Core Decompression for Class I Avascular Necrosis of Humeral Head
Avascular necrosis of the humeral head is a diagnosis of multiple etiologies and unclear prognosis. Prompt diagnosis and treatment are essential to prevent head collapse and avoid resurfacing or joint replacement procedures. Imaging modalities including standard radiography and magnetic resonance imaging establish the diagnosis and stage it according to the degree of necrosis, head collapse, or extension into the glenoid. If the patient stays persistently symptomatic despite conservative treatments and is still in the early stages of the disease course, humeral head core decompression is a reasonable option as it has been ...
Source: Techniques in Shoulder and Elbow Surgery - November 14, 2019 Category: Orthopaedics Tags: Video Technique Source Type: research

An Approach to the Management of Bilateral Posterior Shoulder Dislocations Following Seizure: Case Report, Literature Review, and Proposed Treatment Algorithm
We report a case, describe the surgical techniques used, and propose an algorithm for managing the treatment of a young patient who presents with bilateral posterior dislocations related to a seizure. At her most recent follow-up (57 mo postoperative for the left shoulder and 41 mo postoperative for the right shoulder), she denied any apprehension or instability in either shoulder and had no further dislocations. She reported mild chronic pain in both shoulders, worse in the right than the left. She has a smooth passive range of motion with no crepitus in either shoulder. Her range of motion in forward elevat...
Source: Techniques in Shoulder and Elbow Surgery - November 14, 2019 Category: Orthopaedics Tags: Techniques Source Type: research

Reconstruction of Chronic Distal Biceps Tendon Rupture With Autogenous Semitendinosis Graft Using the “Anatomic Length Method” and Concomitant Bicipital Aponeurosis Repair
We present a novel variation of a surgical technique for reconstruction of chronic distal biceps tendon ruptures using the “Anatomic Length Method.” Graft length for chronic distal biceps tendon rupture reconstruction is extremely variable and typically empirically determined by elbow position during final fixation. These techniques do not account for chronicity and varying degrees of retraction and muscle shortening. For this unique variation in the surgical technique, the graft length used is based on previous anatomic cadaveric measurements done in our center with an external distal biceps tendon length mean...
Source: Techniques in Shoulder and Elbow Surgery - November 14, 2019 Category: Orthopaedics Tags: Techniques Source Type: research

The Mini-open Plication of Medial Collateral Ligament of the Elbow: A New Arthroscopically Assisted Technique
The stability of the medial elbow compartment is not only important for everyday life but also plays a key role in throwing gestures. Valgus stress is a fundamental part of popular sport activities (baseball, squash, tennis, and volleyball). Even the isolated medial collateral ligament (MCL) lesion might develop symptomatic medial instability, which interrupts everyday life. This instability may be symptomatic and patients may refer medial elbow pain. Several techniques for MCL treatment have been described. Most of them are reconstructions in which there are tunnels and free cylindrical grafts. The aim of our study is to ...
Source: Techniques in Shoulder and Elbow Surgery - November 14, 2019 Category: Orthopaedics Tags: Techniques Source Type: research

High-grade Common Extensor Tendon Tears Maintaining Chronic Lateral Epicondylitis: Clinical and Structural Outcome Following Knotless Suture Anchor Repair
We describe the reconstruction of high-grade extensor tendon tears using a knotless suture anchor and hypothesize that this will result in improved elbow pain and function with a high healing rate. Twenty chronic lateral epicondylitis patients with magnetic resonance imaging–confirmed high-grade extensor tendon tears underwent surgery using a knotless suture anchor technique. All underwent clinical and ultrasound assessments and completed the quick Disabilities of the Arm, Shoulder, and Hand and patient-rated tennis elbow evaluation questionnaires at final follow-up. Preoperative and postoperative Mayo Elbow Performa...
Source: Techniques in Shoulder and Elbow Surgery - November 14, 2019 Category: Orthopaedics Tags: Techniques Source Type: research

Clinical Outcomes of Lateral Ulnar Collateral Ligament Repair of the Elbow Using a Cortical Button
The purpose of this retrospective case series was to report a new surgical technique for lateral ulnar collateral ligament (LUCL) repair using a cortical button and the clinical results. Twenty patients underwent a LUCL repair using a cortical button at a single institution were included for evaluation of the demographic, radiologic, and clinical examination data. Nine patients returned for a separate study visit for further clinical examination and outcome surveys. Eighteen patients (mean age: 48 y, 10 males) received at least 1 additional procedure other than a LUCL repair. For the 9 patients who returned for a st...
Source: Techniques in Shoulder and Elbow Surgery - November 14, 2019 Category: Orthopaedics Tags: Research Article Source Type: research

Correction of Elbow Flexion Deformity in Patients Affected With Spasticity Through the Lateral Approach: Surgical Technique and Results
Fixed and dynamic elbow flexion deformity due to spasticity represents a common, yet challenging, clinical entity. Several surgical options have been described in literature, the majority of which utilize the anterior approach, through the antecubital fossa to release biceps. We propose a novel technique, using the lateral approach, as a safer and simpler option that allows release of the brachialis while leaving biceps intact to act as a supinator. All patients that were referred to our institution for treatment of an elbow flexion deformity due to spasticity between 2012 and 2016 were assessed. Patients with a previous h...
Source: Techniques in Shoulder and Elbow Surgery - August 1, 2019 Category: Orthopaedics Tags: Techniques Source Type: research

Reconstruction of the Acromioclavicular Joint With 360-degree Control
Conclusion: This modification of the twin-tailed Dog Bone technique using FibreTape resulted in a high patient self-rating of their shoulder function and a low rate of complications. (Source: Techniques in Shoulder and Elbow Surgery)
Source: Techniques in Shoulder and Elbow Surgery - August 1, 2019 Category: Orthopaedics Tags: Techniques Source Type: research

Anterior Capsular Reconstruction of the Shoulder for Chronic Instability Using a Dermal Allograft
Chronic anterior shoulder instability after failed surgical stabilization procedures poses a significant challenge to orthopedic surgeons. Here, a novel technique of an anterior capsular reconstruction with a dermal allograft is presented. The shoulder remained stable with no recurrent dislocations at a final follow-up of 24 months. Excellent range of motion, strength, and good patient satisfaction is noted. Outcomes following the use of a dermal allograft for anterior capsular reconstruction have not been previously reported in the literature, and its use for chronic anterior shoulder instability shows promising initial r...
Source: Techniques in Shoulder and Elbow Surgery - August 1, 2019 Category: Orthopaedics Tags: Techniques Source Type: research

Glenoid Fractures Treated by Percutaneous Osteosynthesis Under Arthroscopic Control
Glenoid fractures are scarce and their treatment is discussed. Osteosynthesis under arthroscopy has been essentially described in bony Bankart lesions. Concerning bigger fractures of the glenoid cavity, eventually combined with a scapula body fracture, the arthroscopic treatment is difficult and still less practiced. Here, we describe 3 cases of external osteosynthesis by pins and/or cannulated screws under arthroscopic control. We put forward the case of a transclavicular approach for an associated fracture of the lateral quarter of the clavicle. The radiologic and functional results are good, with a rapid recovery of usu...
Source: Techniques in Shoulder and Elbow Surgery - August 1, 2019 Category: Orthopaedics Tags: Techniques Source Type: research

Clinical Results of Conservative Treatment of Severe Proximal Humerus Fractures Requiring Surgical Treatment in Old Patients
The purpose of this study was to investigate the clinical outcomes of nonsurgically treated proximal humerus fractures that would have been otherwise treated surgically had it not been for reasons precluding surgical treatment. A retrospective search for patients treated nonsurgically for a proximal humerus fracture was performed. Injury x-rays of all patients were reviewed independently by 3 orthopedic surgeons. Patients for whom at least 2 surgeons recommended surgical treatment were included. Of 96 eligible patients, 22 patients completed the data collection. There were six 2-part, seven 3-part, five 4-part fractures, a...
Source: Techniques in Shoulder and Elbow Surgery - August 1, 2019 Category: Orthopaedics Tags: Research Articles Source Type: research

Treatment of Sagittal Split Olecranon Fractures Using Dorsal Plates Combined With Tension Band Wiring or Cerclage Wires
We evaluated the results of olecranon fractures with an intra-articular sagittal plane fracture treated by dorsal plates in combination with tension band wiring or cerclage wires. We included patients with comminuted olecranon fractures with sagittal split treated with combination fixation. Postoperative functional assessment, Mayo Elbow Performance Score (MEPS) and complications were recorded. The mean age of patients was 52 years (SD±16). There were 7 female and 5 male patients. There were 2 1B, 7 2B, and 3 3B fractures according to Mayo classification. All patient’s fractures healed satisfactorily. There wa...
Source: Techniques in Shoulder and Elbow Surgery - August 1, 2019 Category: Orthopaedics Tags: Research Articles Source Type: research

CT-guided Navigation in Shoulder Arthroplasty
Successful anatomic and reverse total shoulder arthroplasty require a detailed understanding of each individual patient’s pathology. Advances in preoperative imaging continue to give surgeons a greater ability to customize implants to recreate native anatomy. Technological advancements have attempted to harness this information in the form of patient-specific instrumentation and more recently computed tomography-guided navigation. However, goals of shoulder arthroplasty remain the same: precise implant placement in order to maximize glenohumeral range of motion and stability while minimizing impingement to increase i...
Source: Techniques in Shoulder and Elbow Surgery - May 1, 2019 Category: Orthopaedics Tags: Hot Topics and Controversies Source Type: research

Patch Reinforcement of Rotator Cuff Repairs: Current Indications
Patch reinforcement of rotator cuff repairs is continuing to evolve. Patches in rotator cuff repair can be used for suture reinforcement, augmentation, or interposition. We will discuss current indications for patch reinforcement of rotator cuff repairs. (Source: Techniques in Shoulder and Elbow Surgery)
Source: Techniques in Shoulder and Elbow Surgery - May 1, 2019 Category: Orthopaedics Tags: Hot Topics and Controversies Source Type: research

When is the Reverse Shoulder Arthroplasty Indicated for Massive Rotator Cuff Tears Without Arthritis?
No abstract available (Source: Techniques in Shoulder and Elbow Surgery)
Source: Techniques in Shoulder and Elbow Surgery - May 1, 2019 Category: Orthopaedics Tags: Hot Topics and Controversies Source Type: research

Shoulder Instability: Arthroscopic Capsulolabral Repair: the Gold Standard
There still exists some skepticism in the orthopedic community regarding the effectiveness of all-arthroscopic shoulder stabilization surgeries, mostly due to older literature, which report high failure rates when compared to open surgery. We look to present the modern indications and techniques of arthroscopic shoulder stabilization and highlight recent studies which show equivalent or superior results even in the contact athlete. There exists an abundance of literature which shows arthroscopic shoulder stabilization done with proper anchor placement, incorporating capsulolabral shifts, with the patient positioned in late...
Source: Techniques in Shoulder and Elbow Surgery - May 1, 2019 Category: Orthopaedics Tags: Hot Topics and Controversies Source Type: research

A Triceps Split Approach for Total Elbow Arthroplasty
Total elbow arthroplasty can be performed through a variety of surgical approaches including partial or complete triceps detachment and triceps sparing. The choice is partially influenced by surgeon preference as well as patient-related and prosthetic-related factors. Failure of triceps repair is a known complication of approaches involving triceps detachment and ulnar component malposition is a common complication of triceps sparing techniques. Our approach allows total elbow arthroplasty to be performed without compromise to the triceps insertion and ideal placement of the ulnar component. In our approach the triceps spl...
Source: Techniques in Shoulder and Elbow Surgery - May 1, 2019 Category: Orthopaedics Tags: Techniques Source Type: research

Arthroscopic Technique for Transfragment Fixation of the Supraspinatus Intratendinous Footprint Avulsion
We present an arthroscopic fixation technique for a rare lesion of the rotator cuff. The lesion involves nondisplaced intratendinous avulsion of the supraspinatus footprint with an intact bridge of the supraspinatus tendon on the articular and bursal sides. The surgical technique involves the use of arthroscopic transfragment fixation with a single double-loaded suture anchor which was placed within the avulsed fragment bed. At 3 months from surgery, radiographic healing of the fracture was noted, with full recovery of daily activities and almost complete active range of motion confirmed with improvement of the Oxford Shou...
Source: Techniques in Shoulder and Elbow Surgery - May 1, 2019 Category: Orthopaedics Tags: Techniques Source Type: research

Independent Arthroscopy-assisted Acromioclavicular Ligament Reconstruction: A Novel Technique
A large number of surgical techniques have been described for acromioclavicular (AC) joint (ACJ) dislocations. Most are based on the reconstruction of the coracoclavicular ligaments. These techniques provide the ACJ with vertical stability and have a high. complication rate. Advances in material technology and implants have allowed us to develop a surgical, technique approach to treat ACJ dislocations, that provides this joint with stability in both, vertical and horizontal planes, reconstructing only the AC ligaments. Two drilled holes are made in the acromion under arthoscopic control. Then, 2 tape-type sutures are passe...
Source: Techniques in Shoulder and Elbow Surgery - May 1, 2019 Category: Orthopaedics Tags: Techniques Source Type: research

Movement Patterns of the Shoulder Post Synthetic Interpositional PTFE Patch Repair for Large Rotator Cuff Tears
This study compared the outcomes of polytetrafluoroethylene patch repair (n=15), suture-anchor repair (n=8), reverse total shoulder arthroplasty (n=7), and normal shoulders (n=5). The inter-rater and intrarater reliability of radiography was excellent (r=0.98, 0.96). Glenohumeral joint movement at maximal active abduction following patch repair (59±5 degrees), suture-anchor repair (57±8 degrees) and reverse total shoulder arthroplasty (52±7 degrees) was less than asymptomatic shoulders (95±3 degrees; P (Source: Techniques in Shoulder and Elbow Surgery)
Source: Techniques in Shoulder and Elbow Surgery - May 1, 2019 Category: Orthopaedics Tags: Research Article Source Type: research

Chronic Distal Triceps Rupture Repaired Using Acellular Dermal Allograft as an Interposition Graft
Rupture of the triceps is a rare event. If triceps rupture is not immediately recognized, chronic ruptures produce a therapeutic problem. The residual tendon is often retracted, atrophic and of poor quality, therefore it is not usually appropriate for primary repair due to the high levels of tension encountered. Previously, multiple autograft techniques have been reported; however, this often leaves the patient with an additional surgical site and additional morbidity. Therefore we present our operative technique using acellular dermal allograft (ADA) as an interposition graft for the management of chronic distal triceps r...
Source: Techniques in Shoulder and Elbow Surgery - February 5, 2019 Category: Orthopaedics Tags: Techniques Source Type: research

A Surgical Technique for Corrective Osteotomy of a Complex Distal Humeral Deformity Using 3-Dimensional Printing Technology
Corrective osteotomy for complex deformity correction is a challenging procedure, both in its planning and execution. Traditional planning techniques, particularly when applied to periarticular deformity, are generally inaccurate and the outcome of subsequent osteotomy may be suboptimal. In this described technique, 3-dimensional printed models were generated from preoperative computed tomographic scans to assist in both the planning and execution of a distal humeral osteotomy. A single case is described of cubitus valgus of 40 degrees with fixed flexion deformity following nonunion of a fracture of the lateral condyle of ...
Source: Techniques in Shoulder and Elbow Surgery - February 5, 2019 Category: Orthopaedics Tags: Techniques Source Type: research

Medial Clavicle Osseous Dimensions With Implication on Plate Fixation
Significantly displaced medial clavicle fractures are associated with high rates of painful nonunion. Operative fixation can be challenging due to limited medial bone stock and adjacent vital vascular structures. In total, 21 consecutive chest computer tomographic scans were analyzed to measure anterior-posterior and superior-inferior dimensions of the medial clavicle. Correlation between height and clavicular dimensions were assessed by the Pearson correlation coefficient. Two cases using dual T-locking plates are described. From anterior to posterior, the medial clavicle typically measures 1.44 (SD, 0.26 cm) and 2...
Source: Techniques in Shoulder and Elbow Surgery - February 5, 2019 Category: Orthopaedics Tags: Techniques Source Type: research

Novel Use of Calcium Phosphate Bone Void Filler in Rotator Cuff and Labral Repair
Patients with poor bone quality or cystic changes present a unique problem when utilizing standard arthroscopic rotator cuff and labral repair techniques and implants. Previous studies have looked at multiple methods to augment the bone in the presence of poor bone quality to allow for appropriate fixation with variable success. The following case reports describe the use of AccuFill, an injectable calcium phosphate bone void filler, to augment rotator cuff or labral repair in the setting of deficient bone in the greater tuberosity or glenoid. In the rotator cuff repair case report, follow-up imaging at 1 year show tendon-...
Source: Techniques in Shoulder and Elbow Surgery - February 5, 2019 Category: Orthopaedics Tags: Techniques Source Type: research

Technique for a Novel Arthroscopic Transosseous Rotator Cuff Repair
The authors describe a novel all-arthroscopic anchorless transosseous suture technique that is easy to perform and reproduce and combines the benefits of both the arthroscopic technique and the transosseous approach. This procedure maximizes the tendon-footprint contact area obtaining both medial and lateral fixation without using any implanted device. In the current technical note, the procedure is described in detail providing several tips and tricks. (Source: Techniques in Shoulder and Elbow Surgery)
Source: Techniques in Shoulder and Elbow Surgery - February 5, 2019 Category: Orthopaedics Tags: Techniques Source Type: research

Techniques for Interpositional Graft Reconstruction for Massive Irreparable Rotator Cuff Tears
The management of massive irreparable rotator cuff tears is a challenge for surgeons. Unlike smaller rotator cuff tears massive irreparable tears cannot be managed through standard surgical techniques and have high rates of retear after surgical repair. Interpositional graft reconstruction is a novel surgical technique to manage these massive irreparable tears, with promising preliminary clinical outcomes. In the past interpositional graft reconstructions of massive irreparable rotator cuff tears were complex and invasive, open procedures, however more recently, with the development of specialized devices, a number of tech...
Source: Techniques in Shoulder and Elbow Surgery - February 5, 2019 Category: Orthopaedics Tags: Techniques Source Type: research

True AP Image of the Proximal Radioulnar Joint as a Tool for Assessment of Radial Head Height
Replicating the original bony anatomy during radial head replacement or fracture repair is important for both joint stability and prevention of arthritis, but can be difficult to achieve. An important landmark for determining appropriate radial head height that is often overlooked is the proximal radioulnar joint (PRUJ). We propose a methodology to use an en face view of the lesser sigmoid notch as a fluoroscopic reference point to establish appropriate height for the proximal border of the prosthesis in radial head replacement. 5 fresh frozen cadaveric elbows were dissected medially to assess the relationship of the radia...
Source: Techniques in Shoulder and Elbow Surgery - February 5, 2019 Category: Orthopaedics Tags: Research Article Source Type: research

Arthroscopic Stabilization With Hill-Sachs Remplissage and Bankart Repair: A Surgical Technique
Management of recurrent instability with coexisting Hill-Sachs defect is debatable. Isolated Bankart repairs do not address the bone loss sustained on the humeral side and are associated with higher recurrence risk in those with concomitant humeral bone loss. Further, bone block procedures may not be necessary to achieve stability if there is minimal glenoid bone loss and are associated with higher rate of complications. The arthroscopic remplissage allows the Hill-Sachs defect to be filled with a soft tissue structure to decrease the risk of recurrent dislocations when combined with a soft tissue Bankart repair. Key steps...
Source: Techniques in Shoulder and Elbow Surgery - October 30, 2018 Category: Orthopaedics Tags: Video Technique Source Type: research

Case Report: Reconstruction of a Coronoid Using a Radial Head Autograft for Failed ORIF of Monteggia Variant Fracture Dislocation
In this report we will provide details of the reconstruction technique, as well as information with regard to perioperative management, intraoperative findings, postoperative clinical progression, and subsequent postoperative imaging. Restoration of a fractured coronoid in the setting of Monteggia variant fractures is a technically challenging procedure. Our case demonstrates that using a radial head autograft to repair a severely fractured coronoid can lead to a successful outcome for the patient. (Source: Techniques in Shoulder and Elbow Surgery)
Source: Techniques in Shoulder and Elbow Surgery - October 30, 2018 Category: Orthopaedics Tags: Techniques Source Type: research

Buckle-Down Technique for the Bony Reconstruction of Large Anterior Glenoid Defects
Background: A bony defect of the anterior glenoid is often observed in patients presenting with recurrent dislocation; when this defect is considerably large, bony reconstruction is indicated and results in long-term stabilization of the joint. Conventional procedures for restoring the glenoid surface are associated with numerous postoperative complications related to bone graft fixation. The aim of this study was to devise a novel technique for graft fixation in the context of a large anterior glenoid defect that might mitigate these complications, and to quantify the techniques ability to restore bony stability in the ...
Source: Techniques in Shoulder and Elbow Surgery - October 30, 2018 Category: Orthopaedics Tags: Techniques Source Type: research

Long Head of Biceps Tendon Transfer for Anterior Shoulder Instability
We describe a technique variation for the treatment of recurrent anterior shoulder dislocation: the long head of biceps tendon transfer. This technique follows the same crucial “sling effect” of the Bristow-Latarjet without the risk of coracoid bone block complications or scapular dyskinesis due to detachment of the conjoined tendon and pectoralis minor from the scapula. Moreover, it can be used with capsule-labrum repair. (Source: Techniques in Shoulder and Elbow Surgery)
Source: Techniques in Shoulder and Elbow Surgery - October 30, 2018 Category: Orthopaedics Tags: Techniques Source Type: research

Total Elbow Arthroplasty in the Setting of an Olecranon Fracture
We present a surgical technique that can lead to a successful TEA and olecranon union in the setting of a comminuted distal humerus fracture combined with a displaced olecranon fracture. In this technique, the olecranon fragment was used to achieve superior surgical exposure for our TEA technique and allowed us to achieve good postoperative outcome. This has led us to be more willing to use an olecranon osteotomy for distal humeral fracture visualization in cases where a TEA may be needed. (Source: Techniques in Shoulder and Elbow Surgery)
Source: Techniques in Shoulder and Elbow Surgery - October 30, 2018 Category: Orthopaedics Tags: Techniques Source Type: research

Surgical Management of Coronoid Fractures
Coronoid fractures occur as part of more complex injuries including other bone fractures (ie, radial head) and/or ligamentous injuries. Diagnostic tests include plain elbow x-rays and should include a computed tomographic scan. Indication for coronoid fixation is based on the fracture size and location, and factors related to the injury pattern and the severity of the instability. Fixation is performed when the fracture is big enough so as to be able to be repaired with solid hardware (screws and plates); small flecks of bone either do not need fixation, or, in cases of severe instability, other methods of stabilization sh...
Source: Techniques in Shoulder and Elbow Surgery - October 30, 2018 Category: Orthopaedics Tags: Techniques Source Type: research

Modified Biceps Suspension Procedure for Painful Glenohumeral Inferior Subluxation in Hemiplegic Stroke Patients: A Preliminary Study
In this study, we sought to report the early outcomes of a biceps tendon suspension-rotator interval imbrication procedure performed in 5 hemiplegic stroke patients with intractable shoulder pain. This procedure was a modification of a previously reported technique and involved looping the distal end of the proximal biceps long head tendon through transosseous tunnels in the bicipital groove and imbrication of the rotator interval. The mean pain VAS score was significantly improved from 8 preoperatively to 2 postoperatively. The mean American Shoulder and Elbow Surgeons score was also improved from 12 to 45. Four patients ...
Source: Techniques in Shoulder and Elbow Surgery - October 30, 2018 Category: Orthopaedics Tags: Research Articles Source Type: research

Surgical Management of Bony Encasement of the Ulnar Nerve Secondary to Heterotopic Ossification of the Elbow
Heterotopic ossification (HO) is the most common extrinsic cause of elbow contracture. However, associated ulnar neuropathy at the elbow due to HO is uncommon. The purpose of the study is to describe the surgical management and investigate the effect of operative treatment of HO about the ulnar nerve on neuropathic symptoms. A retrospective review of all patients treated with bony encasement of the ulnar nerve secondary to HO over a 13-year period was performed. All patients underwent surgery for clinically symptomatic or debilitating HO of the elbow. Each patient received HO prophylaxis postoperatively. Subjects underwent...
Source: Techniques in Shoulder and Elbow Surgery - October 30, 2018 Category: Orthopaedics Tags: Research Articles Source Type: research

Corrective Posterior Opening-wedge Glenoid Neck Osteotomy for Excessive Retroversion
Excessive retroversion of the glenoid can cause eccentric loading of the glenohumeral joint and may lead to posterior shoulder instability, posterior labral tears, functional impairment, static posterior shoulder subluxation, and progressive glenohumeral arthropathy. For young patients surgical options are limited and include open labral repair and capsular plication, arthroscopic labral repair and capsular plication, or open posterior opening-wedge glenoid osteotomy. Of these, only the osteotomy can correct the glenoid retroversion and recenter the humeral head. Here, we detail our preoperative work-up, the surgical techn...
Source: Techniques in Shoulder and Elbow Surgery - July 31, 2018 Category: Orthopaedics Tags: Techniques Source Type: research

Internal Fixation of 4-Part Proximal Humerus Fractures and Fracture Dislocations Using Extended Deltoid-splitting Approach, Locking Plates, and Calcium Sulfate Graft: Technical Details
Surgical treatment of 4-part proximal humerus fractures and fracture dislocations remain challenging because of difficulties in exposure, reduction, and achieving a stable internal fixation. We have treated these injuries using extended deltoid-splitting approach with internal fixation using locking plates, calcium sulfate graft, and tuberosity repair with polyethylene sutures. We have used this technique in 21 cases (20 patients) 7 male, 13 female with displaced 4-part fractures or fracture dislocations. The average age was 59 years (range, 27 to 74 y) and average length of follow-up 5 years (range, 3 to 7 y...
Source: Techniques in Shoulder and Elbow Surgery - July 31, 2018 Category: Orthopaedics Tags: Techniques Source Type: research

Trapezius-sparing Approach to Osteochondromas on the Ventral Surface of the Scapula
We describe a novel open trapezius-sparing approach to the ventral surface of the scapula. (Source: Techniques in Shoulder and Elbow Surgery)
Source: Techniques in Shoulder and Elbow Surgery - July 31, 2018 Category: Orthopaedics Tags: Techniques Source Type: research

A Novel Surgical Technique for Interpositional ePTFE Patch Repair of Massive Irreparable Rotator Cuff Tears
Massive rotator cuff tears constitute 10% to 40% of rotator cuff tears. Surgical repair is challenging, with high retear rates (20% to 90%). The aim of this study was to develop a new surgical technique to perform an interpositional expanded polytetrafluoroethylene (ePTFE) patch repair for massive and/or irreparable rotator cuff tears that minimizes arthroscopic knot tying without compromising repair strength. (1) Twelve 30×50 mm ePTFE patches and no.2 sutures (450 mm length) were either sterilized in an autoclave for 15 minutes at 130°C and 120 kPa, or left unsterilized. The sutures and patc...
Source: Techniques in Shoulder and Elbow Surgery - July 31, 2018 Category: Orthopaedics Tags: Techniques Source Type: research

The Effects of Smoking on Shoulder Stiffness Following Arthroscopic Rotator Cuff Repair
We hypothesize that cigarette smoking might predispose patients to the development of shoulder stiffness as a postoperative complication of arthroscopic rotator cuff repair within the first 3 months of operative intervention. To our knowledge this association has not been evaluated before. The study was a prospective study undertaken on a consecutive cohort of 80 patients who underwent arthroscopic rotator cuff repair at a single center. Measurements of passive range of motion, patient-ranked pain and stiffness levels, as well as strength were collected preoperatively and at 1, 6, and 12 weeks postoperatively. Patient smok...
Source: Techniques in Shoulder and Elbow Surgery - July 31, 2018 Category: Orthopaedics Tags: Research Articles Source Type: research

Early Sling Discontinuation Following Rotator Cuff Repair
Following rotator cuff repair, patients typically are immobilized in a sling for 6 weeks with or without early motion. We hypothesize that early sling discontinuation at 2 weeks combined with rehabilitation protocol would not adversely affect clinical outcomes or tendon healing in small nonretracted rotator cuff tears following double-row repair. We prospectively evaluated 20 patients at 6 months postoperatively who underwent double-row rotator cuff repair for small nonretracted tears. Patients were immobilized in a sling for 2 weeks then allowed to remove the sling for daily activities below shoulder height. Formal rehabi...
Source: Techniques in Shoulder and Elbow Surgery - July 31, 2018 Category: Orthopaedics Tags: Research Articles Source Type: research

Treatment of Long Head of Biceps Tendon Lesions Together With Rotator Cuff Tears: Which Method is Preferred? Tenotomy or Tenodesis
Long head of biceps tendon lesions are associated with rotator cuff tears, and, in large tears, surgery is the treatment of choice. Here, we aimed to evaluate outcomes of tenotomy and tenodesis in such cases. In this randomized clinical trial, patients aged 45 to 60 years, who were candidates for arthroscopic treatment of rotator cuff tears, with at least 1 positive biceps test before surgery, were enrolled. Patients were allocated in tenotomy or tenodesis groups using random block. Therapeutic outcomes were investigated by evaluation of occurrence of Popeye deformity, patient’s satisfaction based on visual analog sc...
Source: Techniques in Shoulder and Elbow Surgery - July 31, 2018 Category: Orthopaedics Tags: Research Articles Source Type: research

Total Elbow Arthroplasty for Management of Distal Humeral Nonunions
Distal humeral nonunions are challenging to manage. We share our experience of using total elbow arthroplasty (TEA) for a series of 7 chronic nonunions following trauma. The mean: age at TEA was 72 years; number of operations per patient before TEA was 2.3; time from sustaining a distal humerus fracture to TEA was 10 years. The means for Oxford elbow score: pre-TEA was 9.4 (3 to 14); post-TEA was 41.4 (34 to 47). Average follow-up was 24 months (6 to 62 mo). A Wilcoxon-Mann-Whitney test showed improvement in Oxford elbow score post-TEA was highly significant (P=0.002). Pre-TEA range of motion was essentially flail d...
Source: Techniques in Shoulder and Elbow Surgery - July 31, 2018 Category: Orthopaedics Tags: Research Articles Source Type: research

Primary Synovial Chondromatosis of the Shoulder With Concomitant Intra-Articular and Extra-Articular Involvement: More than a Simple Removal of Loose Bodies Erratum
No abstract available (Source: Techniques in Shoulder and Elbow Surgery)
Source: Techniques in Shoulder and Elbow Surgery - May 2, 2018 Category: Orthopaedics Tags: Erratum Source Type: research

Distal Biceps Endoscopy at the Elbow
Biceps tendon ruptures can be classified as acute or chronic and can be partial or complete. The diagnosis of a complete rupture is a clinical one and early surgical reinsertion is usually recommended. Diagnosing and treating a partial tear is often more complex. Ultrasound and magnetic resonance imaging offer additional information, but it may still be difficult to quantify the extent of the tear. Conservative treatment is generally recommended for a period of at least 6 months. Surgery may be indicated if symptoms persist after this period. As most partial tears occur at the interface between the radial tuberosity and th...
Source: Techniques in Shoulder and Elbow Surgery - May 2, 2018 Category: Orthopaedics Tags: Video Techniques Source Type: research

Acute AC Dislocation Repair in the Supine Position Utilizing a Minimally Invasive “Finger-Scopic” Technique
We describe a minimally invasive technique that requires minimal exposure, combines modern dual suspensory fixation, simplifies setup and imaging, and optimizes the surgical efficiency for operative repair of acute acromioclavicular dislocations. Evidence Level:V. (Source: Techniques in Shoulder and Elbow Surgery)
Source: Techniques in Shoulder and Elbow Surgery - May 2, 2018 Category: Orthopaedics Tags: Video Techniques Source Type: research

Prebending of Osteosynthesis Plates Versus Screw and Cerclage Fixation for Os Acromiale or Acromion Fracture; the 3D Technique and Mechanical Testing
This study compares the in vitro outcome parameters of 2 surgical techniques: hollow screws with cerclage fixation (HC) versus patient-specific plate osteosynthesis (PO). The techniques were tested on scapulae of 5 fresh-frozen cadavers as a treatment for symptomatic os acromiale or acromion fracture, to assess ultimate failure strength, stiffness, and fracture pattern. An existing osteosynthesis plate is preoperatively shaped by a printed 3-dimensional model of the acromion of the cadaver. The strength for the PO group [mean, 254.08±130.35 N (range, 118.12 to 404.19 N); P=0.10] was significantly diffe...
Source: Techniques in Shoulder and Elbow Surgery - May 2, 2018 Category: Orthopaedics Tags: Techniques Source Type: research

Isolated Traumatic Dislocation of the Radial Head in a Pediatric Patient: A Case Report and Literature Review
We report the case of an infant with isolated dislocation of the radial head treated with open reduction. Intraoperative inspection showed that the distal margin of the annular ligament was twisted proximally over the radial head. Reduction of the radial was achieved by repositioning the annular ligament around the head of the radius. One year after the injury, the patient had normal elbow function. The anatomic underlying lesion was a luxation of the radial head out of the annular ligament, which was in fact intact. The literature review shows that closed reduction is usually, but not always, possible. If closed reduction...
Source: Techniques in Shoulder and Elbow Surgery - May 2, 2018 Category: Orthopaedics Tags: Techniques Source Type: research

Arthroscopic Release of the Pronator-Flexor Origin for Medial Epicondylitis
We performed arthroscopic surgery for medial epicondylitis and evaluated pain relief, self-assessed functional outcome, and complications after the procedure. The patients included 2 males and 2 females with a mean age of 48.3 years. The average length of follow-up was 16.2 months. The pronator-flexor origin was partially released from the medial epicondyle in all elbows. In 2 cases, débridement of calcinosis in the pronator-flexor origin was also performed. In 2 of the 5 elbows, active flexion was preoperatively limited to 100 degrees, but the range of flexion recovered to the same as that on the contralateral side...
Source: Techniques in Shoulder and Elbow Surgery - May 2, 2018 Category: Orthopaedics Tags: Techniques Source Type: research

A Method to Facilitate Improved Positioning of a Reverse Prosthesis Stem During Arthroplasty Surgery: The Metaphyseal-centering Technique
Because humeral head offset values vary widely from patient to patient, the final position of the proximal portion of a stemmed humeral prosthesis will sometimes not align well with respect to the center of rotation of the humeral head. This is especially notable when a humeral component with limited modularity is used. To address this problem, a prosthesis-specific method is presented for orienting a reverse shoulder humeral component (AltiVate Reverse, DJO Surgical, Austin, TX). With the metaphyseal-centering technique, priority is given to the positioning of the shell portion of the prosthesis over that of the stemmed p...
Source: Techniques in Shoulder and Elbow Surgery - May 2, 2018 Category: Orthopaedics Tags: Techniques Source Type: research