[Anterior shoulder dislocation: revised Dutch Clinical Guideline in practice].

Shoulder dislocations remain the most frequent of joint dislocations, with anterior displacement of the humeral head being the direction of dislocation seen most often (97%). Recently, the Dutch clinical guideline on shoulder dislocations has been revised on the basis of predetermined bottlenecks in clinical practice. In this paper, the guideline is translated to clinical practice by means of two fictional cases, in which the novel recommendations are incorporated.

Total shoulder arthroplasty for primary glenohumeral osteoarthritis: does posterior humeral subluxation persist after correction of the glenoid version at 5 years minimum?

Background: Primary glenohumeral osteoarthritis is associated with both excessive posterior humeral subluxation (PHS) and excessive glenoid retroversion in 40% of cases. These morphometric abnormalities are a particular issue because they may be responsible for a deterioration in long-term clinical and radiologic outcomes. The aim of this study was to perform a computed tomographic (CT) analysis of patients who underwent total shoulder arthroplasty (TSA) for primary osteoarthritis (OA) with B2-, B3-, or C-type glenoids in whom an attempt was made to correct for excessive glenoid retroversion and excessive posterior humeral subluxation intraoperatively.

BRASD trial: biomechanical reposition techniques in anterior shoulder dislocation-a randomized multicenter clinical trial.

Background: Biomechanical reduction techniques for shoulder dislocations have demonstrated high reduction success rates with a limited pain experience for the patient. We postulated that the combination of biomechanical reduction techniques with the shortest length of stay would also have the lowest pain experience and the highest first reduction success rate.

Methods: A randomized multicenter clinical trial was performed to compare different biomechanical reduction techniques in treating anterior shoulder dislocations without the use of invasive pain relief.

Arthroscopic Latarjet: 2 or 4 Cortical Buttons for Coracoid Fixation? A Case-Control Comparative Study.

Background: While 2 screws are traditionally used for coracoid bone block fixation, no gold standard technique has yet been established when using cortical buttons.

Purpose: To compare anatomic and clinical outcomes of the arthroscopic Latarjet procedure using either 2 or 4 buttons for coracoid bone block fixation.

Study Design: Cohort study; Level of evidence, 3.

Bilateral scapulothoracic arthrodesis for facioscapulohumeral muscular dystrophy: function, fusion, and respiratory consequences.

Background: Scapulothoracic arthrodesis (STA) has been proposed for the treatment of painful scapular winging in patients with facioscapulohumeral muscular dystrophy (FSHD). However, the rate of osseous fusion is variable, and there is a theoretical risk of reduced respiratory function after bilateral STA.

Methods: This was a retrospective study of 10 STAs, performed sequentially, in 5 FSHD patients.

Pyrocarbon interposition shoulder arthroplasty in young arthritic patients: a prospective observational study.

Background: We evaluated survival and midterm results of pyrocarbon interposition shoulder arthroplasty (PISA) in arthritic patients younger than 65 years.

Methods: Fifty-eight PISAs (InSpyre; Tornier-Wright, Bloomington, MN, USA), implanted in 56 patients between 2010 and 2015, were prospectively observed. The mean age at surgery was 52 ± 13 years.

Clavicle fractures in adults; current concepts.

Background: For decades, clavicle fractures have been treated conservatively. In the last 20 years, however, non-union rates after conservative treatment appear higher than previously reported and more evidence regarding operative treatment has become available. This has led to a paradigm shift towards an increase in operative treatment.

Operative treatment versus nonoperative treatment of Achilles tendon ruptures: systematic review and meta-analysis.

Objectives: To compare re-rupture rate, complication rate, and functional outcome after operative versus nonoperative treatment of Achilles tendon ruptures; to compare re-rupture rate after early and late full weight bearing; to evaluate re-rupture rate after functional rehabilitation with early range of motion; and to compare effect estimates from randomised controlled trials and observational studies.

Design: Systematic review and meta-analysis.

Data Sources: PubMed/Medline, Embase, CENTRAL, and CINAHL databases were last searched on 25 April 2018 for studies comparing operative versus nonoperative treatment of Achilles tendon ruptures.

Operative versus nonoperative treatment of proximal humeral fractures: a systematic review, meta-analysis, and comparison of observational studies and randomized controlled trials.

Background: There is no consensus on the choice of treatment for displaced proximal humeral fractures in older patients (aged > 65 years). The aims of this systematic review and meta-analysis were (1) to compare operative with nonoperative management of displaced proximal humeral fractures and (2) to compare effect estimates obtained from randomized controlled trials (RCTs) and observational studies.

Methods: The databases of MEDLINE, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) were searched on September 5, 2017, for studies comparing operative versus nonoperative treatment of proximal humeral fractures; both RCTs and observational studies were included.

Surgical fixation of midshaft clavicle fractures: A systematic review of biomechanical studies.

Purpose: Surgical treatment of displaced midshaft clavicle fractures requires a decision between plate fixation and intramedullary (IM) fixation. Numerous studies report on the biomechanical properties of various repair constructs. The goal of this systematic review was to provide an overview of studies describing the biomechanical properties of the most commonly used surgical fixations of midshaft clavicle fractures.

Intramedullary Fixation of Midshaft Clavicle Fractures.

Clavicle fractures are among the most common fractures occurring in the general population, and the vast majority are localized in the midshaft portion of the bone. Management of midshaft clavicle fractures remains controversial. Although many can be managed nonoperatively, certain patient populations and fracture patterns, such as completely displaced and shortened fractures, are at risk of less optimal outcomes with nonoperative management; surgical intervention should be considered in such cases.

Surgical Versus Nonsurgical Treatment for Midshaft Clavicle Fractures in Patients Aged 16 Years and Older: A Systematic Review, Meta-analysis, and Comparison of Randomized Controlled Trials and Observational Studies.

Background: There is no consensus on the choice of treatment of midshaft clavicle fractures (MCFs).

Purpose: The aims of this systematic review and meta-analysis were (1) to compare fracture healing disorders and functional outcomes of surgical versus nonsurgical treatment of MCFs and (2) to compare effect estimates obtained from randomized controlled trials (RCTs) and observational studies.

Study Design: Systematic review and meta-analysis.

Comparing fracture healing disorders and long-term functional outcome of polytrauma patients and patients with an isolated displaced midshaft clavicle fracture.

Background: Although clavicle fractures are a common injury in polytrauma patients, the functional outcome of displaced midshaft clavicle fractures (DMCFs) in this population is unknown. Our hypothesis was that there would be no differences in fracture healing disorders or functional outcome in polytrauma patients with a DMCF compared with patients with an isolated DMCF, regardless of the treatment modality.

Methods: A retrospective cohort study of patients (treated at our level I trauma center) with a DMCF was performed and a follow-up questionnaire was administered.

Plate fixation or intramedullary fixation for midshaft clavicle fractures: a systematic review and meta-analysis of randomized controlled trials and observational studies.

Background: The last decade has shown a shift toward operative treatment of a subset of midshaft clavicle fractures. However, it is unclear whether there are differences between plate fixation and intramedullary fixation regarding complications and functional outcome. The aim of this systematic review and meta-analysis was to compare plate fixation and intramedullary fixation for midshaft clavicle fractures.

Operative treatment of dislocated midshaft clavicular fractures: plate or intramedullary nail fixation? A randomized controlled trial.

Background: Over the past decades, the operative treatment of displaced midshaft clavicular fractures has increased. The aim of this study was to compare short and midterm results of open reduction and plate fixation with those of intramedullary nailing for displaced midshaft clavicular fractures.

Methods: A multicenter, randomized controlled trial was performed in four different hospitals.

Systematic review of complications after intramedullary fixation for displaced midshaft clavicle fractures.

Background: The number of displaced midshaft clavicle fractures treated surgically is increasing, and open reduction and intramedullary fixation is an emerging surgical treatment option. The study quality and scientific levels of published evidence in which possible complications of this treatment are presented vary greatly.

Methods: We performed systematic computer-based searches of EMBASE and PubMed/MEDLINE.

Biomechanical analysis of two-tendon posterosuperior rotator cuff tear repairs: extended linked repairs and augmented repairs.

Purpose: The purpose of this study was to compare single-row (SR), extended double-row (DR), and augmented, extended double-row (aDR) rotator cuff repairs in a two-tendon, posterosuperior rotator cuff tear (RCT) model with intact rotator cuff tendons.

Methods: RCTs were created and randomly assigned to SR, DR, or aDR repair (5 each) in 20 cadaveric shoulder specimens. A collagen scaffold was used for augmentation.

Association between acromial index and outcomes following arthroscopic repair of full-thickness rotator cuff tears.

Background: The purposes of this study were to evaluate the association between the acromial index and full-thickness rotator cuffs and to determine if the size of the acromial index was associated with outcomes in a cohort of patients who had had arthroscopic repair of full-thickness rotator cuff tears.

Methods: The acromial index was calculated for three groups by individual researchers: 115 patients (120 shoulders) who had arthroscopically repaired full-thickness rotator cuff tears without osteoarthritis (Group I); sixty-four patients (sixty-eight shoulders) who had intact rotator cuffs with osteoarthritis (Group II); and twenty-one patients (twenty-one shoulders) who had intact rotator cuffs, without osteoarthritis, and were managed for other pathology (Group III). The acromial index is the distance between the glenoid plane and the lateral border of the acromion divided by the distance between the glenoid plane and the lateral aspect of the humeral head.

Technique and outcomes of arthroscopic scapulothoracic bursectomy and partial scapulectomy.

Purpose: The purpose of this study was to assess the efficacy of arthroscopic scapulothoracic bursectomy in patients with snapping scapula syndrome with a minimum of 2 years' follow-up.

Methods: In this institutional review board-approved retrospective study, 23 shoulders in 21 consecutive patients were identified that had undergone arthroscopic treatment of snapping scapula syndrome. Each patient described mechanical symptoms with failure of nonsurgical modalities and reported symptomatic relief from a local anesthetic injection before surgical intervention.

Glenohumeral joint preservation: a review of management options for young, active patients with osteoarthritis.

The management of osteoarthritis of the shoulder in young, active patients is a challenge, and the optimal treatment has yet to be completely established. Many of these patients wish to maintain a high level of activity, and arthroplasty may not be a practical treatment option. It is these patients who may be excellent candidates for joint-preservation procedures in an effort to avoid or delay joint replacement.

Rehabilitation after arthroscopic rotator cuff repair: current concepts review and evidence-based guidelines.

Purpose: To provide an overview of the characteristics and timing of rotator cuff healing and provide an update on treatments used in rehabilitation of rotator cuff repairs. The authors' protocol of choice, used within a large sports medicine rehabilitation center, is presented and the rationale behind its implementation is discussed.

Background: If initial nonsurgical treatment of a rotator cuff tear fails, surgical repair is often the next line of treatment.

The effects of arm elevation on the 3-dimensional acromiohumeral distance: a biplane fluoroscopy study with normative data.

Hypothesis And Background: Narrowing of the subacromial space has been implicated in several shoulder pathologies. However, the location of the minimum distance points during clinical testing has not been defined. We sought to measure the in vivo minimum distance and location of the minimum distance points on the acromion and proximal humerus during arm elevation.

Surgical anatomy of the shoulder.

The glenohumeral articulation is a versatile joint that requires a complex integration of bony ligamentous, musculotendinous, and neurovascular structures for proper function. Injuries resulting from dysfunction are common and potentially debilitating. Many of these injuries can be managed nonsurgically; however, if surgical treatment is indicated, a thorough knowledge of the anatomy of the shoulder girdle is critical.