Mid-term results of the use of structural humeral head autograft to correct glenoid bone loss in reverse total shoulder arthroplasty.

Background: Native glenoid bone loss presents technical challenges in shoulder arthroplasty. The purpose of this study is to report the mid-term clinical and radiographic outcomes of patients treated with structural humeral head autograft reconstruction of glenoid bone loss in the setting of reverse total shoulder arthroplasty (rTSA). Methods: Retrospective review of 30 shoulders in 28 patients undergoing rTSA with a structural humeral head autograft to correct glenoid bone loss. Demographics, comorbidities, anatomic details, and patient-reported outcome measures were collected for analysis. Results: Range of motion and patient-reported outcome measures were all significantly improved postoperatively (P < .001). Bone grafts were found to incorporate into 100% of shoulders, with no protheses displaying signs of loosening or other structural concerns. No revision procedures were performed, and all patients were satisfied with their shoulder postoperatively. Two patients developed scapular notching on follow-up. Discussion: The use of a humeral head autograft to reconstruct glenoid bone loss in patients undergoing rTSA is a safe and effective procedure. It allows for a local graft source to be utilized thus avoiding potential comorbidity and complications associated with the use of alternative site autografts or allografts and has the advantage of nearly congruent fit within the defect.

Access to Reconstructive Hand Surgery in the United States-Investigating the Obstacles: A Scoping Review.

BACKGROUND: Mechanisms that affect access to surgical hand care appear to be complex and multifaceted. This scoping review aims to investigate the available literature describing such mechanisms and provide direction for future investigation. METHODS: The methodological framework outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews was used to guide this review. In November 2021, MEDLINE and EMBASE databases were searched. A narrative summary of the characteristics and key findings of each paper is used to present the data to facilitate the integration of diverse evidence. RESULTS: Of 471 initial studies, 49 were included in our final analysis. Of these, 33% were cohort studies; 27% reported that underinsured patients are less likely to get an appointment with a hand specialist or to receive treatment. Overburdened emergency departments accounted for the second-most reported reason (16%) for diminished access to surgical hand care. Elective procedure financial incentives, poor emergency surgical hand coverage, distance to treatment, race, and policy were also notably reported across the literature. CONCLUSIONS: This study describes the vast mechanisms that hinder access to surgical hand care and highlights their complexity. Possible solutions and policy changes that may help improve access have been described.