23 research outputs found
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Orthopedic Treatment of the Traumatized Lower Extremity
This chapter provides an overview of the orthopedic management of the severely traumatized lower extremity and discusses the role of the orthopedist in the team approach to devastating injuries. It deals with a section on evaluation and management, and describes special problems facing the surgeon treating the severely traumatized limb, and provides techniques of fixation and reconstruction. The severely traumatized lower extremity presents a complex problem that often requires the skills of surgeons familiar with orthopedic, soft tissue, and microvascular techniques. Once the initial stabilization and evaluation have occurred, the orthopedist must determine whether an operative emergency exists. By far, the most common operative emergency the orthopedist will see in the setting of lower extremity trauma is an open fracture. Fractures of the metaphysis and articular surface of the distal femur present a challenge to the orthopedic surgeon. Injuries of the distal femur usually benefit from the robust soft-tissue envelope of the thigh, making the need for flap coverage rare
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Shoulder arthroplasty: current principles of anatomic reconstruction
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Radiographic appearance of displaced lesser tuberosity osteotomy: a case series
Lesser tuberosity osteotomy has become a popular method of subscapularis management during total shoulder arthroplasty with high healing rates and reliable functional recovery. One major advantage of this technique is the ability to monitor healing using routing radiographs. Recognition of displacement of the lesser tuberosity may provide a unique opportunity for revision repair before the tuberosity becomes irreversibly retracted.
A series of four patients were identified with a displaced lesser tuberosity osteotomy following total shoulder arthroplasty. Radiographs from these patients were reviewed to identify the optimal radiograph for detecting displacement.
In each of the four cases, the displaced lesser tuberosity osteotomy was not seen on the axillary radiograph. A true AP radiograph consistently provided the only clear view of the displaced osteotomy. CT or MRI was used to confirm displacement of the lesser tuberosity osteotomy. In each case, displacement of the lesser tuberosity resulted from either a traumatic event, or from patient non-compliance with post-operative restrictions.
This is the first report that characterizes the radiographic appearance of failure of the lesser tuberosity osteotomy technique. Displacement of lesser tuberosity osteotomy following shoulder arthroplasty is best observed using a true AP radiograph
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Proximal Humeral Nonunions Treated With Fixed-Angle Locked Plating and an Intramedullary Strut Allograft
OBJECTIVE:To determine if the use of a fixed-angle locked plate plus an intramedullary allograft in the treatment of proximal humeral nonunions resulted in improved union.
DESIGN:Retrospective clinical analysis of patientsʼ medical charts and radiographs.
SETTING:Clinical practice of senior authors.
PATIENTS/PARTICIPANTS:Eighteen patients who presented to the senior authorsʼ clinic between 2001 and 2007 with clinical and radiographic evidence of symptomatic proximal humeral nonunions that were treated with the described method were included for analysis. Patients with severe humeral head bone loss, avascular necrosis, evidence of arthrosis, and less than 12-month clinical follow-up were excluded.
INTERVENTION:All patients with a symptomatic viable nonunion of the proximal humerus were treated with a fixed-angle locked plate and an intramedullary cortical allograft.
MAIN OUTCOME MEASUREMENT:Patients were followed until radiographic union was achieved, with this being the principle determinant of a successful outcome.
RESULTS:Radiographic union was achieved in 17 of 18 patients (94%). The average follow-up was 26.5 months (range 12-49 months). The average time from surgery to radiographic union was 5.4 months (range 2.5-8.8 months). There was 1 failure of fixation, and 2 patients developed transient neurologic sequelae. Range of motion measurements obtained from the most recent clinical follow-up were 115 degrees (range 20-180 degrees) active forward elevation, 37 degrees (range 0-70 degrees) passive external rotation, and active internal rotation was to the 10th thoracic vertebrae. American Shoulder and Elbow Surgeon scores improved from a level of 40 preoperatively to 81 postoperatively, and visual analog scale scores improved from 6.7 to 1.5.
CONCLUSION:Intramedullary strut allograft insertion combined with fixed-angle plating is an effective technique for treating viable nonunions of the proximal humerus and was successful in achieving union in 94% of our patients
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Radiographic Evaluation of Elbow Fractures
Abstract
Fractures and dislocations of the elbow are a common cause of emergency department visits each year. Radiography remains the bedrock of an initial injury assessment, and recognition of distinctive injury patterns based on fracture location, morphology, and severity, guides optimal clinical decision-making. This article reviews basic elbow anatomy, frequently seen fractures and injury patterns, and highlights how these findings influence surgical planning and patient management
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Unstable Sternoclavicular Joint: Indications for and Techniques of Reconstruction
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Cost of Treatment for Proximal Humerus Fractures: An Acute and 90-Day Cost Evaluation
The purpose of this study was to examine the 90-day costs of three common surgical treatments for proximal humerus fractures and compare the costs associated with the initial day and subsequent 89 days of care. This was conducted through a retrospective review of a national database examining patients who suffered proximal humerus fractures. Patients were stratified by type of surgical procedure performed, hemiarthroplasty (HA), reverse shoulder arthroplasty (RSA), and open reduction and internal fixation (ORIF). RSA was the most costly procedure for the same-day and 90-day costs (p < 0.001). Mean initial day reimbursement costs were significantly different among treatment groups, with the highest costs seen with RSA (9,348), and ORIF ($6,745). Subsequent 89-day reimbursement costs were not significantly different for RSA, HA, and ORIF (p = 0.112). The 90-day costs for the surgical treatment of proximal humerus fractures are driven by the initial day costs. RSA was associated with the highest cost, followed by HA and ORIF