Detection of in Tissue Samples from Clean Primary Shoulder Surgeries - Part II.

 Research and identification of ( ) and other microorganisms in deep tissue samples collected in clean shoulder surgeries of patients who did not undergo any previous invasive joint procedure and who had no clinical history of infection.  We analyzed the results of cultures of intraoperative deep tissue samples from 84 patients submitted to primary clean shoulder surgery. Tubes containing culture medium were used for storage and transport of anaerobic agents, prolonged incubation time, and mass spectrometer for diagnosis of bacterial agents.

Allograft-enhanced latissimus dorsi transfer is better than the conventional technique for irreparable posterosuperior rotator cuff tears. A retrospective matched cohort.

Purpose: Latissimus dorsi tendon (LDT) transfer (LDTT) to the greater tuberosity to treat irreparable posterosuperior rotator cuff tears (RCTs) in young active patients has been shown to have up to 36% of clinical failures, most of them happening because of either deltoid origin disruption or post-operative transfer rupture from the greater tuberosity. In an attempt to simultaneously prevent both complications, a modified technique includes the following adaptations to the original technique: reinforcement and augmentation of the LDT with a tendinous allograft, enabling the use of a single deltopectoral approach. The aim of this study is to compare mid-term outcomes of the traditional LDTT technique with this modified transfer.

EVALUATION OF SCAPULAR DYSKINESIA IN PATIENTS THAT UNDERWENT A LATARJET PROCEDURE.

Objective: To quantitatively assess the scapular movement of patients who underwent Latarjet surgery and to identify if they present scapular dyskinesia (SD), as well as correlate with the clinic state and the elevation degree of the shoulder.

Methods: A cross-sectional study was carried out at the Movement Analysis Laboratory (LAM), at the Institute of Physical Activity and Sport Sciences, that quantitatively evaluated, using spherical retroreflective markers, the scapular movements of the control group (10 volunteers) and 22 patients (23 operated shoulders) that had been submitted to Latarjet surgery, between 2011 and 2016, with at least one year postoperative. The results of the control group were used as a parameter of normality and compared to those of the operated group.

Humeral Head Osteonecrosis: Outcomes of Hemiarthroplasty After Minimum 10-Year Follow-Up.

 To analyze long-term functional and radiographic results of partial shoulder replacement for humeral head osteonecrosis.  Retrospective review of thirteen cases, with a mean postoperative follow-up of 17 years (range 10 to 26 years). The findings from the last follow-up were compared to those in which the patients had one year of postoperative follow-up.

Latissimus Dorsi Tendon Transfer using Tendinous Allograft for Irreparable Rotator Cuff Lesions: Surgical Technique.

Latissimus dorsi transfer around the shoulder is the most frequently used surgical technique to treat young patients with irreparable posterosuperior rotator cuff lesions. This technique, as initially described and popularized by Gerber et al., has two main drawbacks that may predispose to complications and unsatisfactory functional results: 1) postoperative rupture of the origin of the deltoid, as its detachment from the acromion is necessary during the superior approach to the shoulder; and 2) postoperative rupture of the transferred tendon.

Hill-Sachs lesion measurement with tridimensional models in anterior shoulder instability.

Objective: To evaluate the reproducibility and repeatability of Hill-Sachs lesion measurement from computed tomography images, with computer software and tridimensional prototype.

Methods: Three-dimensional models were made from computed tomography images from 14 patients with anterior shoulder instability, using InVesalius 3.0 software.

Articular reconstruction of the humeral head with autogenous allograft in the treatment of the osteonecrosis.

The authors describe a surgical biological reconstruction of the humeral head with frozen autogenous allograft technique for the treatment of young patients with focal osteonecrosis of the humeral head. This represents a possible alternative, maybe even definitive for some patients, when compared to hemiarthroplasty or total shoulder arthroplasty. The technique consists of the fixation of a frozen autogenous allograft with previously-molded articular cartilage from the humeral head, after cleansing the osteonecrotic focus.

Clinical evaluation of arthroscopic treatment of shoulder adhesive capsulitis.

Objective: To evaluate the results of arthroscopic releases performed in patients with adhesive capsulitis refractory to conservative treatment.

Methods: This was a retrospective study, conducted between 1996 and 2012, which included 56 shoulders (52 patients) that underwent surgery; 38 were female, and 28 had the dominant side affected. The mean age was 51 (29-73) years.

Evaluation of the results and complications of the Latarjet procedure for recurrent anterior dislocation of the shoulder.

Objective: Evaluate the results and complications of Latarjet procedure in patients with anterior recurrent dislocation of the shoulder.

Methods: Fifty-one patients (52 shoulders) with anterior recurrent dislocation, surgically treated by Latarjet procedure, were analyzed retrospectively. The average follow-up time was 22 months, range 12-66 months; The age range was 15-59 years with a mean of 31; regarding sex, 42 (82.

FATTY MUSCLE INFILTRATION IN CUFF TEAR: PRE AND POST OPERATIVE EVALUATION BY MRI.

Objective: To evaluate the fatty infiltration and atrophy of the supraespinatus in the pre- and postoperative of a rotator cuff lesion (RCL), by MRI.

Methods: Ten patients with full-thickness rotator cuff tears who had undergone surgical arthroscopic rotator cuff repair between September and December 2011 were included. This is a prospective study, with analysis and comparison of fatty infiltration and atrophy of the supraespinatus.

Are the good functional results from arthroscopic repair of massive rotator cuff injuries maintained over the long term?

Objective: To evaluate whether the good and excellent functional results from arthroscopic repair of massive rotator cuff tears are maintained over the long term.

Methods: From the sample of the study conducted by our group in 2006, in which we evaluated the functional results from arthroscopic repair of massive rotator cuff tears, 35 patients were reassessed, 8 years after the first evaluation. The inclusion criteria were that these patients with massive rotator cuff tears operated by means of an arthroscopic technique, who participated in the previous study and achieved good or excellent outcomes according to the UCLA criteria.

Evaluation of the results from non-arthroplastic treatment (arthroscopy) for shoulder arthrosis.

Objectives: To evaluate the functional results from patients with arthrosis who underwent an arthroscopic procedure, in an attempt to correlate these results with the patients' epidemiological profile, surgical technique used, possible complications and postoperative protocol.

Methods: Between 1998 and 2011, 31 patients (32 shoulders) with shoulder arthrosis underwent arthroscopic treatment performed by the Shoulder and Elbow Group of the Department of Orthopedics and Traumatology of Santa Casa de São Paulo. Primary or secondary cases of shoulder arthrosis under the age of 70 years, in which the rotator cuff was intact, were included.

Evaluation of the results from arthroscopic surgical treatment of rotator cuff injuries in patients aged 65 years and over.

Objectives: To evaluate the results from arthroscopic surgical treatment of rotator cuff injuries in patients aged 65 years and over.

Methods: Between 1998 and 2009, 168 patients underwent operations. Five cases were excluded.

Evaluation of the results from surgical treatment of fractures of the lateral extremity of the clavicle, using the double ligature technique.

Objective: To evaluate the incidence of consolidation in surgical treatment of fractures of the lateral extremity of the clavicle using the double subcoracoid ligature technique, with nonabsorbable No. 5 thread.

Methods: Between May 1993 and June 2013, the Shoulder and Elbow Group of our service surgically treated 116 patients (116 shoulders) with fractures of the lateral extremity of the clavicle.

Axillary artery lesion secondary to fracturing of the proximal third of the humerus: case report.

Lesions of the axillary artery are rare in patients with fracturing of the proximal third of the humerus and may have greatly varying clinical manifestations. They are responsible for 15% and 20% of upper-limb artery injuries and the commonest mechanism is a fall to the ground, which accounts for 79% of such injuries. In some cases, the signs only appear later on.

Biomechanical evaluation between the modified Mason-Allen stitch and the locked double-tie stitch on the infraspinatus of sheep.

Objectives: To evaluate and compare the in vitro biomechanical results from two stitches: the Mason-Allen stitch, as modified by Habermeyer; and the locked double-tie stitch developed at our service, on tendons of the infraspinatus muscle of sheep.

Methods: Twenty tendons from the infraspinatus muscle of sheep were randomly divided into two groups: LDT, on which the locked double-tie stitch was performed; and MA, with the modified Mason-Allen stitch. The evaluation was performed in the mechanics laboratory, using a standard test machine with unidirectional traction, constant velocity of 20 mm per second and a 500 N load cell, without force cycling.

Evaluation of the results from surgical treatment of the terrible triad of the elbow.

Objective: to evaluate the results from surgical treatment of the terrible triad of the elbow (fracture of the radial head, fracture of the coronoid process and elbow dislocation) and its complications.

Methods: between August 2002 and August 2010, 15 patients (15 elbows) with the terrible triad were treated by the Shoulder and Elbow Group of the Department of Orthopedics and Traumatology, School of Medical Sciences, Santa Casa de São Paulo. Nine (60%) were male and six (40%) were female; their ages ranged from 21 to 66 years, with a mean of 41 years.

Functional evaluation of arthroscopic repair of rotator cuff injuries in patients with pseudoparalysis.

Objective: to evaluate the functional result from arthroscopic repair of rotator cuff injuries in patients with pseudoparalysis, defined as incapacity to actively raise the arm above 90°, while complete passive elevation was possible.

Methods: we reevaluated 38 patients with a mean follow-up of 51 months (minimum of 24). We analyzed the pseudoparalysis reversion rate and the functional result obtained.

Functional evaluation of patients with injury of the distal insertion of the biceps brachii muscle treated surgically.

Objective: to functionally evaluate patients with injury of the distal insertion of the biceps brachii muscle that was treated surgically.

Methods: between April 2002 and June 2011, 15 elbows of 14 patients underwent surgical treatment performed by the Shoulder and Elbow Surgery Group, Department of Orthopedics and Traumatology, School of Medical Sciences, Santa Casa de São Paulo. The minimum follow-up was six months, with a mean of 28 months.

Osteoid osteoma of the acromion simulating acromioclavicular pain.

The osteoid osteoma is a benign bone tumour that usually presents with nocturnal pain in young adults, relieved by rest and anti-inflammatories. It can affect any bone; however, their occurrence is rare in the acromion. The authors describe a case of osteoid osteoma located in the acromion, with symptoms that simulated acromion claviculararthrosis.

Results of open reduction and internal fixation of severe fractures of the proximal humerus in elderly patients.

Objective: To evaluate clinical and radiological results with open reduction and internal fixation of severe fractures of the proximal humerus in the patients over the age of 60 years.

Methods: Between June 1992 and February 2011, 21 patients with FGEPU over the age of 60 years were treated by open reduction and internal fixation at the Group of Shoulder and Elbow Department of Orthopaedics and Traumatology of Santa Casa de São Paulo Medical School. 18 patients were reviewed.

EVALUATION OF THE COMPLICATIONS OF SURGICAL TREATMENT OF FRACTURES OF THE PROXIMAL EXTREMITY OF THE HUMERUS USING A LOCKING PLATE.

Objective: To evaluate the complications from surgical treatment using a locking plate among patients with fractures of the proximal extremity of the humerus.

Methods: Between July 2004 and December 2009, 56 patients with fractures of the proximal extremity of the humerus were treated using the PHILOS(®) plate. There were 19 male patients and 37 female patients, with a mean age of 62 years (range: 30 to 92 years).

ANALYSIS ON THE VARIATION OF MEDIAL ROTATION VALUES ACCORDING TO THE POSITION OF THE HUMERAL DIAPHYSIS.

Objective: To analyze the validity of measurements of medial rotation (MR) of the shoulder, using vertebral levels, according to the variation in the position of the humeral diaphysis, and to test the bi-goniometer as a new measuring instrument.

Methods: 140 shoulders (70 patients) were prospectively evaluated in cases presenting unilateral shoulder MR limitation. The vertebral level was evaluated by means of a visual scale and was correlated with the angle obtained according to the position of the humeral diaphysis, using the bi-goniometer developed with the Department of Mechanical Engineering of Mackenzie University.

EVALUATION OF THE RESULTS FROM ARTHROSCOPIC SURGICAL TREATMENT FOR TRAUMATIC ANTERIOR SHOULDER INSTABILITY USING SUTURING OF THE LESION AT THE OPENED MARGIN OF THE GLENOID CAVITY.

Objective: To evaluate the clinical results from patients with traumatic anterior shoulder instability that was treated surgically through arthroscopic viewing, using bioabsorbable anchors and a technique for remove the cartilage of the anterior glenoid rim for repairing a Bankart lesion.

Method: Between March 2006 and October 2008, 27 shoulders in 27 patients with a diagnosis of traumatic anterior shoulder instability were operated. The patients' mean age was 28 years and they had had between two and 25 previous episodes of dislocation.