The Saline Load Test is Effective at Diagnosing Traumatic Arthrotomies of the Shoulder.
J Surg Orthop Adv. 2019;28(4):268-271
Authors: Gittings D, Dattilo J, Fryhofer G, Martin A, Hast M, Mehta S
The purpose of this study is to evaluate the fluid volume required for a saline load test to detect intra-articular involvement of the glenohumeral joint after penetrating trauma. A human cadaver study was conducted with 22 thawed, fresh-frozen forequarter amputations. A standard posterior shoulder portal was made with an 11-blade scalpel. A 19-gauge needle was inserted into the anterior portal site, and intra-articular position of both the blade and needle was confirmed with fluoroscopy. The blade was removed and normal saline was injected through the needle until extravasation of fluid was observed through the posterior portal. Injection volume required for extravasation was recorded. A logarithmic distribution of the volumes was then calculated in order to obtain estimated sensitivity ranges. Using a logarithmic distribution, 90%, 95% and 99% of simulated glenohumeral arthrotomies could be detected using injections of: 62 ml [41-96], 81 ml [50-133] and 136 ml [72-252], respectively. (Journal of Surgical Orthopaedic Advances 28(4):268-271, 2019).
PMID: 31886762 [PubMed - indexed for MEDLINE]
Steindler Flexorplasty: A Description of Current Technique and Case Series.
Tech Hand Up Extrem Surg. 2019 Dec;23(4):165-169
Authors: Marinello PG, Gaston RG, Loeffler BJ, Lewis DR
This year marks the 100th anniversary of Dr Steindler's original report of a proximal transfer of the flexor pronator mass to restore elbow flexion. The authors present their updated surgical technique to perform the Steindler flexorplasty. In this procedure, the flexor-pronator mass origin on the medial epicondyle is transferred proximally to the anterior humerus to restore elbow flexion. They also report a retrospective case series of patients from 2007 to 2017 who underwent a Steindler flexorplasty at their institution to restore elbow flexion. In the series, 8 of 9 patients achieved at least 90 degrees of active antigravity (M3) or greater elbow flexion. Outcomes following the Steindler flexorplasty have been reported in the literature over the course of the past 100 years. Although alternative techniques to improve elbow flexion have been developed and performed over the last century, this time tested procedure remains a powerful reconstructive option.
PMID: 31738738 [PubMed - indexed for MEDLINE]
The Osborne-Cotterill Lesion: How an Eponymous Term Arose and Evolved.
J Bone Joint Surg Am. 2019 Aug 21;101(16):e81
Authors: Somford MP, van den Bekerom MPJ, Gosens T, IJpma FFA
PMID: 31436665 [PubMed - indexed for MEDLINE]
Lateral Trochlear Ridge: A Non-Articulating Zone for Anterior-to-Posterior Screw Placement in Fractures Involving the Capitellum and Trochlea.
J Bone Joint Surg Am. 2019 Aug 07;101(15):e75
Authors: Matache BA, Culliton K, Chang Y, Cron GO, Louati H, Pollock JW
BACKGROUND: Coronal shear fractures of the distal aspect of the humerus that involve the capitellum and the trochlea are rare; nevertheless, they are difficult to treat because of the complex fracture patterns and osteochondral nature of the fragments, limiting optimal screw placement. The use of anterior-to-posterior screw fixation by a lag technique (without countersinking) could potentially improve the strength of the construct. Our primary research question was to anatomically determine if there is a non-articulating zone for screw placement along the anterior aspect of the lateral trochlear ridge (aLTR) throughout normal elbow range of motion.
METHODS: Eight fresh-frozen cadaveric elbows were used. The region of interest was defined with 3 polymeric pins inserted in the inferior, middle, and superior-most aspects of the aLTR of each elbow, with use of an extensor digitorum communis (EDC) split approach. The elbows were then mounted on a magnetic resonance imaging (MRI)-compatible compression frame and subjected to high-resolution 7-T MRI at 90°, 120°, and 145° of flexion (positions of potential impingement), and at neutral and maximal pronation and maximal supination for each position of flexion. Portions of the aLTR that had free adjacent space were identified using the sagittal and coronal scans. This non-articulating region was identified as the "non-articulating zone" (NAZ).
RESULTS: The NAZ was found to encompass the proximal 38.2% (range, 30.2% to 48.9%) of the aLTR, measuring, on average, 5.2 mm in width. It was consistently located either directly adjacent to the apex of the ridge or just medial to it. The distal 61.8% of the aLTR articulated with either the ulna or the radial head in some of the elbows.
CONCLUSIONS: Our results suggest that there is a portion of the aLTR that, despite being covered with articular cartilage, is non-articulating throughout normal elbow range of motion.
CLINICAL RELEVANCE: In situations in which headless anterior-to-posterior and posterior-to-anterior screw insertion results in inadequate fixation of capitellar-trochlear fractures, anterior-to-posterior lag screw instrumentation along the non-articulating portion of the aLTR may provide a location for additional fixation in some patients. However, because of variation between patients, each case must be individualized.
PMID: 31393432 [PubMed - indexed for MEDLINE]
Treatment of complete ankylosed elbow with total arthroplasty.
BMJ Case Rep. 2019 Jul 21;12(7):
Authors: D'Ambrosi R, Formiconi F, Ursino N, Rubino M
We reported the case of a 38-year-old patient who in 2017 presented to our institution after post-traumatic complete ankylosis of the elbow. He complained of stiffness and pain, and the radiographs revealed complete fusion of the humeroulnar joint. The Mayo Elbow Performance Score (MEPS) on admission was 31, and the elbow was fused at 90° flexed position. The patient underwent semiconstrained total elbow arthroplasty with Bryan-Morrey approach; after a 2.1 years follow-up, active arc of movement was 120°. The MEPS was excellent with a 100 points score, the patient was able to complete all activities of daily living. We did not report any complications. Total elbow arthroplasty has shown to be a good therapeutic option that make it possible to restore adequate functional range of motion and relieve pain in young patients with post-traumatic stiffness/arthritis of the elbow.
PMID: 31331932 [PubMed - indexed for MEDLINE]
Absolute reliability and concurrent validity of a novel electromechanical pulley dynamometer for measuring shoulder rotation isometric strength in asymptomatic subjects. Study conducted at Pontificia Universidad Católica, Santiago, Chile.
J Pak Med Assoc. 2019 Jul;69(7):1000-1005
Authors: Chamorro C, la Fuente C, Rubio J, Campos C, Chirosa LJ
OBJECTIVE: To estimate the test-retest reliability of measurements in shoulder internal and external rotators' isometric peak torque using a new dynamometer, and to compare it with isokinetic dynamometer.
METHODS: The validity study was conducted in September-October 2016 at Pontificia Universidad Catolica de Chile and the Clinica Las Condes, Santiago, Chile. It comprised of asymptomatic university students who were randomly tested twice within a two-week period while in a supine position at 90° of shoulder abduction, using the novel functional electromechanical pulley dynamometer. Concurrent validity was assessed through comparing the values with the gold standard isokinetic dynamometer in the same position. SPSS 17 was used for data analysis.
RESULTS: Of the 24 subjects, 5(21%) were males and 19(79%) were females. The overall mean age was 23.1±2.2 years, body mass index 23.6±2.13 kg/m2 and Shoulder Pain and Disability Index score was 3.9±6.4. There was no statistically non-significant difference in terms of test-retest trials and between the devices (p>0.05). Absolute reliability was 24.3% for internal rotation and 27.9% for external rotation. Both dynamometer systems were very highly correlated for internal rotators peak torque (0.93) and highly correlated for external rotators peak torque (0.84).
CONCLUSIONS: Compared to the gold standard, the new device was found to be a valid instrument in measuring maximal voluntary isometric peak torque in internal and external rotation.
PMID: 31308571 [PubMed - indexed for MEDLINE]
Early Recognition of a Transient Ischemic Attack Utilizing Cerebral Oxygenation Monitoring During Shoulder Surgery in the Beach Chair Position: A Case Report.
A A Pract. 2019 Sep 01;13(5):176-180
Authors: Aguirre JA, Mohajeri MS, Rupnik B, Brada M, Rosskopf AB, Meyer DC, Eichenberger U, Borgeat A
Shoulder surgery in the beach chair position is routinely performed, and central neurological events are rare but potentially devastating. We present a patient with transient neurological deficits after a sudden blood pressure drop with a simultaneous decrease of regional cerebral saturation values registered by cerebral oximetry. We reviewed published cases and proposed possible strategies to prevent the occurrence of similar complications in this context.
PMID: 31045588 [PubMed - indexed for MEDLINE]
Shoulder and elbow pain in junior high school baseball players: Results of a nationwide survey.
J Orthop Sci. 2019 Jul;24(4):708-714
Authors: Takagishi K, Matsuura T, Masatomi T, Chosa E, Tajika T, Iwama T, Watanabe M, Otani T, Inagaki K, Ikegami H, Aoki M, Okuwaki T, Kameyama Y, Akira M, Kaneoka K, Sakamoto M, Beppu M
BACKGROUND: Despite proposals and guidelines to prevent baseball injuries in young players by societies and organizations, many shoulder and elbow injuries continue to occur among junior high school baseball players. In order to investigate the training conditions of junior high school baseball players and the risk factors for shoulder and elbow pain in the players, we conducted a questionnaire survey among junior high school baseball players throughout the country.
METHODS: The questionnaire survey was conducted among junior high school baseball players in September 2016.
RESULTS: A total of 11,134 junior high school baseball players belonging to 495 teams responded to the survey. Among these, 4004 players trained every day of the week and 1151 players played baseball games every month with no off-season. Among 9752 players who did not have shoulder and/or elbow pain in the spring and summer of 2015, 19.2% of players experienced elbow pain over the course of one year, 13.6% of players experienced shoulder pain, and 28.0% complained of shoulder and/or elbow pain. The frequency of elbow pain was more than that of shoulder pain. At risk for shoulder pain were pitchers and catchers and second-year students, while risk factors for elbow pain were playing pitcher and catcher positions, pitching or throwing ≥300 balls per week, playing ≥10 games on average per month and being left-handed.
CONCLUSION: Risk factors for shoulder pain were different from those for elbow pain. To prevent elbow pain, coaches should pay attention to pitchers and catchers and left-handed players and not allow players to pitch or throw ≥300 full-power balls per week or participate in ≥10 games per month. They should also pay attention to pitchers and catchers and second-year students to prevent shoulder pain. It is important for coaches to train multiple pitchers and catchers.
PMID: 30638688 [PubMed - indexed for MEDLINE]
Direct Comparison of Modified Jobe and Docking Ulnar Collateral Ligament Reconstruction at Midterm Follow-up.
Am J Sports Med. 2019 01;47(1):144-150
Authors: Arner JW, Chang ES, Bayer S, Bradley JP
BACKGROUND: The modified Jobe and docking techniques are the 2 most commonly employed techniques for ulnar collateral ligament (UCL) reconstruction among overhead athletes. However, no study has directly compared these techniques performed by a single surgeon. Current comparisons of these techniques have relied solely on systematic reviews and biomechanical studies.
HYPOTHESIS: There will be no difference in outcomes or return to play between the modified Jobe and docking techniques in elbow UCL reconstruction surgery.
STUDY DESIGN: Cohort study; Level of evidence, 3.
METHODS: Twenty-five modified Jobe and 26 docking UCL-reconstructive surgical procedures were performed by a single surgeon, each with a minimum 2-year follow-up. Kerlan-Jobe Orthopaedic Clinic (KJOC) score, Conway Scale, years played, sex, handedness, sport, position, palmaris versus gracilis graft type, concomitant or future arm/shoulder injuries, and need for additional surgery were compared between the groups. Patients who underwent future shoulder or elbow surgery, no matter the cause, were included.
RESULTS: No difference was seen between the modified Jobe and docking reconstruction cases in regard to KJOC scores (mean ± SD: 78.4 ± 19.5 vs 72.0 ± 26.0, P = .44), Conway Scale (return to play, any level: 84% vs 82%, P = .61), years played (14.7 ± 6.2 vs 15.2 ± 5.8, P = .52), sex ( P = .67), handedness ( P ≥ .999), sport ( P = .44), position ( P = .60), level of competition ( P = .59), and future surgery (12% vs 4%, P = .35). Palmaris graft type had significantly higher KJOC scores than hamstring grafts (82.3 ± 20.0 vs 57.9 ± 21.2, P = .001). The mean follow-up was 6.1 years in the modified Jobe group and 7.3 years in the docking group (mean = 6.7, P = .47).
CONCLUSION: The modified Jobe and docking techniques are both suitable surgical options for elbow UCL reconstruction. There was no statistically significant difference between the techniques in regard to return to play, KJOC score, or need for subsequent surgery at 6.7-year follow-up. This is the first direct clinical comparison of these 2 techniques by a single surgeon at midterm follow-up.
PMID: 30500269 [PubMed - indexed for MEDLINE]