Plate Fixation of Proximal Humerus Fractures: How to Get It Right and Future Directions for Improvement.

Purpose Of Review: Open reduction and internal fixation with locking plates (ORIF-LP) has been used for decades for the surgical management of proximal humerus fractures. Despite good outcomes have been widely published in the literature, unacceptably high rates of complications (up to 40%), many of them yielding poor outcomes and requiring reoperation (up to 25%), have also been reported, especially in elderly patients. Most common complications are related to implant failure, with intra-articular screw penetration as the most frequent and devastating.

Comprehensive arthroscopic management without axillary nerve release or subacromial decompression achieves satisfactory and durable results in young patients with glenohumeral osteoarthritis.

Purpose: The comprehensive arthroscopic management (CAM) procedure is a useful joint-preserving option for young or active patients with glenohumeral osteoarthritis (GHOA). Our objective was to evaluate the results and prognostic factors of the CAM procedure without direct axillary nerve release or subacromial decompression.

Methods: A retrospective observational study among patients with GHOA who underwent the CAM procedure was conducted.

Recurrence of instability after Latarjet procedure: causes, results and treatment algorithm.

Latarjet modifies the anatomy of the shoulder, and subsequent revision surgery is challenging. It is mandatory to determine the cause of recurrence in order to select the best treatment option. A CT scan is needed to measure glenoid track and evaluate coracoid graft status: position, degree of consolidation, and osteolysis.

Classification of proximal humerus fractures according to pattern recognition is associated with high intraobserver and interobserver agreement.

Background: The Mayo-Fundación Jiménez Díaz (FJD) classification for proximal humerus fractures aims to identify specific fracture patterns and apply displacement criteria to each pattern. The classification includes 7 common fracture patterns: isolated fractures of the greater or lesser tuberosity, fractures of the surgical neck, impacted fractures involving head rotation in a varus and posteromedial direction or in valgus, and fractures where the humeral head is dislocated (head dislocation), split (head splitting), or depressed (head impaction). The purpose of this study was to evaluate the intraobserver and interobserver agreement of the Mayo-FJD classification system using plain radiographs (xR) and computed tomography (CT).

Proximal humeral fracture locking plate fixation with anatomic reduction, and a short-and-cemented-screws configuration, dramatically reduces the implant related failure rate in elderly patients.

Background: Multiple studies have reported an unacceptable implant-related complication rate in proximal humeral fractures treated with locking plates, particularly in older patients. Our objective was to compare the fracture fixation failure rates in elderly patients, after a dedicated technique for locking plate fixation with cement augmentation or without it.

Methods: A total of 168 open reduction and internal fixation with locking plates were performed for complex proximal humerus fractures by a single surgeon in 136 women and 32 men older than 65 years of age (average 76 years).

Revision Arthroscopic Bankart Repair Versus Arthroscopic Latarjet for Failed Primary Arthroscopic Stabilization With Subcritical Bone Loss.

Background: Limited evidence is available regarding the recommended technique of revision surgery for recurrent shoulder instability. Only 1 previous study has compared the results of soft tissue repair and the Latarjet technique in patients with persistent shoulder instability after primary surgical stabilization.

Purpose/hypothesis: To evaluate the results of revision surgery in patients with previous surgical stabilization failure and subcritical glenoid bone defects, comparing repeated Bankart repair versus arthroscopic Latarjet technique.

Subscapularis structural integrity and function after arthroscopic Latarjet procedure at a minimum 2-year follow-up.

Background: Subscapularis function after arthroscopic Bankart repair has been widely studied. However, data regarding subscapularis performance after arthroscopic Latarjet procedures are lacking. This study aimed to evaluate subscapularis clinical and radiologic performance after arthroscopic Latarjet procedures.

Most coronoid fractures and fracture-dislocations with no radial head involvement can be treated nonsurgically with elbow immobilization.

Hypothesis: Conservative treatment of isolated coronoid fractures and fracture-dislocations focused on soft-tissue healing can provide good clinical results in the majority of patients. Our aims were (1) to evaluate the outcome of a conservative treatment protocol designed for isolated coronoid fractures with or without associated elbow dislocations (ICFs) and (2) to characterize the fractures with a dedicated image analysis protocol.

Methods: Of 38 consecutive patients sustaining acute ICFs, 28 were treated nonsurgically after meeting specific inclusion criteria, prospectively followed up, and clinically evaluated at least 1 year after sustaining their injuries.

Clinical outcome and prognostic factors of revision arthroscopic rotator cuff tear repair.

Purpose: The aim of this study was to evaluate the clinical outcome of arthroscopic rotator cuff revision surgery in a cohort of patients and to identify prognostic factors for this procedure.

Methods: Fifty-one consecutive patients undergoing revision arthroscopic rotator cuff repair were prospectively followed over a minimum period of one year. Radiologic findings and clinical data regarding primary and revision surgery were collected.

Proximal humeral fractures treated conservatively settle during fracture healing.

Objectives: Determine the relative position of the main fractured fragments of proximal humerus fractures treated conservatively to compare displacement at 2 time points: injury (0), and 1 year later (1).

Design: Prospective, comparative cohort study.

Setting: Level I trauma center.

Heterotopic ossification after surgery for fractures and fracture-dislocations involving the proximal aspect of the radius or ulna.

Background: The objectives of this study were to (1) determine the prevalence of heterotopic ossification after surgery for fractures and fracture-dislocations involving the proximal aspect of the radius or ulna, (2) identify risk factors associated with the development of heterotopic ossification in these injuries, and (3) characterize the severity and location of the heterotopic ossification and the associated range of elbow motion.

Methods: From 2004 to 2008, 142 elbow fractures and fracture-dislocations involving the proximal aspect of the radius or ulna were treated surgically at our institution. Records and radiographs of 130 elbows with adequate follow-up were retrospectively reviewed to identify cases of heterotopic ossification, characterize the ectopic bone, and analyze associated risk factors.

Radiographic survival in total shoulder arthroplasty.

Background: Glenoid component loosening is thought to be a major cause of failure. This study assesses radiographic and clinical failure in shoulder arthroplasty, identifying factors predictive of loosening.

Methods: Three-hundred two shoulder arthroplasties were implanted utilizing a cemented, keeled glenoid component, mean clinical follow-up 8.

Clinical meaning of unexpected positive cultures (UPC) in revision shoulder arthroplasty.

Purpose: This study analyzed the prevalence and clinical meaning of unexpected positive cultures (UPCs) in revision shoulder arthroplasty for causes different than infection.

Methods: Between 1976 and 2007, 107 consecutive patients with UPCs, no previous suspicion of infection, and fulfilling inclusion criteria were identified. Forty-five partial (PSA) and 62 total shoulder arthroplasties (TSA) with different preoperative diagnoses were reviewed.

Nondisplaced proximal humeral fractures: high incidence among outpatient-treated osteoporotic fractures and severe impact on upper extremity function and patient subjective health perception.

Background: Although most proximal humeral fractures are attributed to osteoporosis, they are usually not considered individually in osteoporotic studies because of their lower incidence. The purpose of this study was to evaluate the incidence of nondisplaced proximal humeral fractures in comparison with other outpatient-treated osteoporotic fractures, as well as to assess their functional impact and effects on patient-perceived quality of life.

Materials And Methods: In this multicenter, cross-sectional, prospective study, all osteoporotic fractures in postmenopausal women aged 50 years or older treated nonoperatively in 358 trauma centers were recorded during a 3-month period.

Proximal humerus fracture rotational stability after fixation using a locking plate or a fixed-angle locked nail: the role of implant stiffness.

Background: Fixed-angle locked devices have been developed to improve internal fixation of proximal humerus fractures. Available low-profile precontoured locking plates and intramedullary nails with fixed-angle interlocks are currently favored by most surgeons in this setting. The aim of this study was to assess the relative stability of these two methods of fixation under torsion load.

Anteromedial approach for shoulder arthroplasty: current indications, complications, and results.

Hypothesis: The anteromedial approach to the shoulder with detachment of the anterior deltoid from its clavicular and anterior acromial origins is a method of enhancing exposure for difficult shoulder arthroplasty cases. The aim of this study is to describe the current frequency of use, indications, complications, and results of this approach.

Materials And Methods: Between 2000 and 2003, 723 consecutive shoulder arthroplasties were performed.

Insufficient recovery of neuromuscular activity around the knee after experimental anterior cruciate ligament reconstruction.

Background: Operative and nonoperative treatment of anterior cruciate ligament (ACL) injuries is often associated with a lack of proprioception and persistent muscle weakness of unknown origin.

Methods: This long-term study in the cat experimentally compares both neural and muscular activity in the articular nerves of the knee (PAN and MAN), quadriceps and hamstrings, in the chronic unstable knee, and in the reconstructed knee. We also investigated changes in neuromuscular response due to the mechanical competence of the graft, comparing stable and unstable reconstructed knees.