Reimplantation of a glenoid component following component removal and allogenic bone-grafting.

Background: Glenoid component loosening has been a leading cause of failure of total shoulder arthroplasty. In the present study, we evaluated the outcome of reimplantation of a new glenoid component following removal of the previous glenoid component and placement of an allograft in order to determine the results, risk factors for an unsatisfactory outcome, and rate of failure associated with this procedure.

Methods: We reviewed the data on seven shoulders in seven patients.

Prevalence of pulmonary embolism after total elbow arthroplasty.

Background: Although numerous articles have addressed the risk of pulmonary embolism following total knee and total hip arthroplasty, we were unable to find comparable information for the risk following elbow arthroplasty. We therefore sought to determine the prevalence of pulmonary embolism after total elbow arthroplasty.

Methods: We conducted a retrospective review of the medical records of consecutive patients who had undergone primary elbow arthroplasty (816 procedures) or revision total elbow arthroplasty (260 procedures) at our tertiary-care academic medical institution between June 1981 and June 2001.

Ninety-day mortality after total elbow arthroplasty.

Background: Perioperative mortality, although seldom mentioned and rare after upper-extremity surgery, is one of the potential complications of total elbow arthroplasty. The purpose of this study was to determine the prevalence and risk factors associated with perioperative mortality after elbow arthroplasty.

Methods: The records of 1117 consecutive patients who had undergone 1441 total elbow arthroplasties at our institution between 1970 and 2002 were reviewed to identify patients who had died within ninety days after the procedure.

Respiratory properties of blood in flatback turtles (Natator depressus).

Oxygen equilibrium curves and other respiratory-related variables were determined on blood from the flatback turtle (Natator depressus) and, for comparison, on some samples from the loggerhead turtle (Caretta caretta). The oxygen carrying capacity of the flatback turtle, 4.9-8.

Pulmonary embolism after operative treatment of proximal humeral fractures.

There have been multiple studies on the prevalence of pulmonary embolism, the probability of death from a pulmonary embolism, and the risk factors for the development of pulmonary embolism after lower extremity and pelvic trauma. However, there is no information on the risk of pulmonary embolism after the surgical management of proximal humeral fractures. A review of 137 consecutive patients who underwent operative treatment for acute, isolated proximal humeral fractures at our institution between January 1, 1998, and December 31, 2003, was performed to identify all who sustained a pulmonary embolism.

Polyethylene insert exchange for wear after total shoulder arthroplasty.

Virtually no information is available in the literature to guide clinical decision-making in regard to modular polyethylene exchange with metal-backed glenoid components in total shoulder arthroplasty for the indication of polyethylene wear. This level IV study reports our experience with exchange of the modular polyethylene glenoid component during revision total shoulder arthroplasty. We retrospectively identified 12 shoulders in 11 patients who underwent exchange of the modular polyethylene glenoid component during revision arthroplasty.

The difficult proximal humerus fracture: tips and techniques to avoid complications and improve results.

The indications and techniques for surgical management of fractures of the proximal humerus remain controversial, and the results of treatment are often disappointing, with a relatively high complication rate. Anatomic reduction can be difficult, and loss of fixation because of poor bone quality may lead to fracture displacement and malunion. Hemiarthroplasty has a high rate of shoulder stiffness, tuberosity resorption, and glenohumeral instability.

Acute deep infection after surgical fixation of proximal humeral fractures.

Acute deep infection after open reduction-internal fixation of proximal humeral fractures is uncommon. Currently, there are no reported series on the outcomes of patients treated for infection after surgery for proximal humeral fractures. The purpose of this study was to review the frequency, clinical presentation, bacteriology, treatment, and outcomes of patients with such fractures complicated by acute deep infection.

Patient perceptions of open and arthroscopic shoulder surgery.

Purpose: There has been a significant increase in surgeon as well as patient interest in arthroscopic treatment of shoulder pathology. We hypothesize that patients have a strong preference for arthroscopic shoulder surgery. Currently, there are no data in the literature reporting on how people perceive open versus arthroscopic shoulder surgery.

Infected distal biceps tendon repairs: three case reports.

Numerous reports address the risk of infection with surgery about the elbow. However, there is little information regarding treatment of infected distal biceps repairs. We reviewed the records of 37 consecutive patients with biceps repairs between January 1, 2000, and January 1, 2005, to identify cases of postoperative infection.

Exploring the architecture of the intact supraspliceosome using electron microscopy.

Splicing of pre-mRNA takes place on a massive macromolecular machine in the nucleus of eukaryotic cells, the supraspliceosome. This particle is a multicomponent biological complex of RNA and proteins. It is composed of four sub-structures termed native spliceosomes that splice pre-mRNA.

Deep infection after rotator cuff repair.

Currently, there is little information available concerning the outcome of patients with infection after rotator cuff repair. The purpose of this study was to review retrospectively the incidence, clinical presentation, bacteriology, treatment, and outcomes of patients with rotator cuff repair complicated by deep infection. Between 1975 and 2003, 39 cases of deep infection after rotator cuff repair were identified in 38 patients.

The effect of glenoid component size on the stability of total shoulder arthroplasty.

Frequently, during the course of total shoulder arthroplasty, the measurement of the patient's native glenoid is between the available prosthetic glenoid sizes. Technically, it may be easier for the surgeon to implant a smaller glenoid component. Currently, there is no information regarding the difference in joint stability by use of glenoid components of different sizes.

Humeral head replacement for the treatment of osteoarthritis.

Background: Humeral head replacement has been used successfully for the treatment of osteoarthritis of the shoulder for decades. The purpose of this study was to define the results of this form of treatment, the risk factors for an unsatisfactory outcome, and the rates of failure over time.

Methods: Between 1978 and 1997, sixty humeral head replacements were performed at our institution for the treatment of osteoarthritis.

Early complications of operatively treated proximal humeral fractures.

Minimal information exists regarding early complications after operatively treated proximal humeral fractures. Of the 82 shoulders that had osteosynthesis, 42 had a (nonmedical) complication, with 21 requiring further surgery. Of 42 shoulders with complications, 12 were related to incomplete reduction, 16 had loss of anatomic fracture fixation, 9 had delayed healing, 3 had an infection, 1 had rotator cuff failure, and 1 had loose bodies.

Arthroscopic rotator cuff debridement in patients with rheumatoid arthritis.

There is little information available concerning the results of rotator cuff debridement in patients with rheumatoid arthritis (RA). We performed a review of 16 shoulders with underlying RA that underwent arthroscopic rotator cuff tear debridement; there were 10 full-thickness tears and 6 partial-thickness tears. Of the 10 patients with full-thickness rotator cuff tears, 8 had unsatisfactory results, whereas none of the patients with partial-thickness tears had unsatisfactory results.

Outcomes of shoulder arthroplasty in Olmsted County, Minnesota: a population-based study.

Most studies on shoulder arthroplasty include a diverse group of patients presenting to a tertiary care center. Little information is available regarding outcomes in a community setting. We reviewed 98 residents (110 shoulders) of Olmsted County, Minnesota who had shoulder arthroplasties from 1976 to 2000.

Shoulder arthritis in the young adult: arthroscopy to arthroplasty.

Young adult patients with shoulder arthritis present challenging treatment decisions for the orthopaedic surgeon. Patients treated with shoulder arthroplasty have the youngest average age of all patients who undergo joint arthroplasty. However, in the young, active patient or in those without advanced disease, joint arthroplasty may not be appropriate.

AUG sequences are required to sustain nonsense-codon-mediated suppression of splicing.

More than 90% of human genes are rich in intronic latent 5' splice sites whose utilization in pre-mRNA splicing would introduce in-frame stop codons into the resultant mRNAs. We have therefore hypothesized that suppression of splicing (SOS) at latent 5' splice sites regulates alternative 5' splice site selection in a way that prevents the production of toxic nonsense mRNAs and verified this idea by showing that the removal of such in-frame stop codons is sufficient to activate latent splicing. Splicing control by SOS requires recognition of the mRNA reading frame, presumably recognizing the start codon sequence.

Revision shoulder arthroplasty with positive intraoperative cultures: the value of preoperative studies and intraoperative histology.

Currently, there are no reported results of patients without overt infection who had a positive intraoperative culture during revision shoulder arthroplasty. We therefore reviewed the intraoperative and preoperative investigations as well as the postoperative course of these patients who had positive intraoperative cultures. We reviewed the results of 75 shoulders without overt infection that underwent revision shoulder arthroplasty at our institution between January 1, 1974 and December 31, 2002 who had positive intraoperative cultures.

Double suture technique to delineate PASTA lesions.

A common method of treating PASTA (partial articular surface tendon avulsion) lesions involves completing the tear followed by arthroscopic repair. Frequently, the boundaries of the tear are difficult to determine from the bursal side with the use of a single marking stitch. Therefore, we describe a simple technique that allows the surgeon to reproducibly define the boundaries of the partial tear.

Surgical anatomy of the triceps brachii tendon: anatomical study and clinical correlation.

Background: The triceps tendon has been described as a single unit with contribution from each of the 3 heads of the muscle. An observation at the time of surgical repair of a triceps tendon injury led to an anatomical study to further define the anatomy of this tendon as it inserts on the olecranon.

Hypothesis: The medial head of the triceps has a tendon that is distinct from, and deep to, the common tendon of the long and lateral heads.