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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). Overall...
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 patches were then pulled to...
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 scale ...
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 due to...
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