19 research outputs found
Quantification of rotator cuff tear geometry: the repair ratio as a guide for surgical repair in crescent and U-shaped tears
Surgical repair of symptomatic, retracted rotator cuff tears unresponsive to non-operative treatments requires closure of the tear without undue tension and reattaching the torn tendon to its former insertion site. In this study, the length of the torn tendon edge was hypothesized to be longer than the length of the humeral insertion site. The objective of this study was to quantify the discrepancy in length of the torn tendon edge and the length of the avulsed humeral insertion site.
Full thickness, rotator cuff tears that were found in twelve fresh frozen cadaver shoulders was studied. The length of the torn tendon edge, the length of the avulsed humeral insertion site and the retraction were measured using digital calipers.
Each tear involved the supraspinatus and the infraspinatus was additionally torn in six. The size of the tear was medium in eight and large in four. The length of the torn tendon edge was always longer than the length of the avulsed humeral insertion site. Retraction was 29.9 ± 9.3 mm (range 21–48 mm). The repair ratio, defined as the ratio of length of torn tendon edge to the length of avulsed humeral insertion site, was 2.6 ± 0.4 (range 2.1–3.5).
As only the length of the torn tendon edge equal to the length of the avulsed humeral insertion site can be repaired to bone, a repair ratio more than one precludes a simple repair and an additional repair technique such as margin convergence would be necessary for the remaining unapproximated torn tendon edge in rotator cuff tears. Repair ratio may aid in selection of the surgical repair technique of these rotator cuff tears
Correction to: Cluster identification, selection, and description in Cluster randomized crossover trials: the PREP-IT trials
An amendment to this paper has been published and can be accessed via the original article
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Thermal capsuloplasty of the glenohumeral joint: Technique and results OF treatment
Mobility of the upper extremity is essential in everyday life. Yet a large shoulder range of motion is also partlythe reason that the glenohumeral joint is the most commonly dislocated joint of the body. After such instability, successful surgical treatment requires precise repair of joint pathoanatomy. Traditional open repair techniques involve capsulolabral plication and repair of the Bankart lesion, if present, to the glenoid bone. Because artlu-oscopy allows intra-capsular visualization of the glenohumeral joint, new techniques were developed in hopes of improving results. Instead, arthroscopic techniques have had success rates that often were inferior to the success rates with traditional, open techniques. One reason may be technical differences that influence the adequacy of repair, but failure to restore normal capsulolabral length using the arthroscopic technique may also contribute to poor outcomes. Thermal capsuloplasty enables the surgeon to diminish capsulolabral length using an arthroscopic technique. Not only must the technique of joint pathoanatomy repair be understood, but also the parameters of the instrument used to apply the heat. Clinical outcome may be equal to that of traditional open repair techniques in treatment of some instability types. Yet concerns remain, as rates of nerve injury and difficult-to-repair soft tissue injuries after thermal capsuloplasty remain uncertain
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Internal Fixation of Posterior Pelvic Ring Injuries Using Iliosacral Screws in the Dysmorphic Upper Sacrum.
IntroductionThe correct usage of preoperative and intraoperative imaging allows fixation of posterior pelvic ring injuries with safely positioned iliosacral screws in the setting of sacral dysmorphism.Step 1 preoperative planningObtain CT reformats along the longitudinal axis of the sacrum to determine the orientation and diameter of the osseous corridor for selection of the ideal screw size, length, and trajectory.Step 2 patient positioningProper positioning enables reduction and accurate iliosacral screw placement.Step 3 fracture reductionReduction of the posterior pelvic ring confers stability; if closed reduction is unsuccessful, proceed with open reduction.Step 4 identification of the entry pointThe entry point for an iliosacral screw into the upper sacral segment of a dysmorphic pelvis lies more posterior and caudal on the outer table of the posterior ilium than does a transsacral screw; adjust the entry point on the basis of inlet and outlet fluoroscopic views.Step 5 drilling techniqueInsert a stout cannulated drill bit of 4.5 to 5 mm (depending on the core diameter of the intended iliosacral screw) over the Kirschner wire and drill it into the sacral body under fluoroscopic guidance, in accordance with the preoperative plan.Step 6 screw insertionWith the guidewire in the ideal position, measure the screw length off the inserted guidewire and advance a tap into the pathway; insert the screw and verify its position on the inlet, outlet, and lateral sacral views.ResultsUnderstanding the three-dimensional anatomy of the posterior pelvic ring is essential to successful reduction and fixation of unstable pelvic injuries with use of percutaneous iliosacral screws.IndicationsContraindicationsPitfalls & Challenges
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Internal Fixation of Posterior Pelvic Ring Injuries Using Iliosacral Screws in the Dysmorphic Upper Sacrum.
IntroductionThe correct usage of preoperative and intraoperative imaging allows fixation of posterior pelvic ring injuries with safely positioned iliosacral screws in the setting of sacral dysmorphism.Step 1 preoperative planningObtain CT reformats along the longitudinal axis of the sacrum to determine the orientation and diameter of the osseous corridor for selection of the ideal screw size, length, and trajectory.Step 2 patient positioningProper positioning enables reduction and accurate iliosacral screw placement.Step 3 fracture reductionReduction of the posterior pelvic ring confers stability; if closed reduction is unsuccessful, proceed with open reduction.Step 4 identification of the entry pointThe entry point for an iliosacral screw into the upper sacral segment of a dysmorphic pelvis lies more posterior and caudal on the outer table of the posterior ilium than does a transsacral screw; adjust the entry point on the basis of inlet and outlet fluoroscopic views.Step 5 drilling techniqueInsert a stout cannulated drill bit of 4.5 to 5 mm (depending on the core diameter of the intended iliosacral screw) over the Kirschner wire and drill it into the sacral body under fluoroscopic guidance, in accordance with the preoperative plan.Step 6 screw insertionWith the guidewire in the ideal position, measure the screw length off the inserted guidewire and advance a tap into the pathway; insert the screw and verify its position on the inlet, outlet, and lateral sacral views.ResultsUnderstanding the three-dimensional anatomy of the posterior pelvic ring is essential to successful reduction and fixation of unstable pelvic injuries with use of percutaneous iliosacral screws.IndicationsContraindicationsPitfalls & Challenges
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Protocol-based interdisciplinary co-management for hip fracture care: 3 years of experience at an academic medical center.
BackgroundInterdisciplinary standardized protocols for the care of patients with hip fractures have been shown to improve outcomes. A hip fracture protocol was implemented at our institution to standardize care, focusing on emergency care, pre-operative medical management, operative timing, and geriatrics co-management. The aim of this study was to evaluate the efficacy of this protocol.MethodsWe conducted a retrospective review of adult patients admitted to a single tertiary care institution who underwent operative management of a hip fracture between July 2012 and March 2020. Comparison of patient characteristics, hospitalization characteristics, and outcomes were performed between patients admitted before and after protocol implementation in 2017.ResultsA total of 517 patients treated for hip fracture were identified: 313 before and 204 after protocol implementation. Average age, average Charlson Comorbidity Index, percent female gender, and distribution of hip fracture diagnosis did not vary significantly between groups. There was a significant reduction in time from admission to surgical management, from 37.0 ± 47.7 to 28.5 ± 27.1 h (p = 0.0016), and in the length of hospital stay, from 6.3 ± 6.5 to 5.4 ± 4.0 days (p = 0.0013). The percentage of patients whose surgeries were performed under spinal anesthesia increased from 12.5 to 26.5% (p = 0.016). There was no difference in 90-day readmission rate or mortality at 30 days, 90 days, or 1 year between groups.ConclusionWith the implementation of an interdisciplinary hip fracture protocol, we observed significant and sustained reductions in time to surgery and hospital length of stay, important metrics in hip fracture management, without increased readmission or mortality. This has implications to minimize health care costs and improve outcomes for our aging population.Level of evidenceIII, therapeutic
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Anatomic Osteochondral Allograft Reconstruction for Concomitant Large Hill–Sachs and Reverse Hill–Sachs Lesions
Glenohumeral instability causing bipolar bone loss is increasingly being recognized and treated to minimize recurrence. Large Hill-Sachs and reverse Hill-Sachs lesions of the humerus must be addressed at the time of surgery to prevent recurrent dislocations and restore the native anatomic track. For patients with epilepsy, locked dislocations may create defects that must be addressed with bony procedures, including osteochondral allograft reconstruction as soft-tissue remplissage may not adequately addresses the magnitude of the bone loss. Osteochondral allografts have been successfully used to address bony defects ranging from 20% to 30% of humeral bone loss whereas shoulder arthroplasty is indicated for larger defects where the native anatomy can no longer be restored. In this Technical Note, we present a technique to address concomitant large Hill-Sachs and reverse Hill-Sachs lesions