Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: Fractures of the Shoulder Girdle 18 articles

Articles

Is Reverse Shoulder Arthroplasty Appropriate for the Treatment of Fractures in the Older Patient?: Early Observations

Christopher Lenarz MD, Yousef Shishani MD, Christopher McCrum, Robert J. Nowinski DO, T. Bradley Edwards MD, Reuben Gobezie MD

The treatment of comminuted proximal humerus fractures in older patients is challenging. Variable values of functional outcomes scores, ROMs, patient satisfaction, and bony healing have been reported with conventional techniques, including open reduction and internal fixation, percutaneous pinning, and hemiarthroplasty. Another alternative is reverse total shoulder arthroplasty, although it is unclear whether this provides better ROM or function.

Analysis of Operative versus Nonoperative Treatment of Displaced Scapular Fractures

Clifford B. Jones MD, FACS, Debra L. Sietsema PhD

Operative indications for displaced scapular fractures have been controversial and inconsistent. Surgeons have been dissuaded to operate on these uncommon fractures because of the complex anatomy, approaches, and fracture patterns. It is unclear whether return to work, pain, or complications differ in patients with scapular fractures treated nonoperatively or operatively.

Precontoured Superior Locked Plating of Distal Clavicle Fractures: A New Strategy

Jaron R. Andersen MD, Matt P. Willis MD, Ryan Nelson DO, Mark A. Mighell MD

The ideal management of fractures of the distal third of the clavicle remains a topic of debate. Locked plating is a new treatment method but is not yet widely studied.

Surgical Technique: A Minimally Invasive Approach to Scapula Neck and Body Fractures

Erich M. Gauger MD, Peter A. Cole MD

The approach of choice for open reduction internal fixation of displaced fractures involving the scapula neck or body is from posterior. We describe a new approach that minimizes the surgical insult to the soft tissues but preserves the ability to restore alignment and stability to the fracture.

Endosteal Strut Augment Reduces Complications Associated With Proximal Humeral Locking Plates

Andrew S. Neviaser MD, Carolyn M. Hettrich MD, Brandon S. Beamer MD, Joshua S. Dines MD, Dean G. Lorich MD

Locking-plate technology has renewed interest in plate fixation for treating proximal humerus fractures. Complications associated with these devices, including loss of reduction, screw cutout, and intra-articular penetration, are frequent. Establishing a second column of support may reduce complications and improve clinical outcome scores.

Thromboembolic Events Are Uncommon After Open Treatment of Proximal Humerus Fractures Using Aspirin and Compression Devices

Benjamin J. Widmer MD, Rocco Bassora MD, William J. Warrender BS, Joseph A. Abboud MD

Thromboembolic phenomena have long been recognized as a major cause of morbidity and mortality in hospitalized patients, especially those undergoing reconstructive surgery. We have been empirically treating patients with aspirin, early ambulation, and mechanoprophylaxis after operative management of proximal humerus fractures. However, we have not established the incidence of postoperative deep vein thrombosis and pulmonary embolism in this population.

Locked Plating of Proximal Humeral Fractures: Is Function Affected by Age, Time, and Fracture Patterns?

Clifford B. Jones MD, FACS, Debra L. Sietsema PhD, Daniel K. Williams MD

Locking plate fixation of proximal humeral fractures improves biomechanical stability. It has expanded the indications of traditional open reduction internal fixation and become increasingly common for treating unstable, displaced proximal humeral fractures. Despite improved stability it is unclear whether these improve function and if so for which patients.

Shoulder Arthroplasty for Fracture: Does a Fracture-specific Stem Make a Difference?

Sumant G. Krishnan MD, John R. Reineck MD, Philip D. Bennion MD, Leanne Feher BS, Wayne Z. Burkhead MD

Arthroplasty for shoulder fractures is a technically challenging and unpredictable procedure and its use is controversial.

Function Plateaus by One Year in Patients With Surgically Treated Displaced Midshaft Clavicle Fractures

Laura A. Schemitsch, Emil H. Schemitsch MD, FRCS(C), Christian Veillette MD, MSc, FRCS(C), Rad Zdero PhD, Michael D. McKee MD, FRCS(C)

Based on short-term (1 year or less) followup, primary fixation of displaced midshaft clavicle fractures reportedly results in better function compared with that reported for nonoperative methods. Whether better function persists beyond 1 year is unclear.

Proximal Humerus Fractures in the Elderly Can Be Reliably Fixed With a “Hybrid” Locked-plating Technique

Jonathan D. Barlow MD, Joaquin Sanchez-Sotelo MD, PhD, Michael Torchia MD

Controversy exists regarding the best treatment of proximal humerus fractures in the elderly. Recent studies of open reduction and internal fixation have demonstrated high complication rates.

Precontoured Plating of Clavicle Fractures: Decreased Hardware-related Complications?

Corinne VanBeek MD, Karen J. Boselli MD, Edwin R. Cadet MD, Christopher S. Ahmad MD, William N. Levine MD

Operative treatment of displaced midshaft clavicle fractures reportedly decreases the risk of symptomatic malunion, nonunion, and residual shoulder disability. Plating these fractures, however, may trade these complications for hardware-related problems. Low-profile anatomically precontoured plates may reduce the rates of plate prominence and hardware removal.

Excessive Complications of Open Intramedullary Nailing of Midshaft Clavicle Fractures With the Rockwood Clavicle Pin

Christopher D. Mudd MD, Kevin J. Quigley MD, Lyndon B. Gross MD, PhD

Intramedullary clavicle fixation is a potential alternative to plate fixation. Previous studies documenting the complication rates of intramedullary clavicle fixation have demonstrated variable rates of soft tissue complications and fracture healing.

Three- and Four-part Fractures Have Poorer Function Than One-part Proximal Humerus Fractures

Crispin Ong MD, Christopher Bechtel BA, Michael Walsh PhD, Joseph D. Zuckerman MD, Kenneth A. Egol MD

Locking plates have become a commonly used fixation device in the operative treatment of three- and four-part proximal humerus fractures. Examining function in patients treated nonoperatively and operatively should help determine whether and when surgery is appropriate in these difficult-to-treat fractures.

Can Complications of Titanium Elastic Nailing With End Cap for Clavicular Fractures Be Reduced?

Arno Frigg MD, Paavo Rillmann MD, Christian Ryf MD, Richard Glaab MD, Lisa Reissner MD

We found treatment of clavicular midshaft fractures using titanium elastic nails (TENs) in combination with postoperative free ROM was associated with a complication rate of 78%. The use of end caps reduced the rate to 60%, which we still considered unacceptably high. Thus, we explored an alternative approach.

A Reliable Radiographic Measurement Technique for Extra-articular Scapular Fractures

Jack Anavian MD, Joseph M. Conflitti MD, Gaurav Khanna MD, S. Trent Guthrie MD, Peter A. Cole MD

Currently, neither well-defined nor standardized measurement techniques exist for assessing deformity of extra-articular scapular fractures. To properly evaluate these injuries, compare observations across studies, and make clinical decisions, a validated measurement protocol for evaluating scapular fractures is needed.