstone J, Flatow EL. Greater strength increase with cyst decompression and SLAP repair than SLAP repair alone. Clinical orthopaedics and related research. 2011;469(4):1056-60. Epub 2010/11/26. doi: 10.1007/s11999-010-1661-5. PubMed PMID: 21104358; PubMed Central PMCID: PMCPMC3048282.
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Surgical treatment of shoulder instability using transsubscapularis transfer of the long biceps tendon
/0 Comments/in Vol 3 | Issue 1| Jan-June 2019 /by ASESADMIN2016Acta of Shoulder and Elbow Surgery | Volume 3 | Issue 1 | Jan- June 2019 | Page 13-15 | Yonder Archanjo Ching San Junior, Max RogÃcrio Freitas Ramos, Settings Luiz, Diogo Fagundes Henrique Pereira Alves, Paulo RogÃcrio Moritz Postigo
Authors: Yonder Archanjo Ching San Junior[1], Max RogÃcrio Freitas Ramos[1], Settings Luiz[1], Diogo Fagundes Henrique Pereira Alves[1], Paulo RogÃcrio Moritz Postigo [1].
[1] Consultório: Av. Paisagista José Silva de Azevedo Neto, 200 – Bloco 7
(Ecology) Sala 330 – Barra da Tijuca
Clínica Le Sage: Rua da Assembléia, 10 – Sala 1215 – Centro – Rio de
Janeiro
Address of Correspondence
Dr. Yonder Archanjo Ching San Junior,
Ortopedia e Traumatologia – Cirurgia do Ombro e Cotovelo
Email: yondersanjr@gmail.com
Abstract
Objectives: To describe the long bicepstendon transfer technique for the treatment of anterior shoulder instability.
Method: The long tendon of the biceps brachiiwas detached from the supraglenoid tubercle and transferred to the anterior edge of the glenoid cavity using subscapularis tenotomy, reproducing the slingeffect and increasing the anterior bone block.
Results: The technique is easy to perform and minimises the risks of coracoid process transfer.
Conclusion: Transfer of the long tendon of the biceps brachii is an option for the treatment of glenohumeral instability.
Keywords: Joint instability/pathology, Joint instability/surgery, Shoulder joint/pathology, Shoulder joint/surgery, Cadaver
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