Difficulty in decision making in the treatment of displaced proximal humerus fractures: the effect of uncertainty on surgical outcomes.

Background: Decision making in the management of proximal humerus fractures can be difficult in situations in which the surgeon is uncertain of the ideal treatment.

Methods: Two shoulder surgeons operatively treated 476 proximal humerus fractures from 1998-2014 with open reduction-internal fixation (ORIF), hemiarthroplasty, or reverse shoulder arthroplasty. Operative treatment was stratified by year to determine the evolution of technological influences on treatment over time.

Massive Rotator Cuff Tear: When to Consider Reverse Shoulder Arthroplasty.

Purpose Of Review: The purpose of this review is to discuss the indications for reverse shoulder arthroplasty (RSA) in the treatment of massive rotator cuff tear (MCT), review the reported outcomes in the literature, and outline our approach and surgical technique for treating these patients.

Recent Findings: While RSA remains a successful and well-accepted treatment for cuff tear arthropathy (CTA), management of MCT in the absence of arthritis is controversial. In this particular setting, patients best suited for RSA are elderly, lower-demand individuals with chronic, irreparable MCT, and pseudoparalysis.

Total shoulder arthroplasty with minimum 5-year follow-up: does the presence of subchondral cysts in the glenoid increase risk of failure?

Background: This study evaluated the effect of cystic changes in the glenoid on postoperative outcomes and implant survival after total shoulder arthroplasty (TSA).

Materials And Methods: From 2004 to 2012, 75 patients underwent TSA for primary osteoarthritis with minimum 5-year follow-up. Preoperative 3-dimensional models based on computed tomography imaging were created for all patients.

Classification of instability after reverse shoulder arthroplasty guides surgical management and outcomes.

Background: Revision of unstable reverse shoulder arthroplasty (RSA) remains a significant challenge. The purpose of this study was to determine the reliability of a new treatment-guiding classification for instability after RSA, to describe the clinical outcomes of patients stabilized operatively, and to identify those with higher risk of recurrence.

Methods: All patients undergoing revision for instability after RSA were identified at our institution.

CT-generated radiographs in patients with pelvic ring injury: can they be used in lieu of plain radiographs?

Background: Pelvic ring injury classification traditionally is made using plain radiographs. Recent studies suggest that computed tomography (CT)-generated images have higher diagnostic accuracy than plain films for the classification of acetabular fractures. However, similar studies have not been performed for pelvic ring injuries.

Geriatric High-Energy Polytrauma With Orthopedic Injuries: Clinical Predictors of Mortality.

Background: The impact of orthopedic injuries in the elderly patient with multi-trauma and the effect of operative fixation on these injuries have not been thoroughly evaluated.

Methods: We reviewed geriatric patients (aged 65 and older) between 2004 and 2010 at a level 1 trauma center who sustained high-energy polytrauma (injury and severity score [ISS] ≥ 16) with associated orthopedic injuries. Patients were excluded if they had severe head and spine injuries, died on arrival, or had low-energy mechanisms of injury.

Ligamentous contributions to pelvic stability in a rotationally unstable open-book injury: a cadaver study.

Introduction: Due to the orientation of the sacroiliac joint (SIJ), as the symphysis widens in an open-book pelvic ring disruption, it should displace inferiorly. The purposes of this study were to reconfirm this inferior displacement and to evaluate the relative contributions of the pubic symphysis (PS), the sacrotuberous/sacrospinous ligament complex (STL/SSL) and the anterior sacroiliac ligament (ASIL) to pelvic ring stability in a rotationally unstable open-book injury.

Methods: For each of 6 cadaver pelves, the right hemipelvis was fixed to a table and the PS was sectioned.

Reconstruction of massive midfoot bone and soft tissue loss as a result of blast injury.

Lower extremity blast injuries represent a unique challenge to surgeons and often involve complex, limb-threatening wounds with extensive soft tissue and bone loss. Surgical treatment of these injuries can be difficult because of limited autogenous resources for reconstruction of the defect. In this article, we describe a technique for medial column reconstruction using iliac crest bone graft and soft tissue coverage with an abductor hallucis rotational flap combined with a split-thickness skin graft.