Proposed complementary osteological indicators: Advancing the estimation of puberty stages in Bioarcheology.

OBJECTIVES: The study of puberty is a well-established area of bioarcheological research, which greatly enhances our understanding of adolescence and growth in the past. Since the publications of Shapland and Lewis' works, which have become "standards" for estimating puberty in skeletal material, no additional osteological indicators of puberty have been proposed. Nevertheless, clinical practice constantly develops skeletal maturation markers that could be useful in bioarcheology. This study aims to assess the applicability and reliability of novel puberty indicators as a complementary tool to estimate puberty in skeletal remains. MATERIALS AND METHODS: Four new maturation markers including spheno-occipital synchondrosis, humeral head ossification, calcaneal apophysis ossification, and mandibular premolar mineralization were selected and applied to a sample of 85 adolescents from pre-Roman southern Italy (Pontecagnano, 7th-4th BCE). RESULTS: Despite some limits in adapting the original clinical methods to osteoarcheological material, the use of these novel skeletal indicators had moderate to excellent scoring repeatability and an overall high agreement with the puberty and menarche status previously estimated with standard methods. These results encourage us to apply these markers in bioarcheology. In some cases, minor adaptations of the original scoring systems are suggested to enhance reliability. DISCUSSION: Including the proposed indicators in routine puberty data collection allows us to refine puberty estimation and improve the ability to identify key growth milestones in poorly preserved skeletons. Further application to osteological collections with diverse chronology and geographical differences is needed to assess how and to what extent the newly proposed maturation markers perform.

Total Shoulder Arthroplasty is associated With Less Pain and Better Functional Outcomes, but Humeral Head Resurfacing may be Preferred in Younger, Higher Demand Patients: A Short-Term Outcomes Study in Patients with Glenohumeral Osteoarthritis.

Objectives: This study aimed to compare short-term outcomes following Total Shoulder Arthroplasty (TSA) and Humeral Head Resurfacing (HHR) in patients with glenohumeral osteoarthritis (GHOA). Methods: A retrospective analysis included patients who had undergone either TSA or HHR for GHOA at a single institution. Baseline demographics, complications, range of motion (active forward flexion, FF and active external rotation, ER), visual analog scores (VAS), and Subjective Shoulder Values (SSV) were collected. Results: A total of 69 TSA and 56 HHR patients were analyzed. More HHR patients were laborers (44% versus 21%, P=0.01). There were more smokers in the TSA group (25% versus 11%, P=0.04) and more cardiovascular disease in the HHR cohort (64% versus. 6%, p<0.0001). Postoperative FF was similar, but ER was greater in the HHR (47° ± 15°) vs. TSA group (40° ± 12°, P = 0.01). VAS was lower after TSA vs. HHR (median 0, IQR 1 versus median 3.7, IQR 6.9, p<0.0001), and SSV was higher after TSA (89% ± 13% vs. 75% ± 20% after HHR; p<0.0001). Post-operative impingement was more common after HHR (32% vs. 3% for TSA, p<0.0001). All other complications were equivalent. Conclusion: While younger patients and heavy laborers had improved ER following HHR, their pain relief was greater after TSA. Decisions on surgical technique should be based on patient-specific demographic and anatomic factors.

Anatomic Reversal of Shoulder Joint After Neck of Humerus Fracture.

We report on a singular case of a unique form of post-traumatic reversal of the humeral head after humeral neck fracture, in which the pattern of collapse resulted in the formation of a native reverse polarity shoulder. In essence, the humeral head became a socket, and the glenoid rounded to become a head with well-preserved shoulder function. To our knowledge, this is the first case of an acquired shoulder deformity that bears a remarkable functional similarity to a prosthetic reverse polarity shoulder replacement.

Long-term outcomes of hemiarthroplasty using a smaller head combined with rotator cuff reconstruction in patients with cuff-tear arthropathy.

Background: Hemiarthroplasty (HHR) using a smaller head with rotator cuff reconstruction is a treatment option for cuff-tear arthropathy, offering advantages like facilitating rotator cuff-tear closure, increasing the lever arm of deltoid, and restoring function in irreparable cuff tears. This study aimed to evaluate the long-term outcomes of this procedure. Methods: A retrospective analysis was conducted for 91 shoulders undergoing HHR using a smaller head with rotator cuff reconstruction between May 2005 and September 2012. Surgery involved reducing the size of humeral head and performing rotator cuff reconstruction based on the site of the deficient rotator cuff. The study analyzed University of California, Los Angeles shoulder scores, Japanese Orthopaedics Association shoulder scores, range of motion, and postoperative radiographs. Results: Twenty-eight patients, divided into an elderly group (14 women, 2 men, mean age 74.5 ± 3.8 years) and a younger group (6 women, 6 men, mean age 63.5 ± 3.1 years) were followed up for a mean of 133.2 ± 14.1 months. No complications were reported. The clinical scores and range of motion significantly improved postoperatively and remained over 10 years. Radiographs revealed high incidence of glenoid wear (82.1%), bone resorption (43%) and cranial humeral head migration (54%), with no prosthesis loosening. Conclusion: We believe that HHR using a smaller head with rotator cuff reconstruction is a surgical technique that can maintain stable long-term outcomes in both elderly and younger individuals with cuff-tear arthropathy.

The Kouvalchouk Procedure versus Distal Tibial Allograft for Treatment of Posterior Shoulder Instability: The Deltoid "Hammock" Effect Exists.

BACKGROUND: In 1993, Kouvalchouk described an acromial bone block with a pedicled deltoid flap for the treatment of posterior shoulder instability. This procedure provides a "double blocking" effect in that the acromial autograft restores posterior glenoid bone loss and the deltoid flap functions as a muscular "hammock" resembling the sling effect of the conjoint in the Latarjet procedure. The primary aim of this study was to compare the Kouvalchouk procedure to distal tibial allograft (DTA) reconstruction for the management of posterior shoulder instability with associated bone loss, while the secondary aim was to evaluate the deltoid hammock effect. s METHODS: Ten upper extremity cadavers were evaluated using a validated shoulder testing apparatus in 0° and 60° of glenohumeral abduction in the scapular plane. Testing was first performed on the normal shoulder state and was followed by the creation of a 20% posterior glenoid defect. Subsequently, the Kouvalchouk and DTA procedures were conducted. Forces of 0N, 5N, 10N and 15N were applied to the posterior deltoid tendinous insertion on the Kouvalchouk graft along the physiological muscle line-of-action to evaluate the 'hammock" effect of this procedure. Testing was additionally performed on the Kouvalchouk bone graft with the deltoid muscle sectioned from its bony attachment. For all test states, a posteriorly directed force was applied to the humeral head perpendicular to the direction of the glenoid bone defect, with the associated translation quantified using an optical tracking system. The outcome variable was posterior translation of the humeral head at an applied force magnitude of 30N. RESULTS: The Kouvalchouk procedure with the loaded deltoid flap (10N: P=0.039 and 15N: P<0.001) was significantly better at reducing posterior humeral head translation than the DTA. Overall, increased glenohumeral stability was observed with increased force applied to the posterior deltoid flap in the Kouvalchouk procedure. The 15N Kouvalchouk was most effective at preventing posterior humeral translation, and the difference was statistically significant compared with the 20% glenoid defect (P=0.003), detached Kouvalchouk (P<0.001), and 0N Kouvalchouk (P<0.001). The 15N Kouvalchouk procedure restored posterior shoulder joint stability to near normal levels, such that it was not significantly different from the intact state (P=0.203). CONCLUSIONS: The Kouvalchouk procedure with load applied to the deltoid was found to be biomechanically superior to the DTA for the management of posterior shoulder instability with associated bone loss. Additionally, the results confirmed the presence and effectiveness of the deltoid "hammock" effect.

No Difference in 10-Year Survivorship of Total Shoulder Arthroplasty Versus Hemiarthroplasty for Avascular Necrosis of the Humeral Head.

INTRODUCTION: Avascular necrosis of the humeral head (AVN) is characterized by osteonecrosis secondary to disrupted blood flow to the glenohumeral joint. Following collapse of the humeral head, arthroplasty, namely total shoulder arthroplasty (TSA) or humeral head arthroplasty (hemiarthroplasty) is recommended standard of care. The literature is limited to underpowered and small sample sizes in comparing arthroplasty modalities. Therefore, the aims of this study were (1) to compare the 10-year survivorship of TSA and hemiarthroplasty in the treatment of AVN of the humeral head and (2) to identify differences in their revision etiologies. METHODS: Patients who underwent primary TSA and hemiarthroplasty for AVN were identified using the PearlDiver database. TSA patients were matched by age, gender, and Charlson Comorbidity Index (CCI) to the hemiarthroplasty cohort in a 4:1 ratio since TSA patients were generally older, sicker, and more often female. The 10-year cumulative incidence rate of all-cause revision was determined using Kaplan-Meier survival analysis. Multivariable analysis was conducted using Cox Proportional Hazard modeling. Chi-squared analysis was conducted to compare the indications for revisions between matched cohorts including periprosthetic joint infection (PJI), dislocation, mechanical loosening, broken implants, periprosthetic fracture, and stiffness. RESULTS: In total, 4,825 patients undergoing TSA and 1,969 patients undergoing hemiarthroplasty for AVN were included in this study. The unmatched 10-year cumulative incidence of revision for patients who underwent TSA and hemiarthroplasty was 7.0% and 7.7%, respectively. The matched 10-year cumulative incidence of revision for patients who underwent TSA and hemiarthroplasty was 6.7% and 8.0%, respectively. When comparing the unmatched cohorts, TSA patients were at significantly higher risk of 10-year all-cause revision (HR: 1.39; P = 0.017) when compared to hemiarthroplasty patients. After matching, there was no significant difference in risk of 10-year all-cause revision (HR: 1.29; P = 0.148) and no difference in the observed etiologies for revision (P > 0.05 for all). CONCLUSION: After controlling for confounders, only 6.7% of TSA and 8.0% hemiarthroplasties for humeral head AVN were revised within 10-years of index surgery. The demonstrated high and comparable long-term survivorship for both modalities supports the utilization of either for the AVN induced humeral head collapse.

Effects of humeral head stabilization intervention during aggressive manual passive stretching exercises in patients with painful stiff shoulder: a prospective, comparative study.

BACKGROUND: No reports have been published verifying the effects of manual interventions such as humeral head stabilization on improving function and reducing pain when applying aggressive manual passive stretching in patients with painful stiff shoulders. The purpose of this study was to compare clinical outcomes, such as range of motion, pain, and disability scores, in patients with painful stiff shoulders with and without humeral head stabilization intervention while applying aggressive manual passive stretching. METHODS: Fifty-six patients with painful stiff shoulders were recruited (31 with humeral head stabilization intervention and 25 without such intervention). Clinical outcomes such as active range of motion (A-ROM), pain, and disability scores were evaluated using a goniometer; measurement of activity visual analog scale (A-VAS); and Disabilities of the Arm, Shoulder and Hand (DASH) and Shoulder Pain and Disability Index (SPADI), respectively. RESULTS: All the parameters, A-ROM, A-VAS, and disability scores (DASH and SPADI) were not significantly different between the 2 groups (P > .05) before the intervention. However, after the intervention, the mean difference in A-ROM for flexion, abduction, and external and internal rotation was 18 (95% confidence interval [CI], 14.1-21.7), 31 (95% CI, 24.9-37.4), 17 (95% CI, 13.4-21.4), and 16 (95% CI, 11.6-20.9), respectively. The mean difference in A-VAS and disability scores for DASH and SPADI was -1 (95% CI, -1.5 to -0.8), -27 (95% CI, 32.3 to -22.6), and -23 (95% CI, -27.8 to -18.3), respectively. All of these measurements favored humeral head stabilization. CONCLUSION: During aggressive manual passive stretching in patients with painful stiff shoulders, humeral head stabilization intervention may be more beneficial in improving clinical outcomes such as A-ROM, A-VAS pain levels, and disability scores.

Satisfactory Short-Term Outcomes of Reverse Shoulder Arthroplasty for Complex Three- and Four-Part Fractures of the Humeral Head in Octogenarians.

BACKGROUND: Proximal humeral fractures with severe comminution and poor bone quality are among the most common injuries in the elderly population. Reverse shoulder arthroplasty (RSA) has been widely used to manage complex three- and four-part humeral head fractures. The purpose of the present study was to report the result of this technique in the demanding population of octogenarians. MATERIALS AND METHODS:  Twenty-six patients above the age of 80 years were included in the study and followed for a minimum of one-year follow-up. To assess the functional outcomes the postoperative range of motion (ROM), the Constant score, the visual analog scale for pain, and the disability of the arm and shoulder score (DASH) were measured at 6 and 12 months. Radiological assessment and potential complications were also recorded. RESULTS: The mean age of the study population was 81.9 years (81-86) at the time of surgery. There was a statistically significant improvement in all outcomes over the follow-up intervals. Shoulder ROM was 125.7o for flexion, 98.2o for abduction, 42.2o for internal rotation, and 43.2o for external rotation at 12 months. The mean Constant, DASH, and VAS scores at the last follow-up were 61.3, 31.9, and 0.5, respectively. Reported complications include one superficial surgical site infection. CONCLUSION: RSA is a safe and reliable surgical option with satisfactory outcomes to manage complex three- and four-part fractures of the humeral head as it can provide prompt pain relief and function in octogenarians.

Humeral head size predicts baseplate lateralization in reverse shoulder arthroplasty: a comparative computer model study.

Background: In reverse shoulder arthroplasty (RSA), the ideal combination of baseplate lateralization (BL), glenosphere size (GS), and glenosphere overhang (GOH) with a commonly used 145° neck shaft angle (NSA) is unclear. This is the first study evaluating correlations of body height (BH), humeral head size (HS), glenoid height (GH), and association of gender with best glenoid configurations for range of motion (ROM) maintaining anatomic lateralization (aLAT) for optimized muscle length in 145° and less distalized 135° RSA. Methods: In this computer model study, 22 computed tomographies without joint narrowing were analyzed (11 male/female). A standardized semi-inlay 145° platform stem was combined with 20 glenoid configurations (baseplate [B] 25, 25 + 3/+6 lateralized [l], 29, 29 + 3/6l combined with glenosphere 36, 36 + 2 eccentric [e], 36 + 3l, 39, 39 + 3e, 39 + 3l , 42, 42 + 4e). Abduction-adduction, flexion-extension, external rotation-internal rotation, total ROM (TROM), and total notching relevant (TNR) ROM were computed, best TROM models respecting aLAT (-1 mm to +1 mm) and HS/GH recorded. Second, the 145° models (Ascend Flex stem; Stryker, Kalamazoo, MI, USA) were converted and compared to a 135° inlay RSA (New Perform stem; Stryker, Kalamazoo, MI, USA) maintaining GOH (6.5-7 mm) and aLAT. Results: Best 145° models had eccentric glenospheres (mean BL: 3.5 mm, GOH 8.8 mm, GS 38.1 mm, distalization 23 mm). The 135° models had concentric glenospheres, mean BL 3.8 mm, GOH 6.9 mm, GS 39.7 mm, and distalization 14.1 mm. HS showed the strongest positive correlation with BL in 145° and 135° models (0.65/0.79). Despite reduced GOH in smaller females with a 135° NSA, adduction, external rotation, extension, TNR ROM, and TROM were significantly increased (P = .02, P = .005, P = .005, P = .004, P = .003), abduction however reduced (P = .02). The same trends were seen for males. Conclusion: HS is a practical measure in surgery or preoperatively, and the strong positive correlation with BL is a useful planning aid. Despite reduction of GOH, conversion to a less distalized 135° NSAinlay design is powerful to maintain and even significantly increase all components of TNR ROM (extension/external rotation/adduction) in small females with the drawback of reduced abduction which may however be compensated by scapula motion. Lateralization with a less distalized 135° RSA optimizes muscle length, may facilitate subscapularis repair, and maintains highest rigid body motion.

Vara Deformity and Subluxed Humeral Heads: An Unusual Sign in Pseudohypoparathyroidism.

Pseudohypoparathyroidism is a rare disorder characterized by end-organ resistance to intact parathyroid hormone (PTH) and concomitant laboratory findings of hypocalcemia and hyperphosphatemia. Radiologic evidence of the disease may manifest as a variety of bone abnormalities. This case describes an 11-year-old female with a history of repaired bilateral slipped capital femoral epiphysis who presented with a limited range of motion of the bilateral upper extremities. Laboratory findings were consistent with pseudohypoparathyroidism. Radiographs revealed subchondral resorption of bilateral clavicular heads and multiple ribs and band lucencies of proximal humeral metaphyses, along with vara deformity and inferior subluxation of the humeral heads. This presentation adds to the spectrum of potential radiographic manifestations of pseudohypoparathyroidism.

Bulk osteochondral allograft for massive Hill-Sachs defect combined with Latarjet procedure for bipolar bone loss in anterior instability.

A proportion of patients with anterior glenohumeral instability present with bipolar bone loss comprising large Hill-Sachs lesions and substantial glenoid defect. These are surgically difficult cases to treat. We describe a novel surgical procedure of bulk size-matched osteochondral allograft reconstruction for massive Hill-Sachs lesions combined with the Latarjet procedure for these challenging cases.

A prognostic classification of proximal humerus fractures: the cephalic extension staging.

PURPOSE: Recent publications emphasized the role of dorsomedial metaphyseal extension of humeral head as predictor of ischemia after complex proximal humerus fractures (PHFs). We evaluated on preoperative 3D CT scan of PHFs the surface of this metaphyseal extension and its prognostic value on the occurrence of avascular necrosis (AVN). METHODS: We followed a series of 25 fixations of complex PHF which had a preoperative 3D CT scan and measured the surface area of the posterior metaphyseal extension (PME) of the head. Using approximations, we calculated the ratio between the PME surface area (PMS) and the articular surface area of the head (HS). The PMS/HS ratio was analyzed against the risk of AVN. RESULTS: The measurement of the PMS/HS ratio emphasizes the significance of PME. The incidence of AVN is correlated with the magnitude of PME. Therefore, we include the PME as a fifth element in the characterization of complex PHFs and we propose a 4-stage prognostic classification based on the number of extensions of the humeral head. The head may have 3 extensions: posteromedial (PME), lesser tuberosity (LTE) and greater tuberosity (GTE). The risk of AVN decreases with the number of extensions of the head. CONCLUSION: Our study demonstrates a correlation between the occurrence of AVN and the size of PME in complex PHF cases. We propose a four-stage classification system to facilitate treatment decision-making between fixation and prosthesis.

Risk factors for osteonecrosis of the humeral head after internal fixation of proximal humeral fractures: a systematic review and meta-analysis.

BACKGROUND: Osteonecrosis of the humeral head (ONHH) is a severe complication after the internal fixation of proximal humeral fractures (IFPHF). The risk factors remain controversial though many studies have reported. In this research, meta-analysis was used to evaluate which surgeon-level factors can be modified to lower the risk and we hope to provide evidence-based support for preventing ONHH. METHODS: Literature was retrieved from PubMed, Cochrane Library, Embase, Web of Science, and Scopus for eligible studies published up to January 2023. The pooled odds ratios (ORs) were calculated with their corresponding 95% confidence intervals (CIs) to evaluate. STATA 15.1 software was applied for data synthesis, sensitivity synthesis, and publication bias. RESULTS: 45 articles were published between 2000 and 2022, and 2482 patients were finally included. All articles were observational research, with 7 case-control studies and 38 cohort studies, and the Newcastle Ottawa Scale (NOS) score ranged from 7 to 9. The pooled results suggested that age (OR 0.32, 95% CI 0.14-0.74, P = 0.01), reduction quality (OR 0.08, 95% CI 0.01-0.44, P = 0.00), fracture type (OR 0.44, 95% CI 0.25-0.78, P = 0.01), surgical approach (OR: 4.06, 95% CI 1.21-13.61, P = 0.02) and fixation implant (OR = 0.68, 95% CI = 0.34-1.33, P = 0.02) were risk factors for ONHH after IFPHF. According to sensitivity analysis, Begg (P = 0.42) and Egger (P = 0.68) tests, the results were stable and exhibited no publication bias. CONCLUSIONS: The study showed that age, reduction quality, fracture type, surgical approach and fixation implant were risk factors for ONHH after IFPHF, while gender, varus or valgus, timely operation, injured side, and the existence of medial support have little influence on ONHH, as they could not be considered risk factors and still need further investigations.

Does age affect patient outcomes after humeral head replacement in the treatment of acute proximal humeral fractures? A comparative cohort study with a minimum 10 years long-term follow-up.

BACKGROUND: Humeral head replacement (HHR) is now rarely recommended for complex proximal humeral fractures (PHFs) in older patients. However, in relatively young and active patients with unreconstructable complex PHFs, controversy still exists regarding the treatment options of reverse shoulder arthroplasty and HHR. The goal of this study was to compare the survival, functional, and radiographic outcomes of HHR in patients aged <70 years and those aged ≥70 years after a minimum 10 years follow-up. METHODS: Eighty-seven out of 135 patients undergoing primary HHR were enrolled and then divided into 2 groups based on age: <70 years and ≥70 years. Clinical and radiographic evaluations were performed with a minimum follow-up of 10 years. RESULTS: There were 64 patients (mean, 54.9 years) in the younger group and 23 patients (mean, 73.5 years) in the older group. The younger and older groups had comparable 10-year implant survivorship (98.4% vs. 91.3%). Patients aged ≥70 years had worse American Shoulder and Elbow Surgeons scores (74.2 vs. 81.0, P = .042) and lower satisfaction rates (12% vs. 64%, P < .001) than younger patients. At the final follow-up, older patients had worse forward flexion (117° vs. 129°, P = .047) and internal rotation (17 vs. 15, P = .036). More greater tuberosity complications (39% vs. 16%, P = .019), glenoid erosion (100% vs. 59%, P = .077), and humeral head superior migration (80% vs. 31%, P = .037) were also identified in patients aged ≥70 years. CONCLUSIONS: Unlike the increased risk for revision and functional deterioration over time after reverse shoulder arthroplasty for PHFs in younger patients, a high implant survival rate with lasting pain relief and stable functional outcomes could be observed in younger patients after HHR during long-term follow-up. Patients aged ≥70 years had worse clinical outcomes, lower patient satisfaction, more greater tuberosity complications, and more glenoid erosion and humeral head superior migration than those aged <70 years. HHR should not be recommended for the treatment of unreconstructable complex acute PHFs in older patient populations.

Radiographic comparison of eccentric stemmed vs. concentric stemless prosthetic humeral head positioning after anatomic total shoulder arthroplasty.

INTRODUCTION: Maintaining premorbid proximal humeral positioning is an essential consideration of anatomic total shoulder arthroplasty (aTSA), as malposition of the prosthetic humeral head can result in poor clinical outcomes. Stemless aTSA prosthetic heads are usually concentric, while stemmed aTSA prosthetic heads are typically eccentric in nature. Therefore, the purpose of this study was to compare the ability to restore native humeral head position between stemmed (eccentric) vs. stemless (concentric) aTSA. MATERIALS AND METHODS: Postoperative anteroposterior radiographs of 52 stemmed and 46 stemless aTSAs were analyzed. A best-fit circle was created using previously published and validated techniques to represent the premorbid humeral head position and axis of rotation. This circle was juxtaposed with another circle following the arc of the implant head. Next, the offset in center of rotation (COR), radius of curvature (RoC), and humeral head height above the greater tuberosity (HHH) were measured. Additionally, based on prior studies, an offset of >3 mm at any point between the implant head surface and premorbid best-fit circle was considered significant and further classified as overstuffed or understuffed. RESULTS: RoC deviation was significantly greater in the stemmed cohort than the stemless cohort (1.19 ± 1.37 mm vs. 0.65 ± 1.17 mm, P = .025). There was no statistically significant difference in deviation from premorbid humeral head between the stemmed and stemless cohorts for COR (3.20 ± 2.28 mm vs. 3.23 ± 2.09 mm, P = .800) or HHH (1.12 ± 3.27 mm vs. 0.92 ± 2.70 mm, P = .677). When comparing overstuffed implants to appropriately placed implants, there was a significant difference in overall COR deviation in stemmed implants (3.93 ± 2.51 mm vs. 1.92 ± 1.05 mm, P < .001). Superoinferior COR deviation (stemmed: 2.38 ± 3.01 mm vs. -0.61 ± 1.59 mm, P < .001; stemless: 2.70 ± 1.75 mm vs. -0.16 ± 1.87 mm, P < .001), mediolateral COR deviation (stemmed: 0.79 ± 2.65 mm vs. -0.62 ± 1.27 mm, P = .020; stemless: 0.40 ± 1.41 mm vs. -1.13 ± 1.96 mm, P = .020), and HHH (stemmed: 3.61 ± 2.73 mm vs. 0.50 ± 1.31 mm, P < .001; stemless: 3.98 ± 1.18 mm vs. 0.53 ± 1.41 mm, P < .001) were significantly different between overstuffed implants and appropriate implants in both the stemmed and stemless cohorts. DISCUSSION: Stemless and stemmed aTSA implants have similar rates of reproducing satisfactory postoperative humeral head COR with both producing COR deviation most commonly in the superomedial direction. Deviation in HHH contributes to overstuffing in both stemmed and stemless implants, COR deviation contributes to overstuffing in stemmed implants, while RoC (humeral head size) is not associated with overstuffing. Based on this study, it appears that neither eccentric nor concentric prosthetic heads are superior in recreating premorbid humeral head position.

Rotator Cuff Tendon Dimensional Variability, Novel Patient-Specific Measurement Method-Morphological Measurement for Rotator Cuff Tendon.

INTRODUCTION: The shoulder rotator cuff (RC) is crucial to shoulder function and involvement in shoulder pathology. RC tears have been extensively studied, and several classifications have been devised to quantify their magnitude. Various RC measurement techniques were introduced previously, utilizing cadaveric specimens, X-rays, CT scans, and MRI with different results published regarding humeral heads' different plane diameters and the correlation to age, gender, and height. There are very few studies measuring RC length in the general population. PURPOSE: We aimed to assess the geometrical relation between rotator cuff tendon length and humeral head sagittal and axial diameters. METHODS: A total of 100 shoulder MRI scans of labral tear-suspected patients were reviewed, and the geometrical parameters of the rotator cuff length and proximal humerus sagittal and axial diameters were measured. RESULTS: The healthy population has wide variability in humeral diameter and rotator cuff length. We found a high correlation between humeral head sagittal and axial plane diameters and the rotator cuff tendon dimension. The orthogonal plane diameters disagree with the humeral head being round but rather spheric. The rotator cuff length changes according to the patient's gender and height. CONCLUSION: This is a novel method for rotator cuff measurement, description, and classification according to the percentage of tear instead of length (cm). This method is more clinically oriented and relevant than most other previous methods.

Arthroscopic remplissage: history, indications, and clinical outcomes.

Several surgical procedures have been proposed to address anterior glenohumeral instability, which is one of the most common complaints in the general population. The remplissage, first described in early 2000s, is a procedure performed simultaneously with the arthroscopic Bankart repair to correct large, engaging Hill-Sachs lesions (HSLs). This procedure stabilizes the joint by tenodesing the infraspinatus tendon into the HSL to fill and disengage the defect. This procedure gained popularity because it has relatively low risk and is able to improve shoulder stability while being less invasive than other bone-blocking procedures. The remplissage has become a valuable add-on technique that can substantially improve outcomes in unstable patients undergoing arthroscopic Bankart repair. Nevertheless, several studies in the literature have raised concerns regarding its efficacy in critically unstable patients and the potential range of motion limitations that can arise postoperatively. Additional comparative studies and trials should be conducted to appropriately establish the role of remplissage in treating anterior instability, especially in patients with critical bone loss.

Anatomic total shoulder arthroplasty with a nonspherical humeral head and inlay glenoid: 90-day complication profile in the inpatient versus outpatient setting.

BACKGROUND: Total shoulder arthroplasty (TSA) with a nonspherical humeral head component and inlay glenoid is a successful bone-preserving treatment for glenohumeral arthritis. This study aimed to describe the 90-day complication profile of TSA with this prosthesis and compare major and minor complication and readmission rates between inpatient- and outpatient-procedure patients. METHODS: A retrospective review was performed of a consecutive cohort of patients undergoing TSA with a nonspherical humeral head and inlay glenoid in the inpatient and outpatient settings by a single surgeon between 2017 and 2022. Age, sex, body mass index, American Society of Anesthesiologists (ASA) score, Charlson Comorbidity Index (CCI), and 90-day complication and readmission rates were compared between inpatient and outpatient groups. RESULTS: One hundred eighteen TSAs in 111 patients were identified. Mean age was 64.9 years (range, 39-90) and 65% of patients were male. Ninety-four (80%) and 24 (20%) patients underwent outpatient and inpatient procedures, respectively. Four complications (3.4%) were recorded: axillary nerve stretch injury, isolated ipsilateral arm deep venous thrombosis (DVT), ipsilateral arm DVT with pulmonary embolism requiring readmission, and gastrointestinal bleed requiring readmission. There were no reoperations or other complications. Outpatients were younger with lower ASA and CCI scores than inpatients; however, there was no difference in complications (1/24 vs. 3/94, P=1.00) or readmissions (1/24 vs. 1/94, P=0.37) between these two groups. CONCLUSIONS: TSA with a nonspherical humeral head and inlay glenoid can be performed safely in both inpatient and outpatient settings. Rates of early complications and readmissions were low with no difference according to surgical setting. Level of evidence: IV.

Locked Posterior Shoulder Dislocation with a Large Bone Defect in an Active Patient Treated with Autograft.

Introduction: Posterior glenohumeral joint dislocations are uncommon injuries. The disease often goes undiagnosed and untreated despite positive clinical signs. In the event of a large humeral bone defect, the outcome may be worse. Case Report: This case report presents a 47-year-old man with a 2-year-old locked posterior shoulder dislocation with a large segmental bone defect involving 40% of the humeral head's articular surface. We decided to treat the patient with an open reduction of the shoulder dislocation and reconstruction of the articular surface with iliac crest autograft. We observed an improvement in shoulder mobility and range of motion on all planes, which were beneficial to the patient's daily activities; at follow-up, no pain was reported. Conclusion: Our case report demonstrates that locked posterior shoulder dislocations with a large bone defect and viable humeral head can be treated using an autograft. This will result in optimal clinical results and avoid early prosthetic replacement surgery. Autograft may be a preferred method in the presence of economic constraints or due to the unavailability of allografts or implants.

Minimal invasive plate osteosynthesis for the dislocated humeral head fracture associated with ipsilateral humeral shaft fracture: A case report.

The condition combining a dislocated humeral head fracture and an ipsilateral humeral shaft fracture is seen to be rare in literature, which is limited to case report or case series. Furthermore, effective management of these coexistent injuries is still a subject of debate. The essential purpose of this article is to report another treatment method for this condition. We present a case of a 79-year-old female patient who suffered a three-part humeral head fracture-dislocation associated with the ipsilateral humeral shaft fracture. The combined injuries were managed by minimal invasive plate osteosynthesis (MIPO) through the deltopectoral approach with the eventual result of bone healing and good function after thirty-three months of follow-up. In conclusion, MIPO should be considered a safe and effective option, however, the risk of traumatic osteonecrosis of the humeral head is taken into account before operation decision-making.