Search

Subscapularis function after arthroscopic Bankart repair has been widely studied. However, data regarding subscapularis performance after arthroscopic Latarjet procedures are lacking. This study aimed to evaluate subscapularis clinical and radiologic performance after arthroscopic Latarjet procedures. We included 40 patients who underwent arthroscopic Latarjet procedure with a minimum 2-year follow-up. Clinical evaluation included Western Ontario Shoulder Instability Index and Rowe scores, specific subscapularis isokinetic study, and lift-off tests. Contralateral measurements were used for comparison. Computed tomographic evaluation included graft consolidation, muscle dimensions, and degree of fatty atrophy, calculated as the mean muscle attenuation (MMA). There was a decrease of 8.3% of maximum internal rotation peak torque in the operated arm (P =.02). However, there was no significant difference in the agonist-antagonist ratio: 76.9% in the operated arm and 76% in the contralateral (P =.82). Lift-off strength test demonstrated a decrease in the first year but not at final follow-up (P =.38). There was a significant decrease in lift-off distance of 23% compared to the contralateral side (P <.001). Subscapularis MMA was diminished when compared to the infraspinatus/teres minor (P <.001) at the expense of its upper part (P =.03). Hyperlaxity and number of dislocation episodes were correlated to a lower MMA (P =.046 and P =.005). Arthroscopic Latarjet procedures provide satisfactory clinical results. There seems to be a diminished subscapularis MMA depending on its superior half. Hyperlaxity and number of previous dislocations were correlated to a lower MMA. Although there was a decrease in the maximum internal rotation peak torque, we did not find any difference in the agonist-antagonist ratio or in the final lift-off strength between sides. [ABSTRACT FROM AUTHOR]

Conservative treatment of isolated coronoid fractures and fracture-dislocations focused on soft-tissue healing can provide good clinical results in the majority of patients. Our aims were (1) to evaluate the outcome of a conservative treatment protocol designed for isolated coronoid fractures with or without associated elbow dislocations (ICFs) and (2) to characterize the fractures with a dedicated image analysis protocol. Of 38 consecutive patients sustaining acute ICFs, 28 were treated nonsurgically after meeting specific inclusion criteria, prospectively followed up, and clinically evaluated at least 1 year after sustaining their injuries. All cases underwent elbow computed tomography scans with tri-plane and 3-dimensional reconstructions according to a specific protocol referenced to the proximal ulna. The study included 15 male and 13 female patients, with a mean follow-up period of 32 ± 14 months (range, 12-61 months). An associated dislocation was presented in 8 (29%). Mean extension and flexion were 2° ± 8° (range, –10° to 30°) and 139° ± 11° (range, 110°-155°), respectively. Mean pronation and supination were 74° ± 3° (range, 60°-75°) and 83° ± 9° (range, 40°-85°), respectively. Of the patients, 78% rated their elbow as being normal or nearly normal. The mean Mayo Elbow Performance Score was 95 ± 9 (range, 70-100). The mean Disabilities of the Arm, Shoulder and Hand score was 7 ± 13 (range, 0-57). The mean coronoid fracture height was 5.7 ± 1.2 mm (range, 3.7-7.9 mm). The mean percentage of coronoid height fractured was 33% ± 6% (range, 23%-43%). Mean fracture displacement was 2.7 ± 2 mm (range, 1-9 mm). Of the fractures, 23 (82%) were located at the anteromedial coronoid. An ICF with a perfectly reduced ulnohumeral joint, a competent sublime tubercle, and a fractured coronoid height up to 50% can be treated without surgery with excellent or good results in more than 90% of cases regardless of the location of the fracture in the coronoid or the type of soft tissue–associated disruptions. [ABSTRACT FROM AUTHOR]

Background: Glenoid component loosening is thought to be a major cause of failure. This study assesses radiographic and clinical failure in shoulder arthroplasty, identifying factors predictive of loosening. Methods: Three-hundred two shoulder arthroplasties were implanted utilizing a cemented, keeled glenoid component, mean clinical follow-up 8.6 years. One-hundred fifty one shoulders had preoperative, early postoperative, and most recent radiographs, mean radiographic follow-up 8.0 years, minimum 4 years or less if revision was performed (2 cases). Results: Fifty-two of 151 glenoid components (34%) showed a shift in position or a complete lucent line ?1.5 mm. Four humeral components (3%) shifted or showed a 2-mm lucency in 3 zones. Component survival (Kaplan-Meier) free from radiographic failure at 5 and 10 years were 99% (95% CI) (98-100%) and 67% (95% CI) (58-78%). Glenoid components with lines at the keel on initial radiographs were at risk for radiographic failure, hazard ratio 4.6 95% CI 1.2-17.2, P = .02. No associations were found between radiographic survival and age, gender, diagnosis, glenoid erosion, and preoperative or early subluxation. Late subluxation superiorly was associated with the glenoid at risk for radiographic failure (P = .006). Glenoid component survivals free from revision at 5 and 10 years for the 302 shoulders were 99% (95% CI) (97-100%) and 93% (95% CI) (90-97%). Conclusion: Glenoid radiolucencies are seldom seen early, except beneath the faceplate. Glenoid radiolucencies develop, with notable changes 5 or more years following surgery. Humeral components seldom loosen. Revision rates remain low. The high frequency of late radiographic changes dictates the need for innovation. [Copyright &y& Elsevier]

Purpose: This study analyzed the prevalence and clinical meaning of unexpected positive cultures (UPCs) in revision shoulder arthroplasty for causes different than infection. Methods: Between 1976 and 2007, 107 consecutive patients with UPCs, no previous suspicion of infection, and fulfilling inclusion criteria were identified. Forty-five partial (PSA) and 62 total shoulder arthroplasties (TSA) with different preoperative diagnoses were reviewed. Cases were classified as true infections, possible infections, contaminants, and undetermined. Mean follow-up was 5.6 ± 5.3 years. Results: The prevalence of UPC was 15%. Male sex was a risk factor for UPC. Results of preoperative blood tests and intraoperative pathology were negative in 94 and 97 cases, respectively. Most prevalent bacteria were Propionibacterium acnes (n = 68) and Staphylococcus epidermidis (n = 21). Fifty-three patients received treatment with antibiotics and 54 did not. In 11 patients, a postoperative arthroplasty infection during follow-up was diagnosed by culture and was produced by the same microorganism as the one isolated on the UPC (true infection). Risk factors for true infection vs contamination included revision of a TSA vs a PSA and the number of previous surgeries. Antibiotic use and number of positive cultures did not influence the rate of true infections. Conclusions: UPCs are a prevalent condition in revision shoulder arthroplasty for causes different than infection. In at least 25% of cases, UPC had no clinical relevance. In 10% of cases, a persistent infection was demonstrated. [Copyright &y& Elsevier]

Background: Although most proximal humeral fractures are attributed to osteoporosis, they are usually not considered individually in osteoporotic studies because of their lower incidence. The purpose of this study was to evaluate the incidence of nondisplaced proximal humeral fractures in comparison with other outpatient-treated osteoporotic fractures, as well as to assess their functional impact and effects on patient-perceived quality of life. Materials and methods: In this multicenter, cross-sectional, prospective study, all osteoporotic fractures in postmenopausal women aged 50 years or older treated nonoperatively in 358 trauma centers were recorded during a 3-month period. Fractures were considered osteoporotic if caused by a low-energy trauma. Pathologic fractures were excluded. The incidence of proximal humeral fractures in relation to other osteoporotic fractures was calculated. Patients were interviewed by telephone 6 months after the fracture with the Disabilities of the Arm, Shoulder and Hand and EuroQoL 5D questionnaires. Results: This study comprised 5,147 women (mean age, 72.6 ± 7.5 years) with 5,268 fractures. Of these, 912 (17.5%) had had proximal humeral fractures. The mean Disabilities of the Arm, Shoulder and Hand score was 26.6 ± 25.7. Of the women, 67.3% had pain or discomfort and disclosed significant reductions in functional capacity, especially with regard to self-care (44.5%), daily life activities (56.5%), and anxiety or depression (32.7%). Conclusion: Nondisplaced proximal humeral fractures are among the most common fractures associated with osteoporosis, and they can be a major cause of functional disability and reduction in subjective patient-perceived health. [ABSTRACT FROM AUTHOR]

Hypothesis: The anteromedial approach to the shoulder with detachment of the anterior deltoid from its clavicular and anterior acromial origins is a method of enhancing exposure for difficult shoulder arthroplasty cases. The aim of this study is to describe the current frequency of use, indications, complications, and results of this approach. Materials and methods: Between 2000 and 2003, 723 consecutive shoulder arthroplasties were performed. In 110 (15%) an anteromedial approach was used. Patient data; previous surgery; indications for surgery; pain, motion, and strength before and after surgery; complications; and the need for reoperation were assessed. Results: This approach was used in 9.5% of primary cases and 39% of revision cases. Seventy percent had had previous surgery. For primary arthroplasty, the most frequent diagnoses were osteoarthritis and the sequelae of fractures. In revision cases the most common diagnoses were instability and glenoid loosening. The structural indications for the anteromedial approach were severe scarring, protection of a frail deltoid, improvement in rotator cuff or glenoid exposure, protection of osteopenic bone, or enhancement of exposure in oncologic cases or resections. Ninety patients had more than 2 years of follow-up. Pain improved after primary and revision arthroplasty. Motion only improved in primary arthroplasty. There was little change in strength. No proximal deltoid detachments or other approach-related complications were identified. Conclusions: The anteromedial approach is a reliable technique to improve surgical exposure in difficult shoulder arthroplasty cases. When performed adequately, it can be applied safely without anterior deltoid detachment or clinically evident major complications. [Copyright &y& Elsevier]