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Management of Greater Tuberosity Fractures
The appropriate management of greater tuberosity fractures of the humerus is dependent on the knowledge of relevant anatomy, injury epidemiology, fracture pattern and, importantly, an understanding of the injured patient. Most fractures are nondisplaced and can be treated nonoperatively, following a multiphasic protocol. In general, displacement measuring 5 mm or more is recommended for surgery. Surgery may be performed arthroscopically, percutaneously, with open reduction and internal fixation, or a combination of the aforementioned. Several factors such as surgeon experience, preference, chronicity, size, and comminution...
Source: Techniques in Shoulder and Elbow Surgery - August 6, 2016 Category: Orthopaedics Tags: Techniques Source Type: research

Shoulder Fracture Special Preface
No abstract available (Source: Techniques in Shoulder and Elbow Surgery)
Source: Techniques in Shoulder and Elbow Surgery - August 6, 2016 Category: Orthopaedics Tags: Introduction Source Type: research

Safety of the “Inside-Out” Radiofrequency Ablation Technique for Rapid Localization of the Biceps Tendon in the Subacromial Space
The purpose of this study was to evaluate a novel technique for localization of the long head of biceps tendon in the subacromial space. The procedure was documented in a cadaveric specimen and a subsequent surgical dissection was performed. The biceps tendon was quickly and easily located. Subsequent dissection demonstrated that no iatrogenic injury occurred to the rotator cuff. This technique offers rapid localization of the long head of biceps tendon through “inside-out” division of the transverse humeral ligament. It also offers a reduction in the risk of iatrogenic injury to the adjacent rotator cuff. (Source: Tec...
Source: Techniques in Shoulder and Elbow Surgery - April 28, 2016 Category: Orthopaedics Tags: Techniques Source Type: research

Corrective Surgical Neck Osteotomy for Varus Malunion of the Proximal Humerus
Surgical neck malunions after proximal humerus fractures can be associated with shoulder pain and dysfunction. The purpose of this study was to describe a technique and outcome of corrective osteotomy. This was a retrospective study of 14 patients with a symptomatic varus surgical neck malunion without glenohumeral arthritis who were treated at 2 centers with a valgus, closing wedge surgical neck osteotomy and fixed angle, blade plate fixation. The mean age was 60 years old (range, 44 to 78 y), and the mean interval between original injury and treatment was 24 months (range, 3 to 180 mo). The mean preoperative neck-shaft d...
Source: Techniques in Shoulder and Elbow Surgery - April 28, 2016 Category: Orthopaedics Tags: Techniques Source Type: research

Predictors of Early Complications After Rotator Cuff Repair
To identify risk factors for complications after rotator cuff repair, all repairs (open and arthroscopic, single row and double row, primary and revision) performed by a single surgeon over a 4-year period were reviewed. Complications were classified as minor or major. Minor complications included serous drainage, local erythema resolving with observation or oral antibiotics, and associated shoulder girdle tendinitis. Major complications included wound or deltoid dehiscence, recurrent rotator cuff tear with clinical decompensation, and deep infection requiring surgical treatment. Ninety-two patients (96 repairs, 31 open an...
Source: Techniques in Shoulder and Elbow Surgery - April 28, 2016 Category: Orthopaedics Tags: Techniques Source Type: research

Massive Rotator Cuff Repair With All-Arthroscopic Patch Augmentation: A Surgical Technique
Surgical management of massive rotator cuff tears is plagued by structural failure rates as high as 94%. Multiple arthroscopic and open techniques have been described, but there is no current gold standard. Biological healing at the tendon footprint is key to avoiding failure. Xenograft patch placement has been described as a possible technique to augment the biology of rotator cuff repair when tendon quality is compromised. The purpose of this article is to describe an all-arthroscopic technique of patch augmentation for repair of massive rotator cuff tears. (Source: Techniques in Shoulder and Elbow Surgery)
Source: Techniques in Shoulder and Elbow Surgery - April 28, 2016 Category: Orthopaedics Tags: Techniques Source Type: research

Transtendon Repairs for Partial-Thickness Supraspinatus Tears
Partial-thickness tears of the supraspinatus tendon are a common source of shoulder pain and dysfunction. The ideal treatment of partial-thickness tears involving the articular side remains an area of debate. In this article, we present the transtendon repair technique for partial-thickness articular-sided supraspinatus tears. (Source: Techniques in Shoulder and Elbow Surgery)
Source: Techniques in Shoulder and Elbow Surgery - April 28, 2016 Category: Orthopaedics Tags: Techniques Source Type: research

Bicep Tenodesis Techniques With Rotator Cuff Tears: Fork, Rope, and Open
The long head of the bicep (LHB) brachii tendon is a well-known pain generator in the shoulder. However, it can be difficult to identify the LHB as the cause of the pain as it commonly is combined with other shoulder conditions. Initial treatment of LHB tendon pathologies is usually nonoperative treatment; however, if this fails the surgical options include tenotomy versus tenodesis. Tenotomies can be done quickly and commonly relieve pain associated with the pathology and requires less postoperative restrictions and rehabilitation compared with tenodesis. Despite these advantages, a tenodesis is recommended in patients le...
Source: Techniques in Shoulder and Elbow Surgery - April 28, 2016 Category: Orthopaedics Tags: Techniques Source Type: research

Transverse Ulna Osteotomy for Revision Total Elbow Arthroplasty: Surgical Technique and Outcomes
Revision total elbow arthroplasty (TEA) presents a significant surgical challenge. Component removal, especially of a well-fixed ulnar stem can be particularly difficult and require osteotomy for stem or cement removal. Prior literature has examined the use of a longitudinal osteotomy, which poses risks for healing and distal perforation. In this case series, we present a technique and results of using a transverse osteotomy of the ulna for aid in component removal. A retrospective review of all patients undergoing revision TEA at our institution was performed. Patients who underwent a transverse osteotomy were identified....
Source: Techniques in Shoulder and Elbow Surgery - April 28, 2016 Category: Orthopaedics Tags: Techniques Source Type: research

Versatility Through the Boyd Approach
Complex elbow fractures are among the most difficult to treat due to the multiple articulations requiring reduction and the density of neurovascular structures limiting exposure. Frequently multiple approaches are required to access all bones involved without sacrificing important surrounding structures. Some of the most complex injuries include fractures of the olecranon, radial head, and coronoid from fracture/disruptions of the elbow. In these instances, the ulnohumeral, radiocapitellar, and proximal radioulnar joints are all disrupted and require visualization for appropriate treatment. Boyd first described a single-in...
Source: Techniques in Shoulder and Elbow Surgery - April 28, 2016 Category: Orthopaedics Tags: Techniques Source Type: research

Acromial Malunion After Prior Acromioplasty Associated With Deltoid Dysfunction
Deltoid dysfunction is a devastating complication following shoulder surgery. In this case report we describe complications following an arthroscopic acromioplasty and open rotator cuff repair that resulted in an acromial fracture and malunion, deltoid dysfunction, and compromise of the acromioclavicular/coracoclavicular ligament complex. The patient was informed that data concerning this case would be submitted for publication and she consented. (Source: Techniques in Shoulder and Elbow Surgery)
Source: Techniques in Shoulder and Elbow Surgery - April 28, 2016 Category: Orthopaedics Tags: Techniques Source Type: research

Double-Row, Transosseous-Equivalent Suture-Bridge Repair for Supraspinatus Tears: Power Up the Healing
Arthroscopic rotator cuff repair is one of the most commonly performed surgeries in orthopedics. The primary goal of this procedure is to reduce shoulder pain and restore its function so that patients may return to some of their preinjury activities. Arthroscopic double-row transosseous-equivalent or suture-bridge repair techniques have become increasingly popular over the last decade. This repair technique, which uses 2 rows of suture anchors to recreate a biomechanically favorable healing environment at the anatomic footprint of the rotator cuff, produces a strong fixation construct with improved tendon-to-bone contact a...
Source: Techniques in Shoulder and Elbow Surgery - April 28, 2016 Category: Orthopaedics Tags: Techniques Source Type: research

Fresh Osteochondral Allograft Transplantation for the Treatment of Unstable Osteochondritis Dissecans of the Capitellum in the Elbow
We describe our ligament-sparing technique and clinical experience with the transplantation of fresh osteochondral allograft to treat unstable osteochondritis dissecans of the capitellum, namely in overhead athletes. (Source: Techniques in Shoulder and Elbow Surgery)
Source: Techniques in Shoulder and Elbow Surgery - February 4, 2016 Category: Orthopaedics Tags: Techniques Source Type: research

Distal Ulna Allograft for Proximal Humerus Fractures
In this report, we describe the use of a distal ulna allograft for reconstruction of proximal humerus fractures. Because of its anatomic curve, the distal ulna may aid in reduction and help prevent varus collapse. Surgical technique, procedure pearls, and results are described. (Source: Techniques in Shoulder and Elbow Surgery)
Source: Techniques in Shoulder and Elbow Surgery - February 4, 2016 Category: Orthopaedics Tags: Techniques Source Type: research

Two Double Sliding Rows: A New Technique for Stable Fixation of Lesser Tuberosity Osteotomy After Shoulder Resurfacing Arthroplasty, 2-Year Follow-up
The aim of the work is to describe a new technique, Two Double Sliding Rows (TDSR), for lesser tuberosity osteotomy fixation in shoulder resurfacing or stemless arthroplasties. Thirty shoulders were treated with TDSR. Lesser tuberosity osteotomy fixation was performed with 4 Corkscrew double-loaded suture anchors, implanted 2 medially and 2 laterally to the osteotomy. Assessment at 2-year follow-up included Constant and Murley score, Simple Shoulder Test, and physical examination focused on the subscapularis. Imaging included conventional radiography, computed tomography and ultrasound to assess healing of the osteotomy si...
Source: Techniques in Shoulder and Elbow Surgery - February 4, 2016 Category: Orthopaedics Tags: Techniques Source Type: research