Comparing outcomes of the anterosuperior and deltopectoral approaches in reverse total shoulder arthroplasty for degenerative glenohumeral arthritis: a systematic review.

PURPOSE: Reverse total shoulder replacement (rTSR) improves pain and function in patients with a wide range of shoulder pathology. Anterosuperior (AS) and deltopectoral (DP) approaches are widely used to gain access to the glenohumeral joint in arthroplasty. Our aim was to systematically review the literature comparing outcomes of these two approaches when performing rTSR for degenerative glenohumeral arthritis. METHODS: Systematic review was performed with an electronic multi-database search (Pubmed, Medline & Embase) according to PRISMA guidelines on 18th September 2022. Data from published studies of any study design that met the inclusion criteria were extracted, reviewed and synthesized. RESULTS: A total of 38 studies were identified for full text review, of which four were included. No significant difference in pain and range of motion were observed between approaches. Scapular notching was more common in the anterosuperior approach. Low rates of instability and intra-operative fracture were observed in both. CONCLUSION: Both approaches demonstrate similar clinical outcomes with reference to pain, range of motion and complications when performing rTSR indicated for degenerative joint disease. However, further well-designed studies are required.

Effects of Removal and Reinsertion of Headless Compression Screws.

PURPOSE: This study investigates the loss of compression when 3 commonly used headless compression screws are backed out (reversed), and assesses the ability to re-establish compression with screws of greater diameter. METHODS: Two investigators tested 3 screw designs (Acutrak 2, Synthes HCS, Medartis SpeedTip CCS) in 2 diameters and lengths. Each design had 10 test cycles in a polyurethane foam bone model with compression recorded using a washer load cell. A 28-mm screw of the narrower diameter was inserted until 2 mm recessed and then reversed 30°, 60°, 90°, 180°, 270°, 360°, and 720°. After this the screw was removed completely and a 24-mm screw of greater diameter inserted until recessed 2 mm with the compressive force again recorded. RESULTS: All screws showed an immediate, statistically significant loss of compression at 30° of reversing. The Acutrak 2 Micro screw demonstrated not only the greatest mean compressive force, but also the fastest compressive loss. Insertion of the shorter screw of greater diameter was associated with re-establishment of compression to levels comparable with the original screw. CONCLUSIONS: This study reaffirms the importance of establishing the correct screw length before insertion due to the immediate loss of compression with reversal of these devices. CLINICAL RELEVANCE: If a headless compression screw penetrates the far joint surface, the screw should be completely removed and replaced with a shorter screw of greater diameter.

Patella osteotomy: a new approach for complex trauma around the knee.

Complex floating knee injuries, comprising complete articular distal femur and proximal tibia fractures, are a significant challenge in Orthopedic Traumatology. Traditional surgical approaches can result in a limited exposure, compromising osteosynthesis, with an extensive soft tissue dissection predisposing to adhesion of the quadriceps and arthrofibrosis. The Patella Osteotomy technique provides unrivaled visualization of the articular surfaces of the knee, with a limited soft tissue dissection to permit the anatomical reconstruction of the articular injury, while minimizing the risk of postsurgical complications and reducing intraoperative fluoroscopy time.

Reconstruction of massive uncontained glenoid defects using a combined autograft-allograft construct with reverse shoulder arthroplasty: preliminary results.

BACKGROUND: This report documents our experiences with a new technique for reconstructing massive uncontained defects of the glenoid with reverse total shoulder arthroplasty. MATERIALS AND METHODS: We use a modified deltopectoral approach to perform the combined allograft-autograft construct glenoid reconstruction. We make use of a peripherally seated cortical allograft acting as a sleeve bushing to provide a stable ring under compression in which to house impacted cancellous autograft centrally for early incorporation and in-growth with the long-peg Aequalis (Tornier, Saint-Ismier Cedex, France) reverse total shoulder arthroplasty baseplate. RESULTS: Our case series now comprises 10 patients with postoperative follow-up of up to 36 months. We report the first 5 patients here, all of whom have more than 12 months of follow-up. Computed tomography scanning demonstrates incorporation of the graft as early as 6 months. None of these patients have had loosening, implant failures, dislocations, periprosthetic fractures, or infections. One patient sustained an acromial stress fracture that was successfully treated nonoperatively, and 1 patient has nonprogressive grade I notching. CONCLUSION: The hybrid graft glenoid reconstruction is a useful and versatile technique in the setting of massive uncontained defects of the glenoid and permits the implantation of a reverse total shoulder arthroplasty. We believe this technique is reproducible and uses materials that are both readily available and familiar.

Are snowboarders more likely to damage their spines than skiers? Lessons learned from a study of spinal injuries from the Otago skifields in New Zealand.

AIMS: The aim of this study was to determine the incidence, nature, and circumstances of spinal injuries caused by skiing and snowboarding at the Otago skifields and treated at Dunedin Hospital during the period 1991 to 2002. METHODS: Patients were identified from the audit records of the Department of Orthopaedic Surgery at Dunedin Hospital. RESULTS: Twenty-five cases were included in the study, 18 snowboarders, and 7 skiers. Twenty-two cases had spinal fractures, with skiers having a higher proportion of burst fractures and multiple fractures. The most frequently fractured vertebrae were T12 and L1, and wedge fractures were the most common fracture type. Jump-related activities were the most common cause of injury in snowboarders, in contrast to skiers whose injuries were more commonly fall-related. CONCLUSIONS: Skier-related spinal injuries were rare and sporadic over the study period, whereas snowboarder-related spinal injuries were more frequent and more recent in occurrence.

Differential lung ventilation after single-lung transplantation for emphysema.

OBJECTIVE: To review outcome and cardiovascular and respiratory function after initiation of differential lung ventilation for acute severe native lung hyperinflation in patients who have had a single-lung transplant for end-stage emphysema. DESIGN: Retrospective review. SETTING: Cardiothoracic tertiary referral center. PARTICIPANTS: Thirteen patients who had differential lung ventilation for acute severe native lung hyperinflation, of a total of 132 patients who had a single-lung transplant for end-stage emphysema between 1988 and the end of 2000. INTERVENTIONS: None. measurements and main results: Thirteen patients had differential lung ventilation for acute severe native lung hyperinflation; 7 survived to 1 year after transplant. There was a highly significant (p = 0.0006) improvement in mean PaO(2) from 8.23 (95% confidence interval [CI], 6.15 to 10.3) to 16.6 (95% CI, 12.84 to 20.45) 1 hour after start of differential lung ventilation. The average ratio of estimated dynamic compliance in the native lung compared with the transplanted (donor) lung was 2.69 (95% CI, 1.75 to 3.62). CONCLUSION: In addition to previous case reports, this series shows that differential lung ventilation is an appropriate treatment for acute severe native lung hyperinflation. A difference in estimated effective dynamic compliance of > or = 2.69 between native and transplanted lung may require differential lung ventilation.