Short-term comparative outcomes between reverse shoulder arthroplasty for shoulder trauma and shoulder arthritis: a Southeast Asian experience.

BACKGROUND: Reverse shoulder arthroplasty (RSA), first introduced as a management option for cuff tear arthropathy, is now an accepted treatment for complex proximal humeral fractures. Few studies have identified whether the outcomes of RSA for shoulder trauma are comparable to those of RSA for shoulder arthritis. METHODS: This is a retrospective, single-institution cohort study of all patients who underwent RSA at our institution between January 2013 and December 2019. In total, 49 patients met the inclusion criteria. As outcomes, we evaluated the 1-year American Shoulder and Elbow Surgeons (ASES) and Constant shoulder scores, postoperative shoulder range of motion, intra- and postoperative complications, and cumulative revision rate. The patients were grouped based on preoperative diagnosis to compare postoperative outcomes across two broad groups. RESULTS: The median follow-up period was 32.8 months (interquartile range, 12.6-66.6 months). The 1-year visual analog scale, range of motion, and Constant and ASES functional scores were comparable between RSAs performed to treat shoulder trauma and that performed for arthritis. The overall complication rate was 20.4%, with patients with a preoperative diagnosis of arthritis having significantly more complications than those with a preoperative diagnosis of trauma (34.8% vs. 7.7%). CONCLUSIONS: Patients who underwent RSA due to a proximal humeral fracture or dislocation did not fare worse than those who underwent RSA for arthritis at 1 year, in terms of both functional and radiological outcomes.

The effect of post-fixation olecranon lengthening on range of motion of the elbow: a cadaveric study.

BACKGROUND: Principles of fixation of comminuted olecranon fractures include anatomical reduction of the articular surface and restoration of ulnohumeral joint motion. However, comminution sometimes may not permit anatomical fixation of fracture fragments, resulting in inadvertent olecranon lengthening after plate fixation. The aim of our study is to investigate the relationship between olecranon lengthening following plate fixation and loss of elbow extension. MATERIALS AND METHODS: Transverse olecranon osteotomies were performed on 8 cadaveric elbows. The osteotomy sites were then fixed with olecranon plates. Lengthening of the osteotomy sites were simulated by placement of 2mm, 4mm, 6mm and 8mm blocks. Lateral view photographs of the elbows were taken after each degree of lengthening. These photographs were then printed and measurements of elbow extension were performed with a goniometer with average values taken. The measurements were tabulated and statistical analysis performed to determine the relationship between degree of elbow extension loss and amount of olecranon lengthening. RESULTS: Average values of each degree of lengthening (at 2mm, 4mm, 6mm and 8mm) were taken and compared with the baseline measurement (at 0mm). Cluster analysis showed that for every increment in osteotomy length of 2mm, there is a corresponding increase of 0.79° of elbow extension loss (p<0.01, 95% confidence level 0.55°-1.03°). CONCLUSION: Lengthening of olecranon by increments of 2mm correlates positively with loss of elbow extension. This shows that inadvertent intra-operative olecranon lengthening post-fixation may result in limited range of motion. However, it is reassuring to know that the small degree of extension loss may not translate to functional limitation.

Neuropathic arthropathy of the elbow treated with double-plate arthrodesis and resection site bone graft.

Neuropathic arthropathy of the elbow is a rare condition, which is disabling and difficult to treat. Initial treatment is conservative and arthrodesis is rarely indicated. We describe an unusual case of progressive unilateral elbow swelling in a 37-year-old female domestic helper. She was found to have neuropathic arthropathy of her right elbow secondary to underlying cervico-thoracic syringomyelia. She underwent decompression of the syringomyelia before underdoing elbow fusion. Her elbow was initially immobilized in a cast to minimize bony fragmentation and soft tissue swelling. Serial X-rays were performed with a regular change of cast as the swelling subsided. When there was no further radiological evidence of bony fragmentation, elbow fusion at 60° was performed using a two-plate technique at 7 months after the initial presentation. With well-preserved ipsilateral hand function, she was could still perform household chores despite having a fused elbow. Radiological evidence of successful elbow fusion was documented at 23 weeks after surgery. There were no complications. If elbow fusion is considered, we recommend a trial of immobilization in the preferred angle of fusion to assess the patient's suitability. Factors such as the young age of a patient and good quality bone may also contribute to the success of the fusion.

Minimally invasive helical plating for shaft of humerus fractures: technique and outcome.

INTRODUCTION: The humerus is subjected to substantial amount of torsional stress. Conventional plating may not address this sufficiently and may lead to fixation failure or non-union. A helical plate may offer the solution. We present the surgical technique and functional outcome of 5 cases of humeral shaft fractures treated with this technique in a minimally invasive way. MATERIALS AND METHODS: The operations were performed between 2004 and 2010, by three surgeons. All the patients had closed humeral shaft fractures, either simple transverse or with mild comminution. Two small incisions were made. The proximal incision was placed along the deltopectoral groove over the shaft, and the distal incision was placed as in an antero-lateral approach. The radial nerve was identified and protected. A pre-selected plate was contoured and introduced in the submuscular plane. The plate was placed in a proximal-lateral and distal-anterior position. Screws were inserted through stab incisions. The patients were followed for an average of 6 months. Functional recovery of the shoulder and elbow was assessed using the Constant and Mayo elbow performance score systems. RESULTS: All incisions healed by first intention without complications and all the fractures went on to unite. All patients achieved good to excellent shoulder and elbow function. CONCLUSION: The helical plate technique is a safe and effective method of treating humeral shaft fractures and has good functional outcome.