Discusión entre pares / 52 yrs male displaced fr.surg. neck humerus. Opine please

Indian-Orthopaedic Research-Group

DrAkhilesh Singh

13 horas

52 yrs male displaced fr.surg. neck humerus. Opine please

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  DrAkhilesh Singh CR+IF P/C Pinning with ex.fix

  

  11 horas · Me gusta · 1
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  Javed Shaikh How u will mobilise nw?

  9 horas · Me gusta
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  Sanjay Joseph In this case I would use a proximal humerus locking plate via delto-pectoral approach. Gives predictably good results, allows immediate mobilization and there is seldom need for hardware removal.

Fuente original del artículo / surgeon-describes-shoulder-arthropathy-outcomes-more-than-30-years-after-bristow-repair-for-instability

Surgeon describes shoulder arthropathy outcomes more than 30 years after Bristow repair for instability

• Orthopedics Today, April 2014

Cirujano describe artropatía de hombro resultados más de 30 años después de la reparación de la inestabilidad Bristow

Ortopedia Hoy , abril 2014

NUEVA ORLEANS - En un largo plazo de seguimiento de 31 hombros tratados con la reparación Bristow - Latarjet para la inestabilidad , Lennart Hovelius , MD, informó que cerca de dos tercios de los pacientes permanecieron satisfechos con su resultado quirúrgico .

Hovelius dijo que sus casos estaban entre los de cuatro hospitales de Suecia en la serie original , que se publicó en 1983.

" Estas reparaciones son los primeros que hicimos con coracoides de pie y un tornillo. Once había fallado previamente a cirugía . Todos los pacientes tuvieron seguimiento con rayos X después de 33 años . Resultados : uno tenía la cirugía de revisión . Ninguno tenía más cirugía de cualquier tipo ", dijo .

Según Hovelius , una posible fuerza de este esfuerzo fue que dos observadores clasifican en dos ocasiones casi la cantidad de artropatía en los pacientes que utilizan el sistema Samilson -Prieto durante los 33 años a 35 años de seguimiento.

Sin embargo , algunas de las evaluaciones de la gravedad de la artropatía varió entre los observadores.

" Los valores medios fueron del 27 % artropatía leve, 23 % moderada y el 11 % graves . Sabemos que más del 50 % tenían artropatía 20 años después de la luxación primaria " , dijo Hovelius .

Señaló que , con base en los resultados de esta serie , tal vez el Índice de Western Ontario Inestabilidad de hombro es un sistema mejor utilizar para evaluar a los pacientes después de las reparaciones Bristow . Dijo que los resultados del paciente con ese índice correspondía mejor con la cantidad de la artrosis del paciente .

" La clasificación Samilson tal vez no sea apropiado", dijo Hovelius . - Por Susan M. Rapp

NEW ORLEANS — In a long-term follow-up of 31 shoulders treated with the Bristow-Latarjet repair for instability, Lennart Hovelius, MD, reported that about two-thirds of patients remained satisfied with their surgical result.

Hovelius said his cases were among those from four Swedish hospitals in the original series, which was published in 1983.

“These repairs are the first we did with coracoid standing and one screw. Eleven had previously failed surgery. All patients had the follow-up with X-ray after 33 years. Results: one had revision surgery. None had further surgery of any kind,” he said.

According to Hovelius, a possible strength of this effort was that two observers twice classified nearly the amount of arthropathy in the patients using the Samilson-Prieto system during the 33-years to 35-years follow-up.

However, some of the assessments of arthropathy severity varied between the observers.

“Mean values were 27% mild arthropathy, 23% moderate and 11% severe. We know that more than 50% had arthropathy 20 years after the primary dislocation,” said Hovelius.

He noted that, based on outcomes in this series, perhaps the Western Ontario Shoulder Instability Index is a better system to use to assess patients after Bristow repairs. He said patient outcomes with that index better corresponded with patient’s amount of arthrosis.

“The Samilson classification is perhaps not appropriate,” Hovelius said. – by Susan M. Rapp

Reference:

Hovelius L. Paper #126. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 11-15, 2014; New Orleans.

Disclosure: Hovelius has no relevant financial disclosures.

Panel discusses use of reverse total shoulder arthroplasty for proximal humeral fractures

Panel discusses use of reverse total shoulder arthroplasty for proximal humeral fractures

Management of displaced three- and four-part proximal humeral fractures continues to challenge surgeons. Advocates of nonoperative management, percutaneous pinning, open reduction and internal fixation and hemiarthroplasty all support their technique in certain clinical scenarios. Historically, hemiarthroplasty was considered the “gold standard” for displaced four-part proximal humeral fractures in the elderly patient. While pain relief was reliable, active motion was less predictable and sometimes catastrophic if the tuberosities failed to heal. Reverse total shoulder replacement has emerged as a viable option in the elderly patient with complex displaced four-part proximal humeral fractures.

I would like to thank our esteemed panel, which includes international and national leaders in the field of shoulder arthroplasty, all of whom have extensive experience with reverse total shoulder replacement.

William N. Levine, MDModerator

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Complicated Acromioclavicular Joint Cyst With Massive Rotator Cuff Tear : The American Journal of Orthopedics

Complicated Acromioclavicular Joint Cyst With Massive Rotator Cuff Tear  : The American Journal of Orthopedics

A new case report presents 2 cases involving an infected acromioclavicular joint cyst with a massive rotator cuff tear caused by simple cyst excision

Complicated Acromioclavicular Joint Cyst With Massive Rotator Cuff Tear : The American Journal of Orthopedics

Complicated Acromioclavicular Joint Cyst With Massive Rotator Cuff Tear  : The American Journal of Orthopedics

A new case report presents 2 cases involving an infected acromioclavicular joint cyst with a massive rotator cuff tear caused by simple cyst excision

Is There a Role for Arthroscopy in the Treatment of Glenohumeral Arthritis? : The American Journal of Orthopedics

Is There a Role for Arthroscopy in the Treatment of Glenohumeral Arthritis?  : The American Journal of Orthopedics

February's Guest Editorial by Brian J. Cole, MD and Chris Mellano, MD discusses arthroscopy in the treatment of glenohumeral arthritis

Using Computed Tomography to Assess Proximal Humerus Fractures : The American Journal of Orthopedics

Using Computed Tomography to Assess Proximal Humerus Fractures : The American Journal of Orthopedics

Ramappa and colleagues conducted a study to determine if use of preoperative CT scans affects surgical decision-making with respect to proximal humerus fractures