Proximal Humerus Fractures in the Elderly Can Be Reliably Fixed With a “Hybrid” Locked-plating Technique
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.
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.
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.
Locked Plating of Proximal Humeral Fractures: Is Function Affected by Age, Time, and Fracture Patterns?
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.
Arthroplasty for shoulder fractures is a technically challenging and unpredictable procedure and its use is controversial.
Is Reverse Shoulder Arthroplasty Appropriate for the Treatment of Fractures in the Older Patient?: Early Observations
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.
Thromboembolic Events Are Uncommon After Open Treatment of Proximal Humerus Fractures Using Aspirin and Compression Devices
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.
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.
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.
Function Plateaus by One Year in Patients With Surgically Treated Displaced Midshaft Clavicle Fractures
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.
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.
Excessive Complications of Open Intramedullary Nailing of Midshaft Clavicle Fractures With the Rockwood Clavicle Pin
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.
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.
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.
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.
Diagnostic Performance Tests for Suspected Scaphoid Fractures Differ with Conventional and Latent Class Analysis
Evaluation of the diagnostic performance characteristics of radiographic tests for diagnosing a true fracture among suspected scaphoid fractures is hindered by the lack of a consensus reference standard. Latent class analysis is a statistical method that takes advantage of unobserved, or latent, classes in the data that can be used to determine diagnostic performance characteristics when there is no consensus reference (gold) standard.
Superiority of the Bryan® Disc Prosthesis for Cervical Myelopathy: A Randomized Study with 3-year Followup
The current standard of care for cervical myopathy is anterior discectomy and fusion (ACDF). Although well tolerated in the short term, this treatment might ultimately result in progressive degeneration of adjacent motion segments. Artificial disc arthroplasty offers the theoretical advantage of preservation of motion at the operative level with consequent stress reduction at adjacent levels.
General numerical models of polyethylene wear and THA simulators suggest contact stresses influence wear. These models do not account for some patient-specific factors. Whether the relationship between patient-specific contact stress and wear apply in vivo is unclear.
Deep Venous Thrombosis and Pulmonary Embolism are Uncommon in East Asian Patients after Total Hip Arthroplasty
In Western countries, deep vein thrombosis (DVT) and pulmonary embolism (PE), are relatively common after THA and many surgeons recommend routine pharmacologic thromboprophylaxis. There is some suggestion in the literature that the incidences of DVT and PE may be lower in East Asian patients. Therefore, it would be important to establish the incidences in a large number of East Asian patients who did not receive pharmacologic thromboprophylaxis.
Cannulated Screw and Cable are Superior to Modified Tension Band in the Treatment of Transverse Patella Fractures
Although the modified tension band technique (eg, tension band supplemented by longitudinal Kirschner wires) has long been the mainstay for fixation of transverse fractures of the patella, it has shortcomings, such as bad reduction, loosening of implants, and skin irritation.
Surgical navigation in TKA facilitates better alignment; however, it is unclear whether improved alignment alters clinical evolution and midterm and long-term complication rates.
Postoperative varus alignment has been associated with lower IKS scores and increased failure rates. Appropriate positioning of TKA components therefore is a key concern of surgeons. However, obtaining neutral alignment can be challenging in patients with substantial preoperative varus deformity and it is unclear whether residual deformity influences revision rates.
Clinicians use various criteria to diagnose developmental dysplasia of the hip (DDH) in early infancy, but the importance of these various criteria for a definite diagnosis is controversial. The lack of uniform, widely agreed-on diagnostic criteria for DDH in patients in this age group may result in a delay in diagnosis of some patients.
Falls by orthopaedic patients may lead to negative outcomes such as injury, prolonged hospitalization, delayed rehabilitation, and increased costs.
Surgical Technique: Static Intramedullary Nailing of the Femur and Tibia Without Intraoperative Fluoroscopy
On a recent mission directed at definitive care for victims of the Haitian earthquake, the orthopaedic team developed a technique for freehand distal locking of femoral and tibial nails without intraoperative fluoroscopy or proximally mounted targeting jigs.
The treatment for an early postoperative periprosthetic infection after cementless THA that results in the highest quality of life after the control of infection is unknown. Although common treatments include irrigation and débridement with component retention, a one-stage exchange, or a two-stage exchange, it is unclear whether any of these provides a higher quality of life after the control of infection.
Antimicrobial prophylaxis is considered beneficial for preventing surgical-site infections in clean orthopaedic surgery. However, whether tissue concentrations of cefazolin achieve the minimum inhibitory concentration for the targeted contaminants have yet to be clarified.
Chronic exertional compartment syndrome is diagnosed based on symptoms and elevated intramuscular pressure and often is treated with fasciotomy. However, what contributes to the increased intramuscular pressure remains unknown.
Improvement in Reflux Gastroesophagitis in a Patient with Spinal Muscular Atrophy after Surgical Correction of Kyphoscoliosis: A Case Report
Scoliosis, a three-dimensional deformity, has secondary effects on the gastrointestinal system. Reflux gastroesophagitis with hiatus hernia in patients with scoliosis is difficult to manage. We present a patient in whom primary correction of a spinal deformity was associated with resolution of symptoms of reflux.
Emerging Ideas: Prevention of Posttraumatic Arthritis Through Interleukin-1 and Tumor Necrosis Factor-alpha Inhibition
Despite surgical and mechanical stabilization of an acutely injured joint through ligament reconstruction, meniscus repair, or labral repair, the risk of posttraumatic arthritis remains high. Joint injury triggers three phases of pathogenic events: the early (acute) phase involves joint swelling, hemarthrosis, expression of inflammatory cytokines (especially interleukin-1 [IL-1] and tumor necrosis factor-α [TNF-α]), and biomarkers of cartilage catabolism; an intermediate phase is characterized by reduction of joint inflammation, ongoing joint catabolism, but no evidence yet for typical features of radiographic osteoarthritis (OA); and a late phase characterized by radiographic OA.