Management of bipolar shoulder injuries with humeral head allograft in patients with active, uncontrolled seizure disorder: case series and review of literature.

BACKGROUND: The purpose of this study is to present surgical outcomes after humeral head allograft augmentation and glenoid-based procedures in patients with active, uncontrolled seizure activity and anterior shoulder instability. METHODS: A retrospective review of a surgical database for patients with active seizure disorder and with recurrent shoulder instability managed with humeral head augmentation was performed. All patients underwent surgical intervention. Postoperative outcomes including Shoulder Pain and Disability Index, Simple Shoulder Test, American Shoulder and Elbow Surgeons questionnaire, and the Short Form Health Survey (SF-12) were recorded at a minimum of 2 years. We hypothesized that appropriate management of the bony defects in these bipolar injuries would result in low recurrence and satisfactory outcomes. RESULTS: Ten patients including 8 males and 2 females (15 shoulders) with active seizure-related shoulder instability underwent surgical intervention including allograft bone grafting of the Hill-Sachs lesion for anterior shoulder instability. The average age was 27 years. All patients reported recurrent seizures postoperatively, but only one sustained a shoulder dislocation after surgery that was unrelated to seizure activity.Self-reported satisfaction was "much better" or "better" in 92% of shoulders. Average outcome scores were as follows: American Shoulder and Elbow Surgeons score = 67 (33-100), Shoulder Pain and Disability Index = 32.5 (0-83), Simple Shoulder Test = 9.4 (5-12), SF-12 PCS = 44.1 (21-65), and SF-12 MCS = 50.6 (21-61). The average follow-up was 4.8 years. CONCLUSION: Management of bipolar shoulder injuries with humeral head allograft augmentation and glenoid based surgery leads to low recurrence rates and good clinical outcomes in patients with uncontrolled, seizure-related shoulder instability.

Traumatic Anterior Instability: Treatment Options for Initial Instability.

Because of the lack of bony restraints and minimal articular contact, the glenohumeral joint can attain significant range of motion; however, this results in the propensity for instability. The most generic form of instability, traumatic anterior instability, reliably produces a series of pathoanatomic findings. While reliable, these findings contribute to the complexities of caring for patients after an initial instability event. Numerous studies have examined this issue and determined that careful consideration of patient factors can guide successful treatment, whether it be surgical or nonsurgical, after initial instability. Such forms of treatment have shown to provide a good functional outcome and decreases morbidity. To be able to provide successful treatment requires a thorough understanding of the pathoanatomic of an instability event and the intricacies of the evaluation of a patient after an initial instability event.

Hybrid endovascular pseudoaneurysm and pulmonary stenosis repair in bovine arch.

This case report details the endovascular management of a large aortic pseudoaneurysm in a high-risk patient with a complicated history using a multi-disciplinary, hybrid approach. The pseudoaneurysm compressed the main pulmonary artery to 5 mm with near complete obstruction of the left main pulmonary artery, while also compromising the lumens of the left superior pulmonary vein and left main bronchus. Furthermore, the patient's left upper extremity arteriovenous dialysis fistula and bovine arch anatomy required a hybrid approach of repair that preserved the fistula while treating the aortic, pulmonary, and bronchial pathology.