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Reverse total shoulder arthroplasty allows for improved function and clinical outcomes, but several issues surround its use. The chief advantage of the reverse prosthesis is its use of the deltoid as a replacement for the rotator cuff in providing elevation and abduction of the shoulder; the prosthesis is used most frequently when there is a combination of a symptomatic deficient or nonfunctional rotator cuff and a degenerative glenohumeral joint. Conditions that result in this type of pathology include rotator cuff tear arthropathy, proximal humerus fractures, and tumors. The ideal candidate for the prosthesis is a less active person older than 65 years. Clinical results may depend on the preoperative diagnosis, deltoid and teres minor function, and biomechanical design of the prosthesis. Complications include instability, neurovascular injury, and infection. (J Musculoskel Med. 2011;28:85-94), During the past 20 years, European surgeons have used reverse total shoulder arthroplasty (RTSA) for the treatment of patients with various shoulder problems. In the United States, the FDA approved [...]

Musculoskeletal disease currently is one of the biggest public health issues in terms of associated morbidity and cost. Awareness about this problem is essential to the development of education programs that promote lifestyles conducive to good bone health. Children and teenagers are at particular risk for musculoskeletal problems. The current orthopedic literature and public health programs were reviewed to present an update on musculoskeletal injury and disease in this age group. More specifically, musculoskeletal trauma, osteoarthritis, and osteoporosis are discussed in terms of their impact on daily living and on the cost of health care. Recommendations are made on how to improve bone health in children and teenagers., Musculoskeletal conditions represent a common and costly burden to the American health care system. Roughly 1 of 7 Americans receives care for a musculoskeletal problem, (1) and more than $250 [...]

High ankle sprains are not as common as low ankle sprains, but they are a significant injury, and the diagnosis may be challenging. The primary role of the syndesmosis is to maintain the relationship of the talus to the tibia under physiological loads. To accomplish this, the distal tibiofibular joint must maintain its stability. The syndesmosis is injured most often with external rotation at the ankle joint while the foot is dorsiflexed and pronated. On physical examination, tenderness is located in the area of the anterior syndesmosis. There are several special tests for syndesmosis injuries. Radiographic assessment is helpful. The usefulness of classification systems is not well defined. The optimal rehabilitation program is unknown. Rehabilitation generally is divided into phases., Although high ankle (syndesmosis) sprains are not as common as low ankle (medial or lateral) sprains, they are a significant injury. Differentiating between the types of sprains, understanding the anatomy [...]

ABSTRACT: Differentiation between low and high ankle sprains is critical to delivering appropriate care. The classic mechanism for a low ankle sprain is inversion and plantar flexion. A history of [...]

A healthy 35-year-old man sustained a complete anterior cruciate ligament (ACL) tear of his right knee while playing soccer and underwent an uncomplicated ACL reconstruction with a bone-patella tendon-bone autograft. [...]

El hombro flotante es una lesión rara, pero importante. Aunque suele definirse como una fractura homolateral de clavícula y de cuello de la escápula, estudios recientes sugieren que la rotura ligamentosa asociada con la fractura del cuello de la escápula podría ser un equivalente funcional de este tipo de lesión, independientemente de que exista o no una fractura de clavícula. Conocer el tipo específico de lesión implica saber cuál es su potencial de inestabilidad y correlacionarlo con el resultado clínico, lo cual no resulta fácil. Teniendo en cuenta que es difícil valorar el grado de rotura ligamentosa en las radiografías, las indicaciones para un tratamiento conservador o quirúrgico no se conocen bien. Las fracturas poco desplazadas normalmente dan buenos resultados con el tratamiento conservador. Sin embargo, no conocemos cuál es el grado de desplazamiento de la fractura y el grado de rotura ligamentosa que pueden producir malos resultados tras el tratamiento conservador. Precisamente por ello las indicaciones quirúrgicas son controvertidas. La fijación interna de la fractura desplazada de la clavícula hace que se restablezca el contorno del hombro, que se regule la tensión de las partes blandas y muchas veces que se reduzca indirectamente la fractura del cuello de la escápula. En ciertos tipos de lesión, se recomienda la osteosíntesis de ambas fracturas. Como las evidencias actuales no pueden resolver las mencionadas controversias, los cirujanos ortopédicos debemos elegir un abordaje específico para cada paciente basado en el conocimiento de la patoanatomía de estas lesiones y en nuestra propia experiencia. [ABSTRACT FROM AUTHOR]

Management of the subscapularis in open shoulder surgery is a controversial topic. Subscapularis tenotomy has been the traditional approach, but other techniques have recently been developed to preserve the integrity of the subscapularis tendon. These include subscapularis peel, subscapularis split, and lesser tuberosity osteotomy. The biologic healing and biomechanical properties associated with each surgical approach must be evaluated to determine the best option for each patient. A strong, anatomic repair is required to achieve optimal clinical outcomes.