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Arthroscopic Repair of Greater Tuberosity Fractures

Although isolated fractures of the greater tuberosity of the humerus are less common than three- or four-part fractures of the proximal humerus, they can still result in significant disability. Fractures of the greater tuberosity often result from an anterior dislocation of the shoulder. Their nonsurgical treatment is generally reserved for minimally displaced fractures, and generally has good results, albeit with a lengthy recovery period. The surgical treatment of fractures of the greater tuberosity is controversial and ranges from arthroscopic fixation to open reduction and internal fixation. These fractures can be challenging for a variety of reasons, including the pattern of injury, schemes for their classification, methods of fixation, and the measures used to define the outcome of their treatment. Long-term outcome data on the surgical treatment of fractures of the greater tuberosity are lacking, but the literature shows that it can yield favorable outcomes. This article focuses on the surgical indications and arthroscopic and open surgical techniques for treating fractures of the greater tuberosity, on technical pearls for their surgical treatment, and on rehabilitation of the patient following their surgical treatment.

Radial Head Arthroplasty: State of the Art

Radial head arthroplasty has joined the armamentarium of options for the treatment of complex radial head fractures, elbow instability, and arthritic conditions. A variety of implants has been introduced in the past decade; these differ in metallic composition, design, and method of fixation. Good short- and intermediate-term outcomes have been reported with the use of loose-fitting prostheses. Press-fit devices restore stability and improve pain and motion but are associated with a greater likelihood of implant loosening, leading to revision surgery. Postoperative elbow stiffness, pain, ulnar nerve palsy, posterior interosseous nerve palsy, and heterotopic ossification have all been reported following radial head surgery, but these complications are likely related to the trauma sustained by the elbow. Adequate knowledge of the surgical indications, types of implants, and surgical technique are essential for a satisfactory outcome when a radial head prosthesis is used for the treatment of nonreconstructable radial head fractures.

Rotator Cuff Treatments Pay Off

New study shows impact on societal costs, savings

Mary Ann Porucznik

Shoulder pain associated with an injury to the rotator cuff affects millions of people in the United States and leads to millions of patient visits to physicians. The functional limitations due to these injuries may result in reduced earning for individuals as well as lost productivity and increased costs to society.

Use of 90–90 Plating for Distal Humerus Fractures

Despite the advances made during the past quarter century in surgical technique and orthopaedic implant technology, the optimal technique for the internal fixation of intra-articular fractures of the distal humerus remains controversial. Currently, the two techniques of parallel plating and 90–90 (orthogonal or perpendicular) plating are the most widely used methods for the fixation of such fractures. However, controversy continues to surround the positioning of dual-plate fracture fixation constructs in terms of providing optimal stability. To date, neither clinical outcome nor biomechanical testing has shown either 90–90 or parallel plating to be unequivocally superior for the fixation of distal humerus fractures, and the results of the biomechanical studies of the two techniques have been different and sometimes contradictory. Both approaches have theoretical merits and both practical benefits and drawbacks for the fixation of distal humerus fractures, but in my experience 90–90 plating is best for patients with good bone quality, whereas constructs based on parallel locking plates offer some advantages for the fixation of distal humerus fractures in elderly patients with poor bone quality.

SHO058

Although isolated fractures of the greater tuberosity of the humerus are less common than three- or four-part fractures of the proximal humerus, they can still result in significant disability. Fractures of the greater tuberosity often result from an anterior dislocation of the shoulder. Their nonsurgical treatment is generally reserved for minimally displaced fractures, and generally has good results, albeit with a lengthy recovery period. The surgical treatment of fractures of the greater tuberosity is controversial and ranges from arthroscopic fixation to open reduction and internal fixation. These fractures can be challenging for a variety of reasons, including the pattern of injury, schemes for their classification, methods of fixation, and the measures used to define the outcome of their treatment. Long-term outcome data on the surgical treatment of fractures of the greater tuberosity are lacking, but the literature shows that it can yield favorable outcomes. This article focuses on the surgical indications and arthroscopic and open surgical techniques for treating fractures of the greater tuberosity, on technical pearls for their surgical treatment, and on rehabilitation of the patient following their surgical treatment.