Trapezius Rotation-plasty for Complicated Acromioclavicular Joint Ganglion Cysts
The acromioclavicular joint (ACJ) ganglion (producing the “geyser sign”) produces poor quality skin and risk of infection with repeated aspirations and arthroscopic resection. The primary aim is to present our pedicled muscle flap procedure to prevent wound breakdown and recurrent infection over the ACJ. The secondary aim is to report our case series’ outcomes. By using a distally based rotation flap of the trapezius muscle to the ACJ defect after lateral clavicle excision the overlying skin can be supported by a well vascularized soft tissue bed. Included participants sustained recurrent ganglion cysts p...
Source: Techniques in Shoulder and Elbow Surgery - November 24, 2020 Category: Orthopaedics Tags: Techniques Source Type: research

Intramedullary Screw Fixation Supplemented by Scapular Spine Plating: A Surgical Technique for the Base of Acromion Fracture
In conclusion, intramedullary screw fixation, supplemented with plating, offers a viable surgical treatment for acromion fractures, and combined with a proper postoperative rehabilitation regime, it helps patients to achieve excellent outcomes. (Source: Techniques in Shoulder and Elbow Surgery)
Source: Techniques in Shoulder and Elbow Surgery - November 24, 2020 Category: Orthopaedics Tags: Techniques Source Type: research

The Split Capsule Technique for Chronic Anterior Shoulder Dislocation: A Novel Surgical Technique and Case Series
The authors describe a novel split capsule technique for the open treatment of chronic locked anterior shoulder dislocation. The described technique is easily reproducible and focuses on preservation of the native joint with open reduction of the humeral head and soft tissue repair. The steps entail the creation of a neocapsule of the shoulder, elimination of the pseudoglenoid space with a medial capsular repair, and a combined medial and lateral capsular shift. In the present article, the procedure is outlined in detail with technical pearls, 3 case examples, and a review of treatment options. (Source: Techniques in Shoul...
Source: Techniques in Shoulder and Elbow Surgery - November 24, 2020 Category: Orthopaedics Tags: Techniques Source Type: research

Small Fragment Instrumentation for Periprosthetic Humerus Fracture Fixation Technique
Periprosthetic humerus fractures remain problematic complications that are difficult to adequately reduce and maintain reduction. Patient-related risk factors, including poor bone quality, add an additional level of complexity to maintaining fixation in the setting of relatively narrow cortical margins adjacent to the shoulder prosthesis. Based on the challenges of obtaining adequate proximal fixation and the need to minimize dependence on cerclage fixation because of nerve injury risks and inadequate fracture reduction, the authors propose an alternative method intraoperative fixation. The technique described is a method ...
Source: Techniques in Shoulder and Elbow Surgery - November 24, 2020 Category: Orthopaedics Tags: Techniques Source Type: research

Jeffery Type II Fracture of the Radial Neck of a Child: Description of the Lesion and Novel Method of Closed Reduction
The authors describe the treatment of a 13-year-old patient with a severe, posteriorly dislocated, epiphysiolysis fracture of the proximal radius. This is called a Jeffery type II lesion when the epiphysiolysis fracture takes place at the radial neck during the reduction of elbow posterior dislocation, thus causing radial head posterior displacement. There are (Source: Techniques in Shoulder and Elbow Surgery)
Source: Techniques in Shoulder and Elbow Surgery - November 24, 2020 Category: Orthopaedics Tags: Techniques Source Type: research

“Triple Window” Surgical Approach to the Elbow: A Hybrid Exposure
We present an elbow “triple window” surgical approach that preserves the contractile medial and lateral footprints of the triceps, while affording a better in-line access than a pure “triceps-on” approach. This approach only violates 50% of the central tendinous insertion, with the remainder of the central tendon and the medial and lateral muscular extensions preserved. (Source: Techniques in Shoulder and Elbow Surgery)
Source: Techniques in Shoulder and Elbow Surgery - November 24, 2020 Category: Orthopaedics Tags: Techniques Source Type: research

Management of Supracondylar Fractures in the Prone Position: Case Series, Technique, and Literature Review
In displaced supracondylar humerus fractures, closed reduction percutaneous pinning is recommended and is most commonly performed in the supine position with the arm held in hyperflexion. The risk of iatrogenic ulnar nerve injury with medial pin placement is high in this position. We performed a retrospective case series of 149 patients with displaced supracondylar humerus fractures treated in the prone position. The aim of this study was to evaluate the incidence of iatrogenic ulnar nerve injury with medial pin placement, report our technique, and conduct a literature review to serve as historical control. The rate of iat...
Source: Techniques in Shoulder and Elbow Surgery - November 24, 2020 Category: Orthopaedics Tags: Techniques Source Type: research

A Simplified Technique for Patient Positioning During Olecranon Fracture Fixation
We describe an easy and quick surgical setup requiring only 2 total knee arthroplasty foot positioners (commonly known as “paint rollers”) attached to a surgical table with the patient in a supine position. A retrospective review of 28 patients undergoing operative fixation of olecranon fractures utilizing this positioning method was performed. No patients were found to require repositioning (ie, supine to lateral) for any reason and no airway-related or positioning-related complications were noted. This setup provides excellent exposure to the operative site and stable positioning of the arm with minimal risk ...
Source: Techniques in Shoulder and Elbow Surgery - November 24, 2020 Category: Orthopaedics Tags: Techniques Source Type: research

New Techniques of Olecranon Tension Band Fixation: Biomechanical Evaluation Using Finite Element Method
Various fixation methods have been used to fix olecranon fractures including the plate fixation, intramedullary screws, and tension band technique. Open reduction with tension band wire fixation (TBW) has been widely accepted for the treatment of transverse displaced olecranon fractures. The aim of this study was to determine the stress developed in different types of TBW fixations in olecranon fractures on the basis of finite element analysis. A 3-dimension model of the elbow joint was created on the basis of the computerized tomography scan images. Three different configurations of TBW fixations were evaluated in this st...
Source: Techniques in Shoulder and Elbow Surgery - November 24, 2020 Category: Orthopaedics Tags: Research Article Source Type: research

Distal Biceps Tendon Ruptures: Acute Repair Versus Chronic Reconstruction Using the “Anatomic Length Method” and Concomitant Bicipital Aponeurosis Repair: A Group-matched Comparative Retrospective Study
This study suggests that chronic reconstruction of the distal biceps tendon using the “Anatomic Length Method” is a safe technique that produces similar clinical results to acute distal biceps primary repair. (Source: Techniques in Shoulder and Elbow Surgery)
Source: Techniques in Shoulder and Elbow Surgery - November 24, 2020 Category: Orthopaedics Tags: Clinical Outcomes Source Type: research

Lateralized Versus Nonlateralized Reverse Shoulder Arthroplasty: Impact on Clinical and Functional Outcomes
In conclusion, patients who underwent RSA with a lateralized glenosphere had better internal rotation range of motion, less pain, and better function than those who received a nonlateralized prosthesis. These differences were apparent within 6 months postsurgery. (Source: Techniques in Shoulder and Elbow Surgery)
Source: Techniques in Shoulder and Elbow Surgery - November 24, 2020 Category: Orthopaedics Tags: Clinical Outcomes Source Type: research

Symptomatic Nonunion of the Medial Humeral Epicondyle Fracture: A Case Report and Review of the Literature
We described the case of 1 patient with symptomatic medial humeral epicondyle nonunion, who underwent open reduction and internal fixation with excellent clinical evolution after 1 year of follow-up from time of surgery. The purpose of this study was to evaluate the outcome of open reduction and internal fixation of a medial epicondyle nonunion fragment in 1 case and present a review of the literature. (Source: Techniques in Shoulder and Elbow Surgery)
Source: Techniques in Shoulder and Elbow Surgery - August 13, 2020 Category: Orthopaedics Tags: Clinical Outcomes Source Type: research

Chronic Tear of the Distal Triceps Tendon Treated With Suture Anchors and Fascia Lata Allograft: Case Report, Surgical Technique and Literature Review
Chronic tears of the distal triceps tendon are extremely uncommon lesions. Surgical therapy can be performed with a direct reattachment of the 2 sides of the lesion or—in case of significant tendon retraction—using grafts to fill the resulting gap. Herein, we report a case of a torn distal triceps tendon that occurred in a 33-year-old patient suffering from paraplegia. The resulting functional impairment of the elbow impeded her to use a wheelchair, causing a substantial limitation to her mobility and autonomy. Preoperative clinical evaluation, x-rays, muscle-tendon ultrasound, and magnetic resonance imagingwas...
Source: Techniques in Shoulder and Elbow Surgery - August 13, 2020 Category: Orthopaedics Tags: Clinical Outcomes Source Type: research

Snapping Scapula Syndrome Caused by an Osteochondroma of the Second Rib: A Novel Surgical Technique and Case Report
Snapping scapula syndrome is characterized by painful crepitus at the scapulothoracic articulation, which is worse on movement, in the particular overhead activity. A number of bony causes of snapping scapula syndrome due to ventral scapular exostoses have been previously reported. However, we present a rare case of snapping scapula syndrome resulting from an osteochondroma of the second rib, causing pain at the superior scapula with shoulder movement. This required a novel surgical multidisciplinary approach. Surgical resection was performed via a posterior trapezius-splitting approach resulting in symptom resolution. (So...
Source: Techniques in Shoulder and Elbow Surgery - August 13, 2020 Category: Orthopaedics Tags: Technique Source Type: research

Repair of an Acute Latissimus Dorsi Tendon Rupture Using Bicortical Button Fixation
We report a case of acute rupture of the latissimus dorsi in a competitive gymnast. Initial magnetic resonance imaging confirmed the injury and showed that the tendon had retracted 6 cm. Primary repair using bicortical button fixation, a novel fixation technique, was performed. The patient successfully returned to competition and reported personal best scores on high bar and parallel bars. Cadaveric studies comparing cortical buttons to sutures and suture anchors for tendon reattachment found cortical buttons to have higher loads to failure. Overall, this suggests the technique described here may provide superior ou...
Source: Techniques in Shoulder and Elbow Surgery - August 13, 2020 Category: Orthopaedics Tags: Research Articles Source Type: research

Feasibility of Biceps Tenotomy Using Small Needle Arthroscopy: A Cadaver Analysis
This study demonstrates the safety and efficacy of an intra-articular, minimally invasive tenotomy of the long head of the biceps in a cadaveric model using a portable arthroscopy device as a possible alternative to operating room arthroscopic tenotomy. (Source: Techniques in Shoulder and Elbow Surgery)
Source: Techniques in Shoulder and Elbow Surgery - August 13, 2020 Category: Orthopaedics Tags: Research Articles Source Type: research

Arthroscopic Repair of Type-V SLAP Lesion: A Prospective Cohort Study of an Anchor Above the Anterior Glenoid Mid-equator Based on a New Classification System
On basis of a newly proposed classification of type-V superior labrum anterior to posterior (SLAP) lesion, this study was conducted to investigate this question: “Does concurrent anterosuperior labral anchor repair limit postoperative range of external rotation and increase postoperative pain compared with isolated Bankart repair?.” This prospective cohort study, conducted between September 2014 and December 2017, included 20 patients who were divided into the following groups: group-S (12 patients) of concurrent Bankart and type-IIA SLAP repair by 3 anchors, with one of them above the glenoid mid-equator, and ...
Source: Techniques in Shoulder and Elbow Surgery - August 13, 2020 Category: Orthopaedics Tags: Research Articles Source Type: research

Arthroscopic Internal Fixation of Symptomatic Os Acromiale
The meso-acromion is the most common type of os acromiale and has been associated with subacromial impingement and rotator cuff tears. Surgical treatment might be indicated when nonoperative treatment has been nonsuccessful and depends on the size and location of the os acromiale. Numerous surgical procedures have been described in the current literature, most of them focusing on the os acromiale union. To this, fusion rates depend mostly on the surgical approach and fixation technique and when achieved, is generally associated with good clinical outcomes. The purpose of this article is to describe our preferred technique ...
Source: Techniques in Shoulder and Elbow Surgery - May 15, 2020 Category: Orthopaedics Tags: Video Technique Source Type: research

Posterior Minimally Invasive Plate Osteosynthesis of Humeral Shaft Fractures: An Anatomic Study of “Danger Zones”
The most utilized approach for minimally invasive plate osteosynthesis (MIPO) of humeral fractures has been an anterior percutaneous approach. Other approaches include posterior, which places the radial nerve at risk. We performed a cadaveric study to evaluate safe intervals for screw placement using a posterior approach. MIPO fixation of the humeral shaft was performed on 11 fresh frozen cadaveric specimens following a standard protocol using a 10-hole 4.5 locking compression plate (LCP) plate and cortical screws. After fixation, anatomic dissection of the radial nerve was performed and location of the nerve delineated wi...
Source: Techniques in Shoulder and Elbow Surgery - May 15, 2020 Category: Orthopaedics Tags: Techniques Source Type: research

Anteromedial Surgical Approach for Minimally Invasive Fixation of Humerus Shaft Fractures: A Cadaveric and Clinical Study
The authors describe a new anteromedial (AM) approach for minimally invasive fixation of humerus fractures. A cadaveric study was done initially, followed by the clinical study in a single level 1 trauma center. The AM approach was initially described by cadaveric dissection where the proximal and distal intervals were delineated. The interval for the proximal incision was between the biceps and pectoralis major muscle and the distal interval was made by splitting the brachialis muscle above the medial epicondyle. Six cadavers (12 limbs) were dissected to describe this approach. The same approach was then used on a series ...
Source: Techniques in Shoulder and Elbow Surgery - May 15, 2020 Category: Orthopaedics Tags: Techniques Source Type: research

A Surgical Technique for Revision of Failed Acromioclavicular Joint Reconstruction
We describe a technique for revision stabilization of the ACJ that utilizes a synthetic ligament in combination with augmentation from the coracoacromial ligament and biceps short head aponeurosis (“biceps flip” procedure). (Source: Techniques in Shoulder and Elbow Surgery)
Source: Techniques in Shoulder and Elbow Surgery - May 15, 2020 Category: Orthopaedics Tags: Techniques Source Type: research

A Pilot Biomechanical Study to Evaluate the Efficiency of New Implant to Fix Acromioclavicular Joint
This study was aimed to introduce a new implant designed to fix ACJ and to evaluate its efficiency on the basis of biomechanical modeling and finite element analysis approaches. Computerized tomography scan images of 12 normal shoulders were selected to create a 3d model of shoulder joints. The dimensions of the implant were obtained from the models of shoulder joints and then were evaluated on 5 fresh cadavers. The stress developed in the implant and shoulder articular surfaces were evaluated by finite element analysis on the basis of the models obtained from computerized tomography scan images. The designed implant can b...
Source: Techniques in Shoulder and Elbow Surgery - May 15, 2020 Category: Orthopaedics Tags: Research Article Source Type: research

Proximal Humerus Fractures Managed With Joshi External Stabilizing System
In this study, we have chosen a middle path for treating proximal humerus fractures in the form of closed reduction and Joshi external stabilizing system (JESS) with early mobilization, thus overcoming the problem of shoulder stiffness associated with conservative management and excessive soft tissue dissection associated with the open procedure. We conducted a study on 25 patients with proximal humerus fractures with Neer types 2 and 3 fractures. The mean age was 49.6 years with a female preponderance of 64%. JESS was applied after closed reduction in all cases. Mobilization was started on days 1 or 2 of surgery. All pati...
Source: Techniques in Shoulder and Elbow Surgery - February 24, 2020 Category: Orthopaedics Tags: Clinical Outcome Source Type: research

Surgical Management of Clavicular Malignancies With Resection of the Clavicle Without Reconstruction
Clavicular malignancies are very rare, and few papers which reported that primary tumors are predominant, have been published about the functional and oncological outcomes after surgical treatment. The main purpose of the present study was to report the functional and oncological outcomes of 14 patients with clavicular malignancy, who were managed with total/partial claviculectomy without reconstruction, or followed up without surgical intervention. Of the total patients, 26.7% presented with clavicular cancer of unknown primary, and 42.9% with pathologic fractures of the clavicle. Claviculectomy without reconstruction was...
Source: Techniques in Shoulder and Elbow Surgery - February 24, 2020 Category: Orthopaedics Tags: Research Articles Source Type: research

Treatment of Chronic Lateral Epicondylitis With Autologous Fat Grafting
Despite the self-limiting nature of lateral epicondylitis (LE) the disease has a prolonged course in some patients. Currently there is no optimal treatment of choice for these patients. We treated 6 elbows in 5 patients with LE with free fat grafting. All patients had symptomatic LE (symptom duration>2 y) and magnetic resonance imaging scan consistent with LE, and no finding of osteoarthrosis of the elbow joint, ligament injury, or other condition causing palpable lateral elbow pain. The fat graft was harvested from the abdomen, centrifuged or decanted and 10 mL was injected in and around the lateral epico...
Source: Techniques in Shoulder and Elbow Surgery - February 24, 2020 Category: Orthopaedics Tags: Research Articles Source Type: research

Short-Term to Mid-Term Outcomes of Arthroscopic Stabilization Using PEEK Knotless Anchors
Outcomes of arthroscopic instability repairs vary depending on repair techniques and anchor materials. The purpose of this study is to determine the short to mid-term redislocation, resubluxation rate and clinical outcomes following arthroscopic stabilization of nonabsorbable, biologically inert polymer polyether ether ketone (PEEK) suture anchors. This is a retrospective study with 140 patients who underwent arthroscopic anterior stabilization surgery using PEEK (Pushlock) anchors with a mean follow-up of 40 months. Patient ranked pain scores, clinically assessed range of motion and strength testing were collected preoper...
Source: Techniques in Shoulder and Elbow Surgery - February 24, 2020 Category: Orthopaedics Tags: Research Articles Source Type: research

Ulnar Cortical Window for Removal of a Well-Fixed Ulnar Component in Total Elbow Arthroplasty: Surgical Technique and Case Report
Infection after total elbow arthroplasty can be a devastating problem. Eradication of the infection can often be difficult and may compromise the already tenuous bone and soft tissue, particularly the elbow extensor mechanism. Resection arthroplasty with the complete removal of all foreign material is often necessary to adequately treat the infection. Components may be well fixed and removal may further compromise bone and soft tissue. The authors present a technique of ulnar cortical window that facilitates the removal of a well-fixed ulnar component and the associated cement mantle. An illustrative surgical case is also ...
Source: Techniques in Shoulder and Elbow Surgery - February 24, 2020 Category: Orthopaedics Tags: Techniques Source Type: research

A Novel Technique for Endoscopic Release of the Transverse Scapular Ligament in the Setting of Suprascapular Neuropathy: Case Report and Technique
We present our hybrid endoscopic technique along with a case report demonstrating a good patient outcome to emphasize the successful application of our technique following appropriate utilization of history, physical examination, and diagnostic tests when deciding to operatively treat a patient with isolated suprascapular neuropathy. (Source: Techniques in Shoulder and Elbow Surgery)
Source: Techniques in Shoulder and Elbow Surgery - February 24, 2020 Category: Orthopaedics Tags: Techniques Source Type: research

Antegrade Reduction and Fixation of Coronoid Fractures: A New Arthroscopic Technique
The coronoid process (CP) is important for stabilizing the elbow joint. The elbow’s joint fracture is considered the most common factor in several cases of complex elbow dislocations. The surgical indications for recommending the CP in fractures are prolonged instabilities of the elbow. The open fixation of the CP is a demanding procedure, owing to many complications after the surgeries. Arthroscopic reduction and internal fixation have been proposed to overcome the limitations of open approaches. The aim of our study is to describe, step by step, a new surgical procedure for arthroscopically assisted fracture reduct...
Source: Techniques in Shoulder and Elbow Surgery - February 24, 2020 Category: Orthopaedics Tags: Techniques Source Type: research

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