Novedades en artroplastia de hombro en 2015 / Update in shoulder surgery 2015: arthroplasty

La indicación en la cirugía de sustitución protésica del hombro ha cambiado de una forma drástica en los últimos años, hemos pasado del tratamiento con prótesis parciales para fracturas agudas al uso de prótesis inversas, la prótesis anatómica ha perdido terreno hasta el punto de que en muchos hospitales la prótesis invertida ha superado con creces a la prótesis anatómica. También podemos decir que las indicaciones de prótesis han variado, así hemos ampliado el uso de la prótesis inversa que fue desarrollada para el tratamiento de las artropatías por manguito rotador. Estos implantes en la actualidad se usan además como recurso para fracturas y recambios. En este artículo intentamos hacer una puesta al día de los problemas más frecuentes de las artroplastias y además se hace una revisión de lo publicado en los últimos años haciendo mayor hincapié en los artículos publicados en el JSES, JBJS y los ICL de la AAOS. De forma resumida se valoran las complicaciones que afectan a las prótesis de hombro

Changes in replacement surgery in the shoulder have happened recently: reverse shoulder prosthesis for acute fractures, and more indications for reverse shoulder arthroplasty than before. In this paper an update of most frequent concepts in shoulder surgery during 2015 is performed

Treatment of diaphyseal humeral fractures with the minimally invasive percutaneous plate (MIPPO) technique: a cadaveric study and clinical results.

OBJECTIVES: To assess the clinical, functional and radiologic results of the minimally invasive percutaneous plate technique in the humerus. DESIGN: Retrospective study. SETTING: University-affiliated hospital center. PATIENTS/PARTICIPANTS: Eighty-six skeletally mature patients with humeral diaphyseal fractures requiring surgical stabilization. INTERVENTION: Treatment with locking compression plates using the minimally invasive percutaneous plate technique. MAIN OUTCOME MEASUREMENTS: Cadaveric study: distance between the plate and the neurovascular structures. Clinical outcome measurements included fracture healing, radial nerve palsy, infection, and elbow and shoulder discomfort. Radiographic measurements were time to healing, alignment, and nonunion. RESULTS: The minimum follow-up in all cases was 12 months, and all fractures except three healed. The main complications found were nonunion (three) and transitory radial nerve palsy (three). The patients recovered almost complete elbow and shoulder range of motion with 98% presenting good results; no patient had implant failure. CONCLUSIONS: The results obtained with this technique are encouraging. The technique was associated with no shoulder pain and an almost complete restitution of strength and articular range of motion. Within 6 months, 96% of the patients returned to their normal activities.

Pulsed electromagnetic stimulation of regenerate bone in lengthening procedures.

Distraction osteogenesis for limb lengthening represents the treatment of choice in patients with small stature or limb length discrepancies. Bone lengthening and callus formation requires a long therapy. Pulsed electromagnetic fields (PEMF) are normally used to enhance osteogenesis in patients with non-unions. In this study we investigated whether pulsed electromagnetic fields could be used effectively to encourage callus formation and maturation during limb lengthening procedures. Thirty patients underwent bilateral bone lengthening of the humerus, femur or tibia. At day 10 after surgery, PEMF stimulation was started on one side, for 8 hours/day. Stimulated distraction sites exhibited earlier callus formation and progression, and a higher callus density compared to non-stimulated sites. External fixation could be removed on average one month earlier in PEMF stimulated bones. Our results show that the use of pulsed electromagnetic fields stimulation during limb lengthening allows shortening the time of use of the external fixation.