Arthroscopic versus open repair for traumatic anterior shoulder instability: a meta-analysis.

PURPOSE: The purpose of this study was to critically evaluate the literature to determine whether open or arthroscopic surgical repair for traumatic recurrent anterior shoulder instability results in a better outcome. TYPE OF STUDY: Meta-analysis. METHODS: The search involved clinical studies in all languages in the MEDLINE database from 1966 to October 31, 2003. The following key words were used: (1) anterior shoulder instability, (2) Bankart lesion, (3) traumatic recurrent anterior shoulder instability, and (4) arthroscopic and open Bankart repair. All abstracts were reviewed and articles were included if there was a direct clinical comparison between arthroscopic and open repair for traumatic recurrent anterior shoulder instability. These articles were manually cross-referenced for additional abstracts. The final group of articles was independently critically appraised and the following outcomes were extracted: recurrent instability, return to activity, reoperation rate, and cause of recurrence. RESULTS: The search terms resulted in 677, 183, 68, and 51 hits respectively. From these, 18 articles were determined to be eligible for full review including 2 foreign-language articles. Cross-referencing identified 2 unpublished studies. Eleven studies were included in the final analysis: 1 randomized trial, 2 pseudo-experimental designs, 4 prospective cohorts, 3 retrospective studies, and 1 case control study. Pooled Mantel-Haenszel odds ratio for recurrent instability and return to activity were 2.04 ( P = .003; 95% confidence interval, 1.27, 3.29) and 2.85 ( P = .004; 95% confidence interval, 1.40, 5.78), respectively, in favor of the open repair. CONCLUSIONS: Based on this meta-analysis, open repair has a more favorable outcome with respect to recurrence and return to activity. LEVEL OF EVIDENCE: Level III, Systematic Review of Level III (and II/I) Studies.

Regional antibiotic prophylaxis in elbow surgery.

In this study we describe a technique for the delivery of regional antibiotic prophylaxis in patients undergoing elbow surgery and compare tissue antibiotic concentrations achieved by this technique with those achieved by standard systemic intravenous prophylaxis. We collected bone and fat samples from patients undergoing elective elbow surgery who had received regional antibiotic prophylaxis and measured the tissue antibiotic concentration. For comparison, we measured the antibiotic concentration in bone and fat samples taken from patients undergoing elective shoulder surgery who had received systemic prophylaxis. Mean tissue antibiotic concentrations were significantly higher in the regional antibiotic group (bone, 1484 microg/g vs 35.8 microg/g; fat, 1422.7 microg/g vs 10.7 microg/g; P <.05). No adverse effects were encountered with regional antibiotic delivery. The delivery of regional antibiotic prophylaxis in elbow surgery achieves higher tissue antibiotic concentrations than those achieved with standard systemic delivery. This technique may help reduce the risk of perioperative infection in elbow surgery.

Biomechanical analysis of five fixation techniques used in glenohumeral arthrodesis.

BACKGROUND: The purpose of the present study is to compare five fixation techniques in shoulder fusion. The most common complications resulting from shoulder fusion, non-union and unacceptable arm position, might reflect a failure to achieve rigid fixation during the surgical procedure. METHODS: Twenty-five shoulder fusions were carried out on human cadaveric specimens using the following techniques: screw fixation, external fixation, external fixation supplemented with screw fixation, single plate fixation and double plate fixation. Each specimen was tested on a servohydraulic machine to determine stiffness. RESULTS: There was a statistically significant difference in bending and torsional stiffness between all five fixation techniques. Normalized bending (B) and torsional stiffness (T), in descending order, were: double plate (B = 1.00, T = 1.00), single plate (B = 0.77, T = 0.89), external fixation with screws (B = 0.68, T = 0.74), external fixation alone (B = 0.40, T = 0.53), and screws alone (B = 0.13, T = 0.26). CONCLUSION: The risk of the most common complications resulting from shoulder fusion might be minimized if these biomechanical findings are applied to surgical decision making.