Clavicula quirurgic-no quir

"Este ensayo clínico aleatorio que compara el tratamiento cabestrillo con la osteosíntesis para las fracturas desplazadas de diáfisis clavicular no revelaron diferencias en la puntuación de Constant, la puntuación DASH, o dolor su evaluación al año de seguimiento . Todas las fracturas en el grupo quirúrgico curaron, pero la prevalencia de la falta de unión en el grupo no quirúrgico fue alta (24%). Los pacientes con pseudoartrosis presentaron una mayor discapacidad en comparación con los pacientes con fracturas consolidadas, pero rechazaron  cualquier propuesta de cirugía reconstructiva."

Sling Compared with Plate Osteosynthesis for Treatment of Displaced Midshaft Clavicular Fractures: A Randomized Clinical TrialKaisa J. Virtanen, MD;et alt.(Department of Orthopaedics and Traumatology, Helsinki University Central Hospital and University of Helsinki.)
J Bone Joint Surg Am, 2012 Sep 05;94(17):1546-1553. doi: 10.2106/JBJS.J.01999

Infiltracio del espai subacromial

En un altre raco de la mateixa revista Moltes vegades hem vist controversia sobre la millor localització per la pràctica de infiltracions del espai subacromial. L'article , ben construït i desenvolupat conclou que la infiltracio per via lateral ( la que fem servir!!) o anterior es mes fiable que la posterior :

Injection of the Subacromial Bursa in Patients with Rotator Cuff Syndrome: A Prospective, Randomized Study Comparing the Effectiveness of Different Routes
J Bone Joint Surg Am, 2012 Aug 15;94(16):1442-1447. doi: 10.2106/JBJS.K.00534
Richard A. Marder, MD; Sunny H. Kim, PhD; Jerry D. Labson, MD; John C. Hunter, MD

Journal de l'Agost 12

Use of Platelet-Leukocyte Membrane in Arthroscopic Repair of Large Rotator Cuff Tears: A Prospective Randomized Study .J Bone Joint Surg Am, 2012 Aug 01;94(15):1345-1352. doi: 10.2106/JBJS.K.00394

Stefano Gumina, MD, Franco Postacchini, MD
In conclusion, the use of platelet-leukocyte membrane led to a slight improvement, as assessed by MRI, in the repair integrity of large tears involving the supraspinatus tendon, although this improvement was not associated with a better objective functional outcome.
Nevertheless, many aspects of the use of this membrane still have to be elucidated; further research is necessary to determine
(1) whether the membrane is absorbed, and how much time this requires,
(2) whether the membrane prevents or only slows down the development of rotator cuff retears, and
(3) whether passing the post suture through the membrane and covering it with the rotator cuff is sufficient to maintain the membrane in situ.
The primary limitation of this study is the relatively short duration of follow-up
O sigui que lo dels factorets per facturar pot ser una realitat que siguin mes per facturar que per altre cosa?

 
The Cost-Effectiveness of Single-Row Compared with Double-Row Arthroscopic Rotator Cuff Repair
James W. Genuario, MD, J Bone Joint Surg Am, 2012 Aug 01;94(15):1369-1377. doi: 10.2106/JBJS.J.01876
With use of current data for the average patient presenting with a rotator cuff tear, irrespective of tear size, double-row repair is not a cost-effective method of rotator cuff repair. The incremental cost associated with a second row of implants and associated operating-room time is not offset by the reduction in retear

En temps d'estalvi una bona notícia.

Ream and Run

The Prognosis for Improvement in Comfort and Function After the Ream-and-Run Arthroplasty for Glenohumeral Arthritis: An Analysis of 176 Consecutive Cases

Brian B. Gilmer, MD¹; Bryan A. Comstock, MS²; Jocelyn L. Jette, BS¹; Winston J. Warme, MD¹; Sarah E. Jackins, PT³; Frederick A. Matsen, MD

Sempre he pensat que la hemiartroplàstia  d'espatlla es una bona intervenció per millorar dolor i funció sense hipotecar glena ni diàfisis humeral . El treball del grup de Matsen mostra que la millora de la funció i comoditat obtinguts amb la tècnica de "ream and run" s'estabilitza als 20 mesos . A partir de aquesta data no hi ha una millora significativa. Això podria indicar que les avaluacions dels resultats de aquesta tècnica de hemiartroplàstia d'espatlla s'han de fer com a mínim als 20 mesos.Tambe per extensio la avaluacio de les hemis poden cercar aquest item "estabilitat" funcional.

Single Versus Double-Incision Technique for the Repair of Acute Distal Biceps Tendon Rupture

Conclusions: 
There were no significant differences in outcomes between the single and double-incision distal biceps repair techniques other than a 10% advantage in final flexion strength with the latter. Most complications were minor, with a significantly greater prevalence in the single-incision group.
The Journal of Bone & Joint Surgery, Volume 94, Issue 13



Un tema sempre controvertit vet aqui que al final lo millor sera fer lo que millor un sap fer ...

Pop Art

Les lesions de espatlla en el Valles es un tema calent , Els mercats volen comprar deute Tauli . A veure qui arriba primer no qui ho fa millor. Recordeu que els humans son dats al culte de la vanitat personal.

EFORT

Seguim pensant que la EFORT es un bon lloc on presentar els treballs de recerca i fer algun curs. Tot i que cada any es van fent mes serioses les sessions en tema de espatlla-colze son fluixes. He vist algun xines amb presentacions infumables.

Glenoid Track

Contact between the glenoid and humeral headin abducton , external totation, and horizontal extension: Glenoid track. Nobuyuki Yamamoto. JSES , Vol 15, Nº 5,  2007
Defineix la zona del cap huemral on articula amb la glena en flexio rotacio externa com el glenoid Track i equival al 84% de l'amplada de la glena. en aquesta zona es on hi ha la lesio de Hill-Sachs ó de Malgaine per els Fracofons. Si la lesio de Hill - Sachs s'exten medialment al glenoid track hi ha risc de "egagement" i luxacio

.

fractura coracoides i convulsions

Inestabilidad anterior del hombro asociada a  falta de unión de la coracoides en pacientes con 

un trastorno convulsivo C. Michael Robinson, 

Journal of Bone and Joint Surgery .  2012; 94: E40 6.1   doi: 10.2106/JBJS.K.00188

En conclusión, nuestro estudio identificó una relación no reconocida previamente entre la fractura de coracoides falta de unión y de la  inestabilidad anterior recurrente del hombro en pacientes con un trastorno convulsivo. 

No se encontró en los otros pacientes con inestabilidad  glenohumeral anterior traumática una fractura de la apófisis coracoides. Se recomienda un alto índice de sospecha en el tratamiento de pacientes con un trastorno convulsivo que tienen inestabilidad anterior del hombro, y recomendamos hacer una TC preoperatoria, si hay una fuerte  probabilidad de que una transferencia coracoides se utilice en la cirugía. Esto permite el diagnóstico 

de una fractura coracoides i ò seudoartrosis previa a la cirugía y ayuda a determinar si hay hueso suficiente para permitir un procedimiento de Latarjet. Deben ser consideradas técnicas  alternativas si la falta de unión de la coracoides es muy distal.

Acromion tipo 1,2,3 y 5 .....

Journal of Shoulder and Elbow Surgery

Article in Press

Relationship of radiographic acromial characteristics and rotator cuff disease: a prospective investigation of clinical, radiographic, and sonographic findings

Nady Hamid, MD, Reza Omid, MD, Ken Yamaguchi, MD
Conclusions 
1.-The presence of an acromial spur at the acromial insertion of the coracoacromial ligament is highly associated with the presence of a full-thickness rotator cuff tear in both symptomatic and asymptomatic subjects, even after controlling for confounding variables such as age and sex. 
2.-Spurs measuring greater than 5 mm are associated with larger rotator cuff tears. 
3.-Acromial morphology is an unreliable classification system with poor interobserver reliability. (***)
4.-The acromial index is associated with the development of pain in previously asymptomatic shoulders, but shows no association with the presence of rotator cuff disease.

(***) Reflexionem d'una vegada  la class de Bigliani no es útil en el maneig de les lesions del manegot.

Rotator Cuff Tear Arthropathy: Evaluation, Diagnosis, and Treatment:

Rotator Cuff Tear Arthropathy: Evaluation, Diagnosis, and Treatment: 
AAOS Exhibit Selection
J Bone Joint Surg Am.  2012;94(6):E34 1-11  doi:10.2106/jbjs.k.00746Denis Nam, MD; Travis G. Maak, MD; Bradley S. Raphael, MD; Christopher K. Kepler, MD; Michael B. Cross, MD; Russell F. Warren, MD


Un resum molt ben fet sobre la ARTROSI PER RUPTURA DEL MANEGOT. Serán les proximes pròtesi i cal estar al dia de lo que insistirá la industria en que posem als pacients...

Espatlla "capturada"

Tot hi havent passat 13 anys de la seua descripció el terme es "enginyos". Espatlla capturada per diferenciar-la de la espatlla "capsulitica" ó congelada dels saxons.

Captured shoulder: a complication of rotator cuff surgery.

Mormino MA, Gross RM, McCarthy JA.

Source

Creighton-Nebraska Health Foundation, Orthopaedic Residency Program, Omaha, USA.

Abstract

Thirteen patients who developed restrictive subdeltoid adhesions after rotator cuff repair were identified. These patients underwent second-look arthroscopy and takedown of adhesions at an average of 37 weeks after their index surgery. Clinical findings include pain and restricted motion that does not yield to manipulation under anesthesia. Arthroscopic findings are subdeltoid adhesions and a chondral lesion (companion lesion) of the humeral head articular surface. Patients were reevaluated at 26 weeks after their release of adhesions. Prerelease and postrelease University of California, Los Angeles (UCLA) scores average 14.8 and 30.1, respectively. Prerelease and postrelease UCLA pain scores averaged 2.6 and 7.7, respectively. Prerelease and postrelease range of motion was as follows: Flexion, 141/158; abduction, 123/141; internal rotation, 47/69; and external rotation, 53/74. The authors have proposed a theory to explain the clinical and arthroscopic findings in this subgroup of patients who are dissatisfied after rotator cuff repair. A technique for and the results of release of the subdeltoid adhesions also are reported.

National Trends in Rotator Cuff Repair

National Trends in Rotator Cuff Repair

Alexis Chiang Colvin, MD; Natalia Egorova, PhD, MPH; Alicia K. Harrison, MD; Alan Moskowitz, MD; Evan L. Flatow, MD

The Journal of Bone & Joint Surgery.  2012; 94:227-233  doi:10.2106/JBJS.J.00739

Background: 

Recent publications suggest that arthroscopic and open rotator cuff repairs have had comparable clinical results, although each technique has distinct advantages and disadvantages. National hospital and ambulatory surgery databases were reviewed to identify practice patterns for rotator cuff repair.

Methods: 

The rates of medical visits for rotator cuff pathology, and the rates of open and arthroscopic rotator cuff repair, were examined for the years 1996 and 2006 in the United States. The national incidence of rotator cuff repairs and related data were obtained from inpatient (National Hospital Discharge Survey, NHDS) and ambulatory surgery (National Survey of Ambulatory Surgery, NSAS) databases. These databases were queried with use of International Classification of Diseases, Ninth Revision (ICD-9) procedure codes for arthroscopic (ICD-9 codes 83.63 and 80.21) and open (code 83.63 without code 80.21) rotator cuff repair. We also examined where the surgery was performed (inpatient versus ambulatory surgery center) and characteristics of the patients, including age, sex, and comorbidities.

Results: 

The unadjusted volume of all rotator cuff repairs increased 141% in the decade from 1996 to 2006. The unadjusted number of arthroscopic procedures increased by 600% while open repairs increased by only 34% during this time interval. There was a significant shift from inpatient to outpatient surgery (p < 0.001).

Conclusions: 

The increase in national rates of rotator cuff repair over the last decade has been dramatic, particularly for arthroscopic assisted repair.

Injuries Associated with Traumatic Anterior Glenohumeral Dislocations

Lesions asociades a les luxacions escapulohumerals . Mes freqüents de lo esperades Les neurologiques esperables en 1 de cada tres que tinguin lesions del manegot o fractura troquiter associada!!

Robinson

The Journal of Bone and Joint Surgery (American)  2012; 94:18-26  doi:

10.2106/JBJS.J.01795

Background: A number of shoulder girdle injuries are associated with acute anterior glenohumeral dislocations. In the present study we evaluated the prevalence of neurological deficits, greater tuberosity fractures, and rotator cuff injuries in a population of unselected patients who presented with a traumatic anterior glenohumeral dislocation.

Methods: A prospective trauma database was used to record the demographic details on 3633 consecutive patients (2250 male patients and 1383 female patients with a mean age of 47.6 years) who had sustained a traumatic anterior glenohumeral dislocation between 1995 and 2009. On the basis of these data, we assessed the prevalence of and risk factors for ultrasound-proven rotator cuff tears, tuberosity fractures, and neurological deficits occurring in association with the dislocation.

Results: Of the 3633 patients who had a dislocation, 492 patients (13.5%) had a neurological deficit following reduction and 1215 patients (33.4%) had either a rotator cuff tear or a greater tuberosity fracture. A dislocation with a neurological deficit alone was found in 210 patients (5.8%), a dislocation with a rotator cuff tear or a greater tuberosity fracture was found in 933 patients (25.7%), and a combined injury pattern was found in 282 patients (7.8%). Female patients with an age of sixty years or older who were injured in low-energy falls were more likely to have a rotator cuff tear or a greater tuberosity fracture. The likelihood of a neurological deficit after an anterior glenohumeral dislocation was significantly increased for patients who had a rotator cuff tear or a greater tuberosity fracture (relative risk, 1.9 [95% confidence interval, 1.7 to 2.1]; p < 0.001).

Conclusions: The prevalence of rotator cuff tear, greater tuberosity fracture, or neurological deficit following primary anterior glenohumeral dislocation is greater than previously appreciated. These associated injuries may occur alone or in combined patterns. Dislocations associated with axillary nerve palsy have similar demographic features to isolated dislocations. Injuries associated with a rotator cuff tear, greater tuberosity fracture, or complex neurological deficit are more common in patients sixty years of age or older. Careful evaluation of rotator cuff function is required for any patient with a dislocation associated with a neurological deficit, and vice versa