Treatment of fracture sequelae of the proximal humerus: comparison of hemiarthroplasty and reverse total shoulder arthroplasty.

INTRODUCTION: Fracture sequelae (FS) of the proximal humerus is a challenging scenario in shoulder surgery. Despite they have been traditionally treated with hemiarthroplasty (HA), the use of reverse shoulder arthroplasty (RSA) has been recently introduced. However, there are no studies comparing the results of HA and RSA in FS. The purpose of this study was to compare the functional and quality of life-related outcomes, and complications in the treatment of proximal humeral FS between HA and RSA. MATERIALS AND METHODS: A therapeutic prospective non-randomized comparative study was conducted. All consecutive patients with diagnosis of FS after non-operative treatment of proximal humeral fractures and no previous shoulder surgery were considered for this study. A total of 32 patients (24 females, 8 males) with a mean (SD) age at the time of surgery of 80.1 (4.9) years were finally included: 12 in the HA group, and 20 in the RSA group. FS were treated with shoulder arthroplasty by the implantation of either HA or RSA. Constant score (total and specific items), quality of life (assessed through SF-36), and complications requiring revision surgery were compared between groups. RESULTS: All parameters of the Constant score significantly improved in the postoperative compared to preoperative period when considering the entire sample. The RSA group demonstrated a higher improvement in total Constant score (p = 0.06) and Constant activity level (p = 0.02) compared to the HA group. The HA demonstrated a higher number of complications compared to the RSA (p = 0.05). There were no differences in SF-36 scores between both groups. CONCLUSIONS: The shoulder arthroplasty is an effective treatment for FS with significant improvement in pain and function. The RSA may be a better option than HA for FS given the trend towards better total Constant score and a significantly lower number of complications requiring revision surgery. LEVEL OF EVIDENCE: Therapeutic level II evidence.

Safety and Effectiveness of Shoulder Arthroplasties in Spain: A Systematic Review.

The effectiveness and safety of shoulder arthroplasties in the general context of a Spanish patient population remains unclear. The aim of this study was to ascertain both the effectiveness and safety of primary shoulder arthroplasties and the prosthesis types used in Spain. A systematic review of all the available literature evaluating the effectiveness and safety of primary shoulder arthroplasties in Spain was performed. A narrative synthesis was performed, and evidence tables were created in four dimensions: study design, arthroplasty characteristics, safety, and effectiveness. Orthopaedic Data Evaluation Panel (ODEP) scores were used to evaluate prosthesis types. Twenty-one studies were selected that included a total of 1293 arthroplasties. The most common indication was fractures, while the prosthesis most frequently used was the Delta Xtend (ODEP 10A). The most common complication was scapular notching. Prosthesis revision rate was approximately 6% for follow-ups between 12 and 79 months. In addition, significant improvements were observed in the Constant-Murley test score after the intervention. Currently in Spain, shoulder arthroplasty can be considered a safe and effective procedure with functional recovery and pain reduction for eligible patients with humeral fracture, rotator cuff arthropathy, fracture sequelae and malunion of the proximal humerus, and degenerative disease. Future longitudinal research and population-based studies could serve to confirm these results and identify points of improvement.

Prolonged brachial plexopathy following interscalene block for shoulder arthroplasty / Plexopatía braquial prolongada después de un bloqueo interescalénico en cirugía de hombro

Abstract Interscalene block (ISB) is the brachial plexus approach most frequently used in shoulder surgery, providing better postoperative analgesia and reducing the need for rescue morphine compared to general anesthesia. While it is considered a safe block, it has been associated with a relatively high rate of complications, the most serious of which are postoperative neurologic symptoms, such as paresthesia, dysesthesia, and reduced sensitivity. We present the case of a patient with prolonged neurological deficit lasting 4 months following nerve stimulation-guided ISB. Due to the multifactorial nature of postoperative neurological lesions, it can be difficult to determine their etiology. In our case, the brachial plexopathy was probably due to the administration of local anesthetic through the perineurium. We discuss possible causes and argue for the use of ultrasound associated with nerve stimulation when an ISB is performed in order to reduce the incidence of nerve puncture.

Resumen El bloqueo Interescalénico (BIE) es el abordaje al plexo braquial usado con mayor frecuencia en cirugía de hombro, que permite una mejor analgesia postoperatoria y reduce la necesidad de morfina de rescate, en comparación con la anestesia general. Si bien es cierto que se considera un bloqueo seguro, se ha asociado a una tasa de complicaciones relativamente alta, siendo la complicación más seria los síntomas neurológicos postoperatorios (SNPO), tales como parestesia, disestesia, y pérdida de la sensibilidad. Presentamos el caso de un paciente con déficit neurológico prolongado de 4 meses de duración, luego de BIE guiado por neuroestimulación. Debido a la naturaleza multifactorial de las lesiones neurológicas postoperatorias, puede ser difícil determinar su etiología. En nuestro caso, la plexopatía braquial se debió posiblemente a la administración de anestésico local (AL) a través del perineuro. Hacemos referencia a las posible causas y la opción de ultrasonido asociado a la neuroestimulación cuando se realiza un bloqueo interescalénico, a fin de reducir la incidencia de punción del nervio.

Distal Clavicle Osteolysis after Modified Weaver-Dunn's Procedure for Chronic Acromioclavicular Dislocation: A Case Report and Review of Complications.

Distal clavicle osteolysis after acromioclavicular joint stabilization has only been described after the use of hardware for clavicle stabilization or synthetic graft causing a foreign body reaction. This paper reports a very rare case of distal clavicle osteolysis after modified Weaver-Dunn procedure for the treatment of chronic acromioclavicular joint dislocation. The paper also provides a comprehensive review of complications of this surgical technique and discusses a potential vascular etiology and preventive strategies aimed at avoiding clavicle osteolysis.