The Cost-Effectiveness of Reverse Total Shoulder Arthroplasty Versus Open Reduction Internal Fixation for Proximal Humerus Fractures in the Elderly.

Background: Open reduction and internal fixation (ORIF) of proximal humerus fractures in elderly individuals (age >70) carries a relatively high short-term complication and reoperation rate but is generally durable once healed. Reverse total shoulder arthroplasty (RTSA) for fractures may be associated with superior short-term quality of life but carries the lifelong liabilities of joint replacement. The tradeoff between short and long-term risks, coupled with disparities in quality of life and cost, makes this clinical decision amenable to cost-effectiveness analysis.

Continuously monitoring shoulder motion after total shoulder arthroplasty: maximum elevation and time spent above 90° of elevation are critical metrics to monitor.

Background: Traditional clinical shoulder range-of-motion (ROM) measurement methods (ie, goniometry) have limitations assessing ROM in total shoulder arthroplasty (TSA) patients. Inertial measurement units (IMUs) are superior; however, further work is needed using IMUs to longitudinally assess shoulder ROM before TSA and throughout post-TSA rehabilitation. Accordingly, the study aims were to prospectively capture shoulder elevation in TSA patients and to compare the results with healthy controls.

A concise shoulder outcome measure: application of computerized adaptive testing to the American Shoulder and Elbow Surgeons Shoulder Assessment.

Background: Patient-reported outcome measures enable quantitative and patient-centric assessment of orthopedic interventions; however, increased use of these forms has an associated burden for patients and practices. We examined the utility of a computerized adaptive testing (CAT) method to reduce the number of questions on the American Shoulder and Elbow Surgeons (ASES) instrument.

Methods: A previously developed ASES CAT system was applied to the responses of 2763 patients who underwent shoulder evaluation and treatment and had answered all questions on the full ASES instrument.

Assessing Shoulder Biomechanics of Healthy Elderly Individuals During Activities of Daily Living Using Inertial Measurement Units: High Maximum Elevation Is Achievable but Rarely Used.

Current shoulder clinical range of motion (ROM) assessments (e.g., goniometric ROM) may not adequately represent shoulder function beyond controlled clinical settings.

Acute versus delayed reverse total shoulder arthroplasty for the treatment of proximal humeral fractures in the elderly population: a systematic review and meta-analysis.

Background: Recent literature has shown that acute reverse total shoulder arthroplasty (RTSA) yields good outcomes in the treatment of displaced proximal humeral fractures, and there have also been recent studies showing that delayed RTSA can be successfully used for sequelae of proximal humeral fractures such as nonunion and malunion. The use of meta-analysis affords the opportunity to formally compare the outcomes of acute RTSA for fracture and delayed RTSA for fracture sequelae.

Methods: We searched the MEDLINE, Embase, and Cochrane Library databases.

Decreased Reoperations and Improved Outcomes With Reverse Total Shoulder Arthroplasty in Comparison to Hemiarthroplasty for Geriatric Proximal Humerus Fractures: A Systematic Review and Meta-Analysis.

Objectives: We sought to compare range of motion, clinical outcome scores, and complications after reverse total shoulder arthroplasty (RSA) and hemiarthroplasty (HA) in geriatric patients with acute proximal humerus fractures.

Data Sources: We searched MEDLINE (1946-2017), EMBASE (1947-2017), the Cochrane Central Register of Controlled Trials (1898-2017) and ClinicalTrials.gov in October 2017.

Falling Down on the Job: Evaluation and Treatment of Fall Risk Among Older Adults With Upper Extremity Fragility Fractures.

Background: Clinical practice guidelines recommend fall risk assessment and intervention for older adults who sustain a fall-related injury to prevent future injury and mobility decline.

Objective: The aim of this study was to describe how often Medicare beneficiaries with upper extremity fracture receive evaluation and treatment for fall risk.

Design: Observational cohort.

Analysis of polyethylene wear of reverse shoulder components: A validated technique and initial clinical results.

One of the most prevalent phenomena associated with reverse total shoulder arthroplasty (rTSA) is scapular notching. Current methods examine only the damage to the scapula and no methods are available for quantifying the total wear volume of the polyethylene humeral bearing. Quantifying the polyethylene material loss may provide insight into the mechanism for scapular notching and into the particle dose delivered to the patient.

Fatigue failure of reverse shoulder humeral tray components of a single design.

Background: Modularity in shoulder arthroplasty provides surgical flexibility and facilitates less-complex revision surgery. Modular designs must fit in the glenohumeral joint space, necessitating minimal thickness and careful material selection. The potential for fatigue fracture is higher, and fatigue fracture has been experienced by patients.

Use of the spider limb positioner in oncologic lower extremity surgery.

Orthopedic extremity surgery presents a unique set of restraints and difficulties relative to other surgical specialties. Among these is the positioning of heavy limbs in sometimes awkward positions for long periods of time. Ideal positioning of an extremity allows accurate and precise surgery to occur at otherwise difficult to access joints and proximal bones and soft tissues.

Functional improvement after humeral shaft nonunion in a patient with glenohumeral ankylosis.

Functionally limiting heterotopic ossification about the shoulder represents an uncommon clinical entity, which has been most commonly reported as a consequence of prolonged immobilization in intensive care unit patients. Severe cases may result in complete glenohumeral ankylosis, with resultant upper extremity motion through the scapulothoracic joint, and significant functional consequences. We report the case of a 72-year-old male with spontaneous glenohumeral ankylosis who suffered a humeral shaft fracture with resultant painless nonunion.

Reverse shoulder arthroplasty for treatment of proximal humeral fractures in older adults: a systematic review.

Background: Displaced proximal humeral fractures have traditionally been treated with hemiarthroplasty in older adults, but sometimes hemiarthroplasty results in poor functional outcomes due to rotator cuff deficiency. Reverse shoulder arthroplasty (RSA) can offer potentially improved outcomes in these situations. We assessed the functional outcomes of older adults treated with RSA for proximal humeral fractures compared with hemiarthroplasty.

Quality of osteoporosis care of older Medicare recipients with fragility fractures: 2006 to 2010.

Objectives: To assess uptake of postfracture care guidelines in community-dwelling Medicare recipients with fractures.

Design: Retrospective observational cohort study.

Setting: Claims-based study using U.

The cost-effectiveness of single-row compared with double-row arthroscopic rotator cuff repair.

Background: Interest in double-row techniques for arthroscopic rotator cuff repair has increased over the last several years, presumably because of a combination of literature demonstrating superior biomechanical characteristics and recent improvements in instrumentation and technique. As a result of the increasing focus on value-based health-care delivery, orthopaedic surgeons must understand the cost implications of this practice. The purpose of this study was to examine the cost-effectiveness of double-row arthroscopic rotator cuff repair compared with traditional single-row repair.

The cost-effectiveness of reverse total shoulder arthroplasty compared with hemiarthroplasty for rotator cuff tear arthropathy.

Background: Hemiarthroplasty (humeral head replacement [HHR]) and reverse shoulder arthroplasty (RSA) are surgical options for cuff tear arthropathy (CTA). RSA may provide better pain relief and functional outcomes, but it costs more and may have a higher complication rate. The goal of this study was to compare the cost-effectiveness of these two treatments and to use sensitivity analysis to determine the drivers of the model.

How do emergency department physicians rate their orthopaedic on-call coverage?

Purpose: Throughout the United States, the lack of orthopaedic on-call coverage at many institutions has been described as a "crisis." This study sought to understand how emergency department (ED) physicians perceive their orthopaedic on-call coverage. Specifically, the study looked at availability of orthopaedic coverage, adequacy of coverage, and reasons for patient transfers.