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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
Treatment of Acute Acromioclavicular joint injuries using hook plate: a retrospective study
/0 Comments/in Vol 2| Issue 2| July-Dec 2017 /by ASESADMIN2016Acta of Shoulder and Elbow Surgery | Volume 2 | Issue 2 | July-Dec 2017 | Page 16-19 | Sebastian Trindade, Paola Del Re
Authors: Sebastian Trindade [1], Paola Del Re [2].
[1] Service of a upper limb of the Trinidad Mitre Clinical (CABA) and Medical Corporation Clinical (prov. Buenos Aires)
[2] Trinidad Mitre Clinical (CABA) and Medical Corporation Clinical (prov. Buenos Aires)
Address of Correspondence
Dr. Sebastian Trindade,
Manager of the service of a upper limb of the Trinidad Mitre Clinical (CABA) and Medical Corporation Clinical (prov. Buenos Aires)
Member Titular of The Argentina Association of Orthopedics and Traumatology (AAOT)
Email: trindadesebastian@gmail.com
Abstract
Introduction: Traumatic injuries of the AC joint are frequent in orthopedic practice accounting for about 9% of all shoulder injuries, the most commonly used classification is Rockwood. The purpose of this retrospective IVevidence level study is to present our experience using for the joint stabilization the hook plate described by Blazer 1976.
Material and Methods: from the period of August 2005 to March 2012 312 patients with acromio-clavicular dislocations were treated in our department, 51 were classified as III and IV type following Rockwood classification, 38 patients (11%) were treated with hook plate. The mean follow-up was 19 months, ranging from 11 to 26 months. The mean age was 36 years old (20-49). The surgery was performed at the average of 14 days from de injury.
Results: Patients were evaluated 6 and 18 months with the modified Quick-DASH, VAS and Constant Murley scales with 95% satisfaction. Discussion: In the surgical treatment, the method of fixation for the stability of the acute AC injury is a matter of debate. In clinical experience, none of them have proven to be any better than others. Based on an old principle of surgery in which different procedures of equal result should be chosen the simplest, animated by simplicity and reproducibility in the technique with low number of complications and an early rehabilitation we continue using this surgical procedure
Key words: Luxation A-C, Plate Hook. Level of Evidence: IV
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Conservative treatment for humeral surgical neck non-unions
/0 Comments/in Vol 2| Issue 2| July-Dec 2017 /by ASESADMIN2016Acta of Shoulder and Elbow Surgery | Volume 2 | Issue 2 | July-Dec 2017 | Page 12-15 | Federico Alfano
Authors: Federico Alfano [1].
[1] Spanish Hospital of Buenos Aires
Address of Correspondence
Dr. Federico Alfano
Spanish Hospital of Buenos Aires
Email: drfedericoalfano@gmail.comm.br
Abstract
Introduction: 2-part non-union of the surgical neck fracturesof the humerus after conservative treatment may result from initial displacement, secondary disimpaction,interposition of soft tissue, synovia fluid at the site of fracture, aggressive rehabilitation, bad patient compliance, and many other intrinsic causes. A wide variety of treatments for this condition have been proposed. They include conservative treatment, ORIF (with or without bone grafting), hemiarthroplasty and reverse arthroplasty. Most reports emphasize possible treatment options and their results. Nonetheless, it is hard to address conservative treatment since it is a very disabling disease. The aim of the present study is to evaluate the results achieved with conservative treatment for surgical neck non-unions in elderly patients. Although we advocate for surgical treatment for 2-part non-union of the surgical neck fractures, the group of patients included in the study didn’t accept our surgical indication or surgery was contraindicated because of increased operative or anesthetic risks.
Materials and Method: Retrospectively, 13 shoulders with a 2-year follow-up period were included in the study. 9 of the 13 patients were female. The mean age of the patients was 83.3 years (range 75–91 years). The dominant arm was affected in 4 patients. In the current study it was found that bone cavitation may occur early in the course of the disease, even in cases of hypertrophic non-union. It seems clear that 2-part surgical neck fractures can develop non-union in distinct manners. We found an association between hypertrophic non-union andgleno-humeral arthritis. In these cases, it looks like the limited range-of-motion in the gleno-humeral joint causes fracture instability and continuous movement between fragments, leading to hypertrophic non-unions. As stabilization of a fracture provides the essential mechanical component to allow calcification of the fibrous cartilage,on the contrary, early active mobilization exercises of a stiff joint leads to early mobilization of the fracture sitebefore bone healing had occurred.
Results: All patients complained of pain and functional impairment within the first year (with a mean Constant Score of 13.1, 15.1, 17.2 at 3, 6 and 12 months respectively). After that period most patients complained mainly about poor active range of motion (with a mean Constant Score of 24.7 and25.6 at 18 and 24 months respectively). The mean pain score improved from 8.4 at 6 months to 4.1 at the time of follow-up (p < 0.05).Mean active elevation didn´t improve although home-based exercises or supervised strengthening was carried out. All patients had internal and external rotation lag signs. At the time of last follow-up, the average active shoulder range of motion was 73° of total elevation, 20° of external rotation; on internal rotation, the ipsilateral thumb could reach the ipsilateral buttock. The two patients with combined preexisting gleno-humeral arthritis and hypertropic non-unions had worse outcome in terms of pain and range of motion.
Conclusions: Pain relief after 12 months was associated to three anatomical changes during the natural course of the disease. These are the development of a capsule-like formation of connective tissue in the non-union site, a varus cephalic displacement and bone cavitation process interruption (which was represented by the proximal humerus metaphyseal region and subcapital head sclerosis). In cases of preexisting gleno-humeral arthritis we advocate for reverse arthroplasty. If the hypertropic non-unions had occurred we would advocate for surgical stability and earlier mobilization. In all other cases, we still prefer the surgical indication if the patient has an unacceptable pain. If surgery is not possible, we can still expect reduction of pain but any improvement in terms of range of motion after 12 months of conservative treatment.
Key words: Conservative treatment, humeral surgical neck non-unions, elderly patients.
References
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3. Martin C, Guillen M, Lopez G. Treatment of 2- and 3-part fractures of the proximal humerus using external fixation: a retrospective evaluation of 62 patients. ActaOrthop. 2006; 77: 275–8.
4. Neer CS II. Displaced proximal humeral fractures: part I. Classification and evaluation. J. Bone Joint Surg 1970; 52-A: 13.
5. Neer CS II. Displaced proximal humeral fractures: part II. Treatment of three-part and four-part displacement. J. Bone Joint Surg. 1970; 52-A: 1090–103.
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25. Jacobson JA, Duquin TR, Sanchez-Sotelo J, Schleck CD, Sperling JW, Cofield RH.Anatomic shoulder arthroplasty for treatment of proximal humerus malunions. J Shoulder Elbow Surg. 2014 Aug;23(8):1232-9.
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Anterior instability of the shoulder with more than 10 years evolution, treated with Latarjet Procedure, long-term results
/0 Comments/in Vol 2| Issue 2| July-Dec 2017 /by ASESADMIN2016Acta of Shoulder and Elbow Surgery | Volume 2 | Issue 2 | July-Dec 2017 | Page 9-11 | Domingo Beltramelli, Mauricio Oehler, Bruno Pintos, Emerson Kucharski, Viviana Teske
Authors: Domingo Beltramelli [1], Mauricio Oehler [2], Bruno Pintos [2], Emerson Kucharski [2], Viviana Teske [2]
[1] Jef of Shoulder Group Montevideo Uruguay and CASMU Hospital
[2] Shoulder Group and CASMU Hospital Montevideo Uruguay
Address of Correspondence
Dr. Alexandre de Almeida:
Rua Vitório Buzelatto, 222/601. Caxias do Sul, RS, Brazil.
Zip: 95020290.
E-mail: bone@visao.com.br
Abstract
Background: The purpose of this study is to make a retrospective evaluation of the long-term evolution of patients who were operated using the Latarjet in order to evaluate the results regarding the rate of recurrence and arthrosis in the series taken.
Materials and Methods: We considered 58 patients who were operated more than 10 years ago using Latarjet procedure, average follow-up of 13,8 years. The average age at the time of the surgery was 27 years old, 46 of them were males and 12 females and 39 of the total had their dominant side affected. 33 practiced sports, 18 professionally and 15 as a spare time activity. In 22 cases the technique was performed using one screw, and in 36 cases were used two screws.
Results: Using the Carter Rowe scale for the functional evaluation, from a preoperative average of 38,5 we reached 88,2 at the end of follow-up. The recurrence was 5,7%. All the cases show glenoid bone injury that were reviewed using preoperative x-ray which were considered to compare with current evolving x-ray analyzing arthrosis with the Samilson-Prieto criteria. Only 2 patients showed arthrosis in stage 1 in the preoperative. At the time of the evaluation 18% show arthrosis, 2 cases in stage 3, 4 in stage 2 and 4 cases in stage 1. From the ones that practiced sports professionally, 15 resume their activity, and from the ones practicing sports recreationally, 10 resume it.
Conclusions: The Latarjet procedure shows excellent results to treat anterior instability of the shoulder in the long-term. The levels of recurrence and arthrosis are low.
Level of evidence: Level 4. Case Series. Treatment Study.
Keywords: Latarjet procedure, anterior instability of the shoulder, arthrosis.
References
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Experience of surgical management of acute and chronic post-traumatic elbow instability. A retrospective study
/0 Comments/in Vol 2| Issue 2| July-Dec 2017 /by ASESADMIN2016Acta of Shoulder and Elbow Surgery | Volume 2 | Issue 2 | July-Dec 2017 | Page 5-8 | Felipe Patricio Cichero, Warner Larrondo, Juan Antonio Castellaro, Gonzalo Díaz, Julio Terán
Authors: Felipe Patricio Cichero [1], Warner Larrondo [2], Juan Antonio Castellaro [3], Gonzalo Díaz [3], Julio Terán [3]
[1] Fellow of shoulder and elbow surgery Clínica Dávila, Santiago, Chile.
[2] Chief of shoulder and elbow surgery unit Clínica Dávila, Santiago, Chile.
[3] Staff surgeon of shoulder and elbow unit Clínica Dávila, Santiago, Chile.
Address of Correspondence
Dr. Felipe Patricio Cichero,
Clínica Dávila, Recoleta 464, Recoleta, Santiago, Chile.
Email: felipe.cichero@gmail.com
Abstract
Background: The elbow is the second most commonly dislocated major joint in adults.Elbow dislocation can lead to acute or chronic instability. There are different surgical options and functional outcomes in both cases. The purpose of this study is to assess the functional outcomes and the postoperative complications of these two groups.
Methods: We retrospectively reviewed the functional outcomes of cases of acute and chronic post-traumatic elbow instability that were surgically managed between 2013 and 2016 in adult population. All patients were assessed radiographically and clinically using the Mayo Elbow Performance Score and The Disabilities of the Arm, Shoulder and Hand Score at six months follow-up.
Results: Four male patients were included, two in each group of acute and chronic instability. In Three cases the medial and lateral collateral ulnar ligaments were reconstructed using semitendinosus allograft. In one case the repair of both collateral ligaments was performed usingsuture anchors. Two acute coronoid fractures were managed by using the lasso-type technique and one nonunion treated with two cannulated screws. The mean post operative Mayo Elbow Performance Score were 95 for the acute instability group and 85 for the chronic instability group. The mean Disabilities of the Arm, Shoulder and Hand post operative scores were 5,8 and 18,3 for the acute and chronic instability groups respectively. There was one case of ulnar neuropaxia that resolved spontaneously at two months follow-up. All patients had a reduced and concentric elbow in control radiographs at six months follow-up.
Conclusions: Both groups presented satisfactory results after being managed by different surgical techniques.
Keywords: Elbow instability, elbow dislocation, collateral ligaments.
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Current Trends in Shoulder Replacement: The Rational for a short stemmed humeral head replacement
/0 Comments/in Vol 2| Issue 2| July-Dec 2017 /by ASESADMIN2016Acta of Shoulder and Elbow Surgery | Volume 2 | Issue 2 | July-Dec 2017 | Page 2-4 | Christoph U. Schulz
Authors: Christoph U. Schulz [1]
[1] Praxis für Spezielle Orthopädie München, Germany
Address of Correspondence
Dr. Christoph U. Schulz,
Praxis für Spezielle Orthopädie München
associate Professor at Ludwig Maximilinas University Munich, Germany
Email: dr.schulz@orthospezial.de
Abstract
This review covers the variable aspects of humeral head replacements with special focus on short stem prosthesis
Keywords: Shoulder replacement, Humeral head, short stem
References
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Abstracts From The Argentina Congress Of Shoulder Surgery.
/0 Comments/in Vol 2| Issue 2| July-Dec 2017 /by ASESADMIN2016ASES Vol 2 Issue 2 July-Dec 2017 page 33-35
[1] Differences in postoperative rehabilitation after inverted prosthesis by traumatic pathology compared to degenerative disease
Ramon, E. Alentorn-Geli, P. Alvarez, R. Unzurrunzaga, N. Lama , X. Alvarez , R. Cugat
[2] Return to sports after arthroscopic capsulolabral repair using knotless suture anchors for anterior shoulder instability in soccer players: minimum 5-year follow-up study
Alvarez, E. Alentorn-Geli, S. Ramon, G. Steinbacher, M. Rius, J. Boffa , E. Sala, R. Seijas, D. Barastegui, X. Cusco,
R. Cugat
[3] Clavicular Blockade with local anesthesia in osteosynthesis of clavicle
Carlos Acevedo , Diogenes Rondelli .
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