Development of a vibration haptic simulator for shoulder arthroplasty

© 2018, CARS. Purpose: Glenoid reaming is a technically challenging step during shoulder arthroplasty that could possibly be learned during simulation training. Creation of a realistic simulation using vibration feedback in this context is innovative. Our study focused on the development and internal validation of a novel glenoid reaming simulator for potential use as a training tool. Methods: Vibration and force profiles associated with glenoid reaming were quantified during a cadaveric experiment. Subsequently, a simulator was fabricated utilizing a haptic vibration transducer with high- and low-fidelity amplifiers; system calibration was performed matching vibration peak–peak values for both amplifiers. Eight experts performed simulated reaming trials. The experts were asked to identify isolated layer profiles produced by the simulator. Additionally, experts’ efficiency to successfully perform a simulated glenoid ream based solely on vibration feedback was recorded. Results: Cadaveric experimental cartilage reaming produced lower vibrations compared to subchondral and cancellous bones (p≤ 0.03). Gain calibration of a lower-fidelity (3.5 gpk-pk,0.36grms) and higher-fidelity (3.4 gpk-pk,0.33grms) amplifier resulted in values similar to the cadaveric experimental benchmark (3.5 gpk-pk,0.30grms). When identifying random tissue layer samples, experts were correct 52 ± 9 % of the time and success rate varied with tissue type (p= 0.003). During simulated reaming, the experts stopped at the targeted subchondral bone with a success rate of 78 ± 24 %. The fidelity of the simulation did not have an effect on accuracy, applied force, or reaming time (p\u3e 0.05). However, the applied force tended to increase with trial number (p= 0.047). Conclusions: Development of the glenoid reaming simulator, coupled with expert evaluation furthered our understanding of the role of haptic vibration feedback during glenoid reaming. This study was the first to (1) propose, develop and examine simulated glenoid reaming, and (2) explore the use of haptic vibration feedback in the realm of shoulder arthroplasty

Anterior Transpsoas Approach for Removal of Cement Leakage after Sacroplasty

Introduction: Sacroplasty is a minimally invasive treatment option for severe pain due to sacral insufficiency fracture. Cement leakage is a known risk of sacroplasty. Despite the elevated risk to the L5 nerve root and lumbosacral trunk from cement leakage anterior to the sacral ala, there are no reports regarding surgical management of this complication. Technical Note: We describe an anterior retroperitoneal transpsoas approach to the sacral ala to remove cement leakage causing acute L5 radiculopathy in a 57-year-old gentleman who had undergone sacroplasty for sacral insufficiency fracture (Denis zone 1). The approach provides rapid and excellent visualization of the sacral ala without manipulation of the iliac vessels. Conclusions: We recommend that surgery be considered in a timely fashion, to utilize neuromonitoring, and that surgeons be aware of the considerable variability of the neurologic structures that will be encountered, which is described in this technical note.</p

Management of Proximal Humerus Fractures in Adults&mdash;A Scoping Review

Proximal humerus fractures are the third most common fracture type in adults, with their incidence increasing over time. There are varied approaches to both the classification and treatment of proximal humerus fractures. Optimal treatments for this fracture type are still widely open to debate. This review summarizes the current and historical treatment modalities for proximal humerus fractures. In this paper, we provide updates on the advances and trends in the epidemiology, classification, and operative and nonoperative treatments of proximal humerus fractures

Cephalic vein patency after deltopectoral approach to the shoulder and the effect on upper extremity edema

© 2020 American Shoulder and Elbow Surgeons Background: The effect of the direction of cephalic vein mobilization in a deltopectoral approach to the shoulder on limb edema is unknown. The primary objective was to evaluate the effect of the direction of cephalic vein mobilization/ligation on limb edema after elective shoulder arthroplasty. The secondary objectives were to: evaluate the effect of the arthroplasty procedure performed on limb edema; correlate postoperative ultrasonographic patency with intraoperative assessment. Methods: A cohort of 62 patients undergoing primary shoulder arthroplasty using the deltopectoral approach were enrolled and prospectively followed. Exclusion criteria included: surgery for fracture and prior open anterior shoulder procedure. Surgeons documented the direction of vein mobilization and if it was ligated. Patency was assessed by doppler ultrasound and standardized limb circumference measurement preoperatively, at 2 weeks and 12 weeks postoperatively. Results: Arm circumference was significantly increased at 2 weeks in all cohorts (lateral, p\u3c0.001; medial, p = 0.007; ligated, p = 0.011) and at 12 weeks in the laterally-mobilized (p = 0.022) and ligated cohorts (p = 0.003) as compared to preoperatively. Reverse shoulder arthroplasty demonstrated significantly greater arm circumference at 12 weeks as compared to total shoulder arthroplasty (p = 0.014). Intraoperative determination of patency was moderately correlated with 2- and 12-week (r = 0.70, 0.59) ultrasound assessment. Conclusion: Medial cephalic vein mobilization in a deltopectoral approach resulted in significantly less arm edema at 3-months when compared to lateral mobilization/ligation. Reverse shoulder arthroplasty demonstrated greater arm edema at 3-months when compared to total shoulder arthroplasty. Intraoperative determination of cephalic vein patency was moderately correlated with postoperative vein patency as assessed by ultrasound. Level of Evidence: III

Management of rheumatoid arthritis of the elbow with a convertible total elbow arthroplasty

© 2019 Journal of Shoulder and Elbow Surgery Board of Trustees Background: Total elbow arthroplasty (TEA) is commonly performed in patients with rheumatoid arthritis (RA). The purpose of this study was to compare outcomes and complications of unlinked and linked TEA using a convertible system in patients with RA. Methods: All patients with RA who underwent TEA at a single center with a minimum of 2 years\u27 follow-up were reviewed. Demographic information, patient-reported outcome scores, functional outcome assessments, and radiographic parameters were evaluated at most recent follow-up. Results: We evaluated 82 patients (27 with unlinked TEA and 55 with linked TEA) with RA. The mean age at surgery was 61 ± 10 years, with a mean follow-up period of 6 ± 4 years. Demographic characteristics were similar between groups, with the exception of longer follow-up in the unlinked group (8 years vs. 5 years, P = .001). No differences in range of motion were noted. Elbow strength was similar other than pronation strength (74% ± 8% for unlinked vs. 100% ± 8% for linked, P = .03). The mean Mayo Elbow Performance Index was 83 ± 16; Patient Rated Elbow Evaluation score, 15 ± 18; and QuickDASH (short version of the Disabilities of the Arm, Shoulder and Hand questionnaire) score, 34 ± 20. No differences in the rates of reoperation (17% vs. 24%, P = .4), complications (32% vs. 31%, P = .4), or revisions (13% vs. 17%, P = .3) were found between unlinked and linked devices. Four patients with instability, all with unlinked designs, underwent revision to a linked design. Four patients, all with linked designs, underwent revision for aseptic loosening of smooth short-stem ulnar components. Conclusion: TEA using a convertible implant design provides good patient-reported outcomes at mid-term follow-up in patients with RA. Our study was unable to detect a difference in the use of either unlinked or linked implant designs; further large comparison trials are needed

Diabetic Kidney Disease Is Associated With Increased Complications Following Operative Management of Ankle Fractures

Background: Diabetes mellitus and peripheral neuropathy are established risk factors for complications in operatively treated ankle fractures. Generally, the presence of peripheral neuropathy and diabetic nephropathy have been used as independent variables in studies of diabetic ankle fracture cohorts but are typically treated as binary risk factors. Our purpose was to quantify the effects of risk factors on complication rate specific to diabetic patients undergoing ankle fracture fixation. Methods: We identified 617 rotational ankle fractures treated operatively at a single academic medical center from 2010 to 2019, of which 160 were identified as diabetic. Of these, 91 ankle fractures in 90 diabetic patients met criteria for retrospective review of clinical and radiographic data. Criteria included perioperative laboratory studies, including glycated hemoglobin (HbA 1c ) and estimated glomerular filtration rate (eGFR), as well as follow-up radiographs in the electronic record. We defined complications in this surgical cohort as deep surgical site infection, unplanned return to the operating room, and failure of fixation. Logistic regression was performed and odds ratios (ORs) calculated. Results: The overall complication rate was 28.6% (26/91) in this cohort. Median follow-up was 29 weeks (range: 5-520 weeks). Mean perioperative HbA 1c in patients who experienced postoperative complications was 7.6% (range: 5.1%-14.2%) compared with 7.8% (range: 5.6%-13.5%) who did not ( P = .69). Diabetic patients with chronic kidney disease (eGFR <60 mL/min per body surface area) (OR 5.29, P = .006) and peripheral neuropathy (OR 4.61, P = .003) were at significantly higher risk of all complications compared with diabetic patients without these comorbidities. Of note, we did not find an association between perioperative HbA 1c or body mass index and complication rate. Conclusion: Patients with diabetes complicated by chronic kidney disease are at significantly higher risk of complications following operative management of ankle fractures. Our study also corroborated previous reports that within this high-risk cohort, the presence of peripheral neuropathy is a significant risk factor for complications. These sequalae of diabetic disease are manifestations of microvascular disease, glycosylation of soft tissues, and impaired metabolic pathways. Identifying these risk factors in diabetic patients allows for patient-specific risk stratification, education, and management decisions of ankle fractures. Level of Evidence: Level III, retrospective cohort study

Effect of Concomitant Elbow Injuries on the Outcomes of Radial Head Arthroplasty: A Cohort Comparison

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. Objectives: To compare physical impairments and patient-reported outcomes in patients after simple and complex elbow injuries who were treated with radial head arthroplasty. Design: Prospective. Setting: Quaternary upper extremity referral hospital. Patients/Participants: 148 patients with isolated elbow trauma and no previous injury to the elbow were prospectively enrolled after radial head arthroplasty for an acute unreconstructable fracture. Injury patterns were classified as simple or complex based on the presence or absence of associated elbow fractures and/or dislocation. Intervention: Radial head arthroplasty. Main Outcome Measurements: Patient-Rated Elbow Evaluation (PREE), Disability of the Arm, Shoulder, and Hand, range of motion (ROM), and Biodex measurements. Results: At a minimum 1-year follow-up PREE and Disability of the Arm, Shoulder, and Hand, and ROM and strength values were similar. Forty-four patients evaluated at a mean of 7 years demonstrated no effect of injury pattern on clinical outcomes at any time point. Continued statistical improvements in PREE, supination ROM, and flexion ROM at medium term compared with earlier follow-up were observed. Eight patients required secondary surgery, 2 in the simple injury group and 6 complex injury patients. Conclusions: Concomitant elbow injuries do not affect the longer term outcomes of patients with unreconstructable radial head fractures requiring radial head arthroplasty. Patient outcomes continued to improve beyond 2 years of follow-up. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence