Management of Three- and Four-Part Proximal Humerus Fractures.

The management of three- and four-part proximal humerus fractures remains controversial because the literature has supported all forms of management, including nonsurgical management, open reduction and internal fixation (ORIF), and shoulder arthroplasty. Specific patient factors ultimately influence the decision of which treatment best fits the patient and the fracture. Surgeons should understand the rationale for nonsurgical and surgical management of these fractures, including ORIF and reverse shoulder arthroplasty.

Massive Rotator Cuff Tears in Patients Older Than Sixty-five: Indications for Cuff Repair versus Reverse Total Shoulder Arthroplasty.

The decision to perform rotator cuff repair (RCR) versus reverse total shoulder arthroplasty (rTSA) for massive rotator cuff tear (MCT) without arthritis can be difficult. Our aim was to identify preoperative variables that are influential in a surgeon's decision to choose one of the two procedures and evaluate outcomes. We retrospectively reviewed 181 patients older than 65 who underwent RCR or rTSA for MCT without arthritis.

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.

The influence of patient- and surgeon-specific factors on operative duration and early postoperative outcomes in shoulder arthroplasty.

Background: Increased operative duration has been shown to have demonstrable effects on the outcomes and complications in multiple areas of orthopedic surgery. We sought to determine if patient- and surgeon-specific factors correlated to operative duration in shoulder arthroplasty. Our hypothesis was that increased surgeon and trainee volume would decrease operative times and that more complex pathology would increase operative duration.

Visualization of the extra-articular portion of the long head of the biceps tendon during intra-articular shoulder arthroscopy.

Purpose: To quantify the amount of the extra-articular long head of the biceps tendon (LHBT) seen during intra-articular shoulder arthroscopy by pulling the tendon into the joint with a probe through an anterior portal while viewing through a standard posterior portal.

Methods: Intra-articular shoulder arthroscopy was performed on 10 forequarter cadaveric specimens. The extra-articular portion of the LHBT was evaluated by pulling the tendon into the joint with an arthroscopic probe inserted through an anterior portal.

Cervical corpectomy with ultra-low-dose rhBMP-2 in high-risk patients: 5-year outcomes.

Twenty-four consecutive patients with cervical spondylosis who were treated with cervical corpectomy and recombinant human bone morphogenetic protein-2 (rhBMP-2) with standalone anterior instrumentation were evaluated. Mean number of levels fused was 2.4.

Inheritable risk factors for venous thromboembolism in patients undergoing lower extremity total joint arthroplasty.

Venous thromboembolism is a common and undesirable complication of both total hip and knee arthroplasty. The basic biology and major modifiable risk factors predisposing to thromboembolism are well established, but a complete understanding of the role and management of inherited coagulopathies is lacking. In this manuscript, we have attempted to review the fundamental pathophysiology of the coagulation cascade, analyze recent literature on heritable coagulopathies leading to venous thromboembolism in patients undergoing lower extremity joint arthroplasty, and discuss how an understanding of such factors may affect clinical practice.