Abstract:
:Restoration of painless and satisfactory elbow function after a fracture of the distal humerus requires anatomic reconstruction of the articular surface, restitution of the overall geometry of the distal humerus, and stable fixation of the fracture fragments to allow early and full rehabilitation. Although these goals are now widely accepted by the orthopaedic community, they may be technically difficult to achieve, especially in the presence of substantial osteoporosis or comminution. Failure, when it occurs, typically occurs at the supracondylar level through loss of fixation in the distal fragments. To prevent such failure and thereby maximize the potential for union and full elbow mobility after a severely fractured distal humerus, 2 principles must be satisfied: (1) fixation in the distal fragment must be maximized and (2) all fixation in distal fragments should contribute to stability between the distal fragments and the shaft. There are 8 technical objectives by which these principles are met: (1) every screw in the distal fragments should pass through a plate; (2) engage a fragment on the opposite side that is also fixed to a plate; (3) as many screws as possible should be placed in the distal fragments; (4) each screw should be as long as possible; (5) each screw should engage as many articular fragments as possible; (6) the screws in the distal fragments should lock together by interdigitation, creating a fixed-angle structure; (7) plates should be applied such that compression is achieved at the supracondylar level for both columns; and (8) the plates must be strong enough and stiff enough to resist breaking or bending before union occurs at the supracondylar level. These can be achieved with parallel plating. Severe metaphyseal comminution and bone loss are managed by supracondylar shortening. From the biomechanical data in the literature, 3 conclusions can be reached concerning fixation of distal humeral fractures. First, the concept that plates need to be placed perpendicular (90 degrees /90 degrees orientation) is unsubstantiated and incorrect. Second, parallel placement of 2 plates in the sagittal plane is as strong or stronger than the 90 degrees /90 degrees orientation. Finally, linking the plates together through the bone, thereby creating the architectural equivalent of an arch, offers the greatest biomechanical stability for comminuted distal humeral fractures. This can be done by interdigitating and locking the screws together as they pass through the distal fragments from the medial and lateral plates placed in the sagittal plane.
journal_name
J Shoulder Elbow Surgjournal_title
Journal of shoulder and elbow surgeryauthors
O'Driscoll SWdoi
10.1016/j.jse.2004.09.033keywords:
subject
Has Abstractpub_date
2005-01-01 00:00:00pages
186S-194Sissue
1 Suppl Seissn
1058-2746issn
1532-6500pii
S1058274604002940journal_volume
14pub_type
杂志文章abstract:HYPOTHESIS:This study evaluated the diagnostic efficacy of computed tomography arthrography (CTA) in the assessment of various shoulder pathologies with arthroscopic correlation. We hypothesized that CTA would be cost-effective and effectively comparable with magnetic resonance arthrography (MRA) for assessing labral d...
journal_title:Journal of shoulder and elbow surgery
pub_type: 杂志文章
doi:10.1016/j.jse.2009.04.012
更新日期:2010-01-01 00:00:00
abstract:BACKGROUND:Treatment of partial thickness supraspinatus tendon tears is controversial with no clearly defined treatment algorithms based on severity of tears. This study aims to evaluate the relationship between depth of partial thickness tears and strain. METHODS:Bursal-sided partial thickness tears were created at 1...
journal_title:Journal of shoulder and elbow surgery
pub_type: 杂志文章
doi:10.1016/j.jse.2008.12.011
更新日期:2009-05-01 00:00:00
abstract::The surgical treatment of chronic acromioclavicular injuries remains controversial. There is increasing use of autogenous tendon grafts to perform these reconstructions. This study examined the mechanical properties of differing configurations of these grafts. Mechanical testing of acromioclavicular joint reconstructi...
journal_title:Journal of shoulder and elbow surgery
pub_type: 杂志文章
doi:10.1016/j.jse.2008.01.143
更新日期:2008-09-01 00:00:00
abstract:HYPOTHESIS AND BACKGROUND:The purpose of this study was to compare the accuracy of patient-specific guides for total shoulder arthroplasty (TSA) with traditional instrumentation in arthritic cadaver shoulders. We hypothesized that the patient-specific guides would place components more accurately than standard instrume...
journal_title:Journal of shoulder and elbow surgery
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jse.2014.10.013
更新日期:2015-06-01 00:00:00
abstract:BACKGROUND:Restoration of native glenohumeral joint line is important for a successful outcome after reverse shoulder arthroplasty (RSA). The aims of this study were to quantify the restoration of glenoid joint line after structural bone grafting and RSA, and to evaluate graft incorporation, correction of glenoid versi...
journal_title:Journal of shoulder and elbow surgery
pub_type: 杂志文章
doi:10.1016/j.jse.2020.09.031
更新日期:2020-11-02 00:00:00
abstract:BACKGROUND:There is currently disagreement among experts in the field of shoulder surgery when attempting to define the term "pseudoparalysis." Multiple surgical techniques to address this condition have been investigated; however, many studies have recruited heterogeneous patient populations and have used varying defi...
journal_title:Journal of shoulder and elbow surgery
pub_type: 杂志文章
doi:10.1016/j.jse.2020.08.029
更新日期:2020-09-09 00:00:00
abstract:BACKGROUND:This study investigated if patients with an intact tendon repair or partial-thickness retear early after rotator cuff repair display differences in clinical evaluations and whether early tendon healing can be predicted using these assessments. METHODS:We prospectively evaluated 60 patients at 16 weeks after...
journal_title:Journal of shoulder and elbow surgery
pub_type: 杂志文章
doi:10.1016/j.jse.2015.09.019
更新日期:2016-04-01 00:00:00
abstract::The purpose of this study is to report on our experience with thermal capsulorrhaphy in the treatment of multidirectional instability of the shoulder. Thirty-three consecutive patients (33 shoulders) with multidirectional instability were treated with arthroscopic thermal capsulorrhaphy. Twelve patients had a history ...
journal_title:Journal of shoulder and elbow surgery
pub_type: 杂志文章
doi:10.1067/mse.2002.121476
更新日期:2002-03-01 00:00:00
abstract::The configuration of percutaneous pinning may affect the stability of the fixation of 2-part surgical neck fractures of the humerus. In this investigation, the mechanical properties of four different pin configurations were analyzed by use of 36 fresh-frozen swine femora as an experimental model. The bones were select...
journal_title:Journal of shoulder and elbow surgery
pub_type: 杂志文章
doi:10.1016/j.jse.2004.04.013
更新日期:2005-01-01 00:00:00
abstract:BACKGROUND:Subacromial analgesia (SAA) is hypothesized to reduce pain after arthroscopic shoulder surgery by delivering a continuous infusion of local anesthetic directly to the surgical site. The purpose of this systematic review and meta-analysis was to evaluate the efficacy of SAA vs. placebo for pain relief after a...
journal_title:Journal of shoulder and elbow surgery
pub_type: 杂志文章,meta分析
doi:10.1016/j.jse.2019.11.010
更新日期:2020-03-01 00:00:00
abstract::One hundred twenty-seven shoulders treated with replacement arthroplasty for osteonecrosis of the humeral head were reviewed and assessed by mailed questionnaire for results, durability, and complications. These included 71 humeral head replacements and 56 total shoulder replacements. Thirty-six shoulders were lost to...
journal_title:Journal of shoulder and elbow surgery
pub_type: 杂志文章
doi:
更新日期:2000-05-01 00:00:00
abstract::Currently, there is no information in the literature on operative treatment of proximal humeral fractures in patients with rheumatoid arthritis. Eleven patients underwent osteosynthesis of the proximal humerus from December 1987 to December 2002. Nine patients were treated for acute fractures, and two were treated for...
journal_title:Journal of shoulder and elbow surgery
pub_type: 杂志文章
doi:10.1016/j.jse.2005.02.023
更新日期:2005-11-01 00:00:00
abstract::Two cases of long thoracic nerve palsy associated with thoracic outlet syndrome are reported. Both patients had abnormal posture, with low-set shoulders and winged scapulae. Clinically there was weakness of the serratus anterior muscle with partial denervotion on electromyography. The diagnosis of thoracic outlet synd...
journal_title:Journal of shoulder and elbow surgery
pub_type: 杂志文章
doi:10.1016/S1058-2746(09)80005-0
更新日期:1994-01-01 00:00:00
abstract::The purpose of this study was to document the diagnosis, surgical treatment, and functional outcome in patients with subscapularis ruptures after shoulder arthroplasty. Prospective objective and subjective data were collected on 7 patients with symptomatic rupture of the subscapularis tendon after shoulder arthroplast...
journal_title:Journal of shoulder and elbow surgery
pub_type: 杂志文章
doi:10.1016/j.jse.2005.02.013
更新日期:2005-09-01 00:00:00
abstract::In theory, a prolonged, local infusion of anesthetic into a surgical field should reduce postoperative pain. Recently, disposable products have become available to implement this, but the balance between cost and benefit is controversial. This study evaluated such a device in two specific types of arthroscopic surgery...
journal_title:Journal of shoulder and elbow surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s1058-2746(03)00207-6
更新日期:2003-11-01 00:00:00
abstract:BACKGROUND:The suprascapular region is the most common site of suprascapular nerve entrapment. The aim of the present study was to determine the morphologic variation of the superior transverse scapular ligament (STSL) and measure the reduction in size of the suprascapular opening. Other structures that might be potent...
journal_title:Journal of shoulder and elbow surgery
pub_type: 杂志文章
doi:10.1016/j.jse.2012.11.017
更新日期:2013-09-01 00:00:00
abstract:BACKGROUND:Preoperative planning software is widely available for most anatomic total shoulder arthroplasty (ATSA) systems. It can be most useful in determining implant selection and placement with advanced glenoid wear. The purpose of this study was to quantify inter- and intrasurgeon variability in preoperative plann...
journal_title:Journal of shoulder and elbow surgery
pub_type: 杂志文章
doi:10.1016/j.jse.2020.04.010
更新日期:2020-12-01 00:00:00
abstract:BACKGROUND:Osteointegration of press-fit radial head implants is achieved by limiting micromotion between the stem and bone. Aspects of stem design that contribute to the enhancement of initial stability (ie, stem diameter and surface coating) have been investigated. The importance of total prosthesis length and level ...
journal_title:Journal of shoulder and elbow surgery
pub_type: 杂志文章
doi:10.1016/j.jse.2011.11.025
更新日期:2012-11-01 00:00:00
abstract:BACKGROUND:Acromioclavicular joint separations continue to be a challenge for surgeons, and modern arthroscopically assisted techniques are becoming increasingly widespread. The aim of this study is to evaluate if the use of a biological support in association with a nonresorbable subcoracoid fixation can improve long-...
journal_title:Journal of shoulder and elbow surgery
pub_type: 杂志文章
doi:10.1016/j.jse.2020.02.014
更新日期:2020-10-01 00:00:00
abstract::From 710 consecutive open rotator cuff repairs by a single surgeon, the results of 667 were available for detailed analysis. Patient-assessed outcomes and the ability to perform specific activities of daily living, employment, and recreation were correlated with independent nonstructural variables including age, sex, ...
journal_title:Journal of shoulder and elbow surgery
pub_type: 杂志文章
doi:10.1067/mse.2002.122271
更新日期:2002-05-01 00:00:00
abstract:BACKGROUND:Since US Food and Drug Administration approval of the reverse prosthesis in 2003, the incidence of shoulder arthroplasty in the United States has risen dramatically. With increasing demand, efforts have shifted from traditional volume-based health care models to more patient-centered care. The purpose of thi...
journal_title:Journal of shoulder and elbow surgery
pub_type: 杂志文章
doi:10.1016/j.jse.2018.05.029
更新日期:2018-09-01 00:00:00
abstract:BACKGROUND:Arthroscopic excision of an osteoid osteoma was first reported in the knee joint; since then, there have been several reports of arthroscopic excisions in the knee, shoulder, and elbow, with inconclusive outcomes because of a limited number of cases. The aim of this prospective study was to evaluate the medi...
journal_title:Journal of shoulder and elbow surgery
pub_type: 杂志文章
doi:10.1016/j.jse.2017.01.010
更新日期:2017-05-01 00:00:00
abstract:BACKGROUND:The influence of preoperative rotator cuff fatty infiltration (FI) and muscle atrophy (MA) on the postoperative outcome of total shoulder arthroplasty (TSA) has only rarely been investigated and reported in the literature. We hypothesized that more FI and MA would be associated with a worse postoperative fun...
journal_title:Journal of shoulder and elbow surgery
pub_type: 杂志文章
doi:10.1016/j.jse.2017.12.021
更新日期:2018-06-01 00:00:00
abstract:BACKGROUND:Instability arthropathy is a known cause of glenohumeral osteoarthritis (OA) among patients with and without prior shoulder stabilization. This study aims to compare the clinical, radiographic, and patient-reported outcome measure (PROM) scores among total shoulder arthroplasty (TSA) patients with and withou...
journal_title:Journal of shoulder and elbow surgery
pub_type: 杂志文章
doi:10.1016/j.jse.2020.04.003
更新日期:2020-07-01 00:00:00
abstract:BACKGROUND:Pain is a complex and subjective reality and can be magnified by nonorganic or nonanatomic sources. Multiple studies have demonstrated a correlation between psychological factors and patients' perceptions of musculoskeletal pain and disability. In addition, nonorganic findings as part of the physical examina...
journal_title:Journal of shoulder and elbow surgery
pub_type: 杂志文章
doi:10.1016/j.jse.2018.02.056
更新日期:2018-07-01 00:00:00
abstract:BACKGROUND:Fatty infiltration of the muscle bellies is an important prognostic factor in rotator cuff tears. It was described initially in computed tomography examinations, and there is an ongoing debate about whether magnetic resonance (MR) is a reliable method for staging fatty infiltration. This study sought to dete...
journal_title:Journal of shoulder and elbow surgery
pub_type: 杂志文章
doi:10.1016/j.jse.2015.02.011
更新日期:2015-08-01 00:00:00
abstract:OBJECTIVE:To investigate the technical feasibility of harvesting a vascularized bone graft from the acromion pedicled on the acromial branch. BACKGROUND:Complex fractures of the proximal humerus may result in partial or total avascular necrosis of the head fragment. Treatment of avascular necrosis of the humeral head ...
journal_title:Journal of shoulder and elbow surgery
pub_type: 杂志文章
doi:10.1016/j.jse.2011.03.030
更新日期:2012-05-01 00:00:00
abstract::The purpose of this study was to define the anatomy and dimensions of the rotator interval (RI). Thirty-two fresh-frozen cadaveric shoulders were thawed, all external musculature was removed, and coracoid osteotomy was performed to visualize the rotator cuff and RI. The 3 sides of the RI (triangle) were measured in dy...
journal_title:Journal of shoulder and elbow surgery
pub_type: 杂志文章
doi:10.1016/j.jse.2005.02.022
更新日期:2005-11-01 00:00:00
abstract:BACKGROUND:Shoulder arthroscopy is a common orthopedic procedure typically performed on an outpatient basis. Occasionally, patients require an unplanned hospital admission. An understanding of the incidence and risk factors for admission after shoulder arthroscopy may assist surgeons in determining which patients may b...
journal_title:Journal of shoulder and elbow surgery
pub_type: 杂志文章
doi:10.1016/j.jse.2018.09.031
更新日期:2019-05-01 00:00:00
abstract::A prospective study was undertaken to determine if patients recover pre-injury level of shoulder function 1 year after 1 part proximal humeral fractures. Of the 67 patients enrolled, 43 were female and 24 male with an average age of 64.8 years (range, 25-90 years). All patients underwent a similar treatment protocol c...
journal_title:Journal of shoulder and elbow surgery
pub_type: 临床试验,杂志文章
doi:10.1016/j.jse.2007.07.016
更新日期:2008-03-01 00:00:00