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Four-dimensional Computer Simulation for Chronic Monteggia and Monteggia-like Lesions
The pattern of 3-dimensional deformity of the forearm in missed Monteggia fracture and Monteggia-like lesions is very complicated. Recently, computer-assisted preoperative planning using 3-dimensional computed tomography (CT) modeling has been used for the treatment of malunited fractures. We developed a 4-dimensional simulation system by adding the anatomic motion axis to the 3-dimensional CT scan data of the affected arm in 1 position. Our system is based on the motion axis of the forearm passing through the center axis of the radial head and capitellum to the ulnar fovea. We simulate the osteotomy angle and amount of co...
Source: Techniques in Shoulder and Elbow Surgery - May 2, 2017 Category: Orthopaedics Tags: Techniques Source Type: research

Resurfacing Total Shoulder Replacement With Both Humeral and Glenoid-sided Biological Fixation: The Cage Match
Resurfacing humeral heads have several advantages over stemmed total shoulder replacement including bone preservation and the potential for more anatomic humeral reconstruction. With a systematic approach to glenoid exposure including complete release of the anterior, inferior, and posterior capsules, these advantages can be realized in the setting of total shoulder arthroplasty. The Cage Match technique describes such a combination using the Equinoxe Resurfacing Humeral head in combination with the Equinoxe Cage Glenoid. This combined technique provides biological fixation on both the humeral and glenoid side by bone ingr...
Source: Techniques in Shoulder and Elbow Surgery - February 2, 2017 Category: Orthopaedics Tags: Techniques Source Type: research

Antibiotic Spacer for Infected Structural Flail Elbow: A New Surgical Technique
We present an elbow salvage technique involving a custom-fabricated antibiotic spacer affixed to a fully threaded Ilizarov rod, forming a lollipop-shaped construct that is impacted into the distal humeral medullary canal. This provides a spherical surface with which the radius and ulna articulate. We advise against using a smooth Steinmann pin with this technique. In our experience, this technique has restored the soft tissue tension at the elbow and provided a stable, functional joint. (Source: Techniques in Shoulder and Elbow Surgery)
Source: Techniques in Shoulder and Elbow Surgery - February 2, 2017 Category: Orthopaedics Tags: Techniques Source Type: research

Predictors of Postoperative Pain and Narcotic Use After Primary Arthroscopic Rotator Cuff Repair
To determine specific patient characteristics that might be predictive of pain and narcotic use after primary arthroscopic rotator cuff repair, repairs performed by a single surgeon over a 4-year period were identified. Patient-specific preoperative factors investigated included tobacco use, narcotic use, chronic pain syndromes, disability claims, mood disorders (depression/anxiety), workers’ compensation claims, and obesity. Outcome measures included visual analog pain scores and narcotic usage. For the 65 repairs in the study, significant predictors of increased pain scores at 12 weeks were preoperative narcotic use, c...
Source: Techniques in Shoulder and Elbow Surgery - February 2, 2017 Category: Orthopaedics Tags: Research Article Source Type: research

Biologic Options in Rotator Cuff Repair: Current Indications and Techniques
The normal rotator cuff tendon to bone insertion site is not recreated after repair. Instead of the normal fibrocartilaginous transition zone, repaired tendons heal with a layer of interposing scar tissue. This alteration in the biology makes rotator cuff repairs prone to failure. Various methods have been proposed to biologically augment rotator cuff repairs including platelet-rich plasma, patches, stem cells, and molecular factors such as cytokines. Currently, there is insufficient evidence in the literature to support platelet-rich plasma as an augment for rotator cuff repair. Patches should only be used as an augment a...
Source: Techniques in Shoulder and Elbow Surgery - February 2, 2017 Category: Orthopaedics Tags: Rotator Cuff Disease: State of the Art in 2016-Techniques Source Type: research

Superior Capsular Reconstruction for Irreparable Rotator Cuff Tears
One of the greatest challenges faced by shoulder surgeons remains the chronic massive irreparable rotator cuff tear. Several surgical options have been introduced but each has unique shortcomings particularly in physiologically young patients. As a result the technique of superior capsular reconstruction has been developed as an alternative solution in these patients. This technique is supported by biomechanical rationale as well as early promising clinical results with significant improvements in pain, range of motion, and patient-reported outcomes. For these reasons there is great interest in this procedure and the conti...
Source: Techniques in Shoulder and Elbow Surgery - February 2, 2017 Category: Orthopaedics Tags: Rotator Cuff Disease: State of the Art in 2016-Techniques Source Type: research

The Evolution of Arthroscopic Rotator Cuff Repair Techniques: What Repair Construct to Use and How to Do It Well
Arthroscopic repair of rotator cuff tears has gone through progressive advances in the arthroscopic principles of repair, repair techniques, and how implants are utilized to maximize healing potential. The type of rotator cuff tear from partial tears to full thickness tears, whether traumatic or degenerative, affects the way we approach these tears. In this review, we will present technical pearls on our method for repair of partial articular-sided and bursal-sided rotator cuff tear, as well as full thickness tears amenable to surgical repair. (Source: Techniques in Shoulder and Elbow Surgery)
Source: Techniques in Shoulder and Elbow Surgery - February 2, 2017 Category: Orthopaedics Tags: Rotator Cuff Disease: State of the Art in 2016-Techniques Source Type: research

Rehabilitation Strategies After Rotator Cuff Repair: How to Optimize Outcomes
The postoperative management of patients undergoing rotator cuff repair plays an important role in determining the outcome of the surgical procedure. The purpose of this article is to discuss the various rehabilitation strategies that are currently being utilized after rotator cuff surgery and the rationale behind them. In examining the recent literature, our goal is to outline the risks and benefits of various rehabilitation strategies in an effort to provide information to optimize patient outcomes after their rotator cuff repair. (Source: Techniques in Shoulder and Elbow Surgery)
Source: Techniques in Shoulder and Elbow Surgery - November 2, 2016 Category: Orthopaedics Tags: Techniques Source Type: research

Arthroscopic Patch Augmentation for Rotator Cuff Repair
Revision rotator cuff repair and surgical repair of massive rotator cuff tears present a significant technical challenge to orthopedic surgeons with unacceptably high failure rates. Rotator cuff repair augmentation using biological or synthetic patches has been proposed as a potential method to improve repair integrity, particularly in those patients with poor tendon quality. The purpose of this review is to discuss the available patch or scaffold options and review the surgical technique and technical pearls. (Source: Techniques in Shoulder and Elbow Surgery)
Source: Techniques in Shoulder and Elbow Surgery - November 2, 2016 Category: Orthopaedics Tags: Techniques Source Type: research

Revision Rotator Cuff Repair: Tips and Tricks to Get it Repaired and to Get it to Heal
Revision rotator cuff repair is a complex and increasingly common problem. Failure of initial tendon healing is caused by a variety of factors, most prominently biological, but technical factors of the primary surgery and post-operative trauma also contribute. Identifying a failed rotator cuff surgery is based on a combination of imaging and physical exam. However, the decision to proceed with a revision rotator cuff repair is more complex and based on predicted success of the revision procedure as well as an extensive discussion with the patient that revision cuff surgery is more complex procedure with higher failure rate...
Source: Techniques in Shoulder and Elbow Surgery - November 2, 2016 Category: Orthopaedics Tags: Techniques Source Type: research

The Natural History of Rotator Cuff Disease: Evidence in 2016
Significant advancements have been made in the understanding of the natural history of symptomatic and asymptomatic rotator cuff (RC) tearing as well as the indications for their treatment. RC tears have a significant predilection toward tear enlargement. Risk factors for tear enlargement include the initiation of pain, higher degrees of muscle degeneration, older age, longer duration of follow-up, and increased tear severity (full-thickness vs. partial-thickness). It is still unclear if larger tear size (width) predisposes toward a higher risk for tear enlargement. Increased tear retraction appears to be associated with f...
Source: Techniques in Shoulder and Elbow Surgery - November 2, 2016 Category: Orthopaedics Tags: Techniques Source Type: research

Foreword
No abstract available (Source: Techniques in Shoulder and Elbow Surgery)
Source: Techniques in Shoulder and Elbow Surgery - November 2, 2016 Category: Orthopaedics Tags: Foreword Source Type: research

Reverse Total Shoulder Arthroplasty for Proximal Humerus Fracture
Reverse shoulder arthroplasty (RSA) has gained wide acceptance for its primary indication, cuff tear arthropathy. The last 5 years, however, has seen the utilization of RSA increase, dramatically, as one of the preferred methods for treating proximal humeral fractures in the elderly. By utilizing surgical techniques that focus on tuberosity reconstruction, excellent results can be see with reverse shoulder replacement for fracture; in fact, RSA for fracture has demonstrated more reliable outcomes than hemiarthroplasty for fracture and is favored in the elderly population. (Source: Techniques in Shoulder and Elbow Surgery)
Source: Techniques in Shoulder and Elbow Surgery - August 6, 2016 Category: Orthopaedics Tags: Techniques Source Type: research

Open Reduction and Internal Fixation of 3- and 4-Part Proximal Humerus Fractures
This article begins with an overview of fracture classification and pertinent anatomic considerations to identify those fractures amenable to open reduction and internal fixation. A surgical technique guide follows, accompanied by tips and technical pearls from the author. The goal of surgery in these cases is to obtain stable, anatomic fixation, and to avoid the most common complications of fixation: avascular necrosis, varus collapse, and intra-articular screw penetration. (Source: Techniques in Shoulder and Elbow Surgery)
Source: Techniques in Shoulder and Elbow Surgery - August 6, 2016 Category: Orthopaedics Tags: Techniques Source Type: research

Hemiarthroplasty for Proximal Humerus Fractures
Fractures of the proximal humerus are most commonly treated nonoperatively. Displaced 3-part or 4-part proximal humeral fractures in elderly patients are best treated with arthroplasty. Despite the increased utilization of reverse shoulder arthroplasty, hemiarthroplasty for the treatment of these fractures has traditionally been the gold standard. It is important to understand the key concepts of performing a hemiarthroplasty for these fractures. A well-performed hemiarthroplasty may outperform other surgical options in nonelderly patients. (Source: Techniques in Shoulder and Elbow Surgery)
Source: Techniques in Shoulder and Elbow Surgery - August 6, 2016 Category: Orthopaedics Tags: Techniques Source Type: research