Lateral Clavicular Autograft for Repair of Reverse Hill-Sachs Defect

Posterior dislocations of the shoulder joint can result in an impression fracture over the anteromedial humeral head, termed the reverse Hill-Sachs lesion, the presence of which can contribute to recurrent dislocations. Methods described to repair this defect include using allografts, iliac crest and coracoid process autografts, and bone graft substitutes. We describe a novel technique using the lateral end of the ipsilateral clavicle as an autograft in a 78 year old man with a reverse Hill Sachs lesion. This graft can be harvested through the same incision and does not compromise the stability of the acromioclavicular joint or any future shoulder arthroplasty.

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A New Method to Determine the Humerus Height and Humeral Head Retroversion for Hemiarthroplasty

10.21203/rs.3.rs-31603/v1 ◽

2020 ◽

Author(s):

Wanfu Wei ◽

Jian`an Li ◽

Guoyun Bu ◽

Tao Yang

Keyword(s):

Linear Regression ◽

Blood Loss ◽

Linear Relationship ◽

Shoulder Arthroplasty ◽

Humeral Head ◽

Shoulder Joint ◽

Operation Time ◽

Treatment Groups ◽

Constant Murley Score ◽

Significant Difference

Abstract Background Placement of shoulder prosthesis used for reconstruction of a complex proximal humerus fractures is critical because it is related to clinical outcomes after hemiarthroplasty. To achieve the anatomical placement of the prosthesis, we introduced a simple operative method to determine the humerus height and humeral head retroversion, and retrospectively investigated the clinical and radiographic outcomes of our procedure.Method 34 patients, treated by shoulder arthroplasty for 4-part or 3–part proximal humeral fracture during the period between June 2016 and December 2018, were enrolled in the study. Eventually 29 patients, 18 women and 11 men with an average age of 68.4 years (range 58–85 years), were followed up successfully. Of which 13 patients treated with classic method were matched to 19 of the 29 new method treated patients by operation time, blood loss, pain, range of motion, Constant-Murley score and radiographic features.Results There was a significant difference between the two treatment groups in operation time (p = 0.024), while there was no significant difference in blood loss (p = 0.078). No significant difference was found between the two treatment groups in Visual Analog scale (p = 0.225), Constant-Murley score (p = 0.930), and radiological outcomes (p = 0.504). There was linear regression and correlation between Constant-Murley score and age (p = 0.027), while there was no linear relationship between status of tuberosity and the function of the shoulder joint (p = 0.931).Conclusion We introduce a new operative technique to determine the humerus height and humeral head retroversion for shoulder arthroplasty operation. Based on the data, there is linear regression and correlation between Constant-Murley score and age, while there is no linear relationship between status of tuberosity and the function of the shoulder joint. Our present analyses reveal that our protocol is personalized, easy, effective and feasible.

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Joint Preserving Treatment of Chronic Locked Posterior Shoulder Dislocation by Means of Combined Humeral Allograft Reconstruction and Posterior Glenoid Autograft Augmentation

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/a-1651-0943 ◽

2021 ◽

Author(s):

Katja Rüttershoff ◽

Doruk Akgün ◽

Philipp Moroder

Keyword(s):

Shoulder Arthroplasty ◽

Humeral Head ◽

Shoulder Dislocation ◽

Iliac Crest ◽

Young Patients ◽

Posterior Shoulder Dislocation ◽

Allograft Reconstruction ◽

Locked Posterior Shoulder Dislocation ◽

Posterior Shoulder ◽

Fresh Frozen

AbstractChronic locked posterior shoulder dislocations are challenging to treat and often warrant total shoulder arthroplasty. While joint preserving treatment is preferable in young patients, surgical techniques to treat this pathology have rarely been described in the literature. This technical note presents the treatment of a 30-year-old male patient with a chronic locked posterior shoulder dislocation by means of combined humeral allograft reconstruction and posterior glenoid autograft augmentation. Restoration of the spheric humeral head surface was obtained using a fresh-frozen femoral allograft fixed with two reabsorbable screws. Due to the intraoperatively persistent posterior instability after humeral reconstruction, the posterior glenoid was augmented with a tricortical iliac crest autograft, which was fixed with two metal screws. This treatment strategy resulted in a full range of motion and a centered stable shoulder joint at one-year follow-up. Therefore, the procedure of segmental reconstruction of the humeral head with a fresh-frozen allograft combined with a posterior glenoid augmentation with an iliac crest bone autograft is a joint-preserving treatment alternative to shoulder arthroplasty in young patients when humeral head reconstruction alone does not suffice.

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A Modified Method to Determine the Humerus Height and Humeral Head Retroversion for Hemiarthroplasty

10.21203/rs.3.rs-68852/v1 ◽

2020 ◽

Author(s):

Wanfu Wei ◽

Jian`an Li ◽

Guoyun Bu ◽

Tao Yang

Keyword(s):

Linear Regression ◽

Blood Loss ◽

Linear Relationship ◽

Shoulder Arthroplasty ◽

Humeral Head ◽

Shoulder Joint ◽

Operation Time ◽

Treatment Groups ◽

Constant Murley Score ◽

Significant Difference

Abstract Background Placement of shoulder prosthesis used for reconstruction of a complex proximal humerus fractures is critical because it is related to clinical outcomes after hemiarthroplasty. To achieve the anatomical placement of the prosthesis, we introduced a simple operative method to determine the humerus height and humeral head retroversion, and retrospectively investigated the clinical and radiographic outcomes of our procedure.Method 34 patients, treated by shoulder arthroplasty for 4-part or 3–part proximal humeral fracture during the period between June 2016 and December 2018, were enrolled in the study. Eventually 29 patients, 18 women and 11 men with an average age of 68.4 years (range 58-85 years), were followed up successfully. Of which 13 patients treated with classic method were matched to 19 of the 29 new method treated patients by operation time, blood loss, pain, range of motion, Constant-Murley score and radiographic features. Results There was a significant difference between the two treatment groups in operation time (p=0.024), while there was no significant difference in blood loss (p=0.078). No significant difference was found between the two treatment groups in Visual Analog scale (p=0.225), Constant-Murley score (p=0.930), and radiological outcomes (p=0.504). There was linear regression and correlation between Constant-Murley score and age (p=0.027), while there was no linear relationship between status of tuberosity and the function of the shoulder joint (p=0.931). Conclusion We introduce a new operative technique to determine the humerus height and humeral head retroversion for shoulder arthroplasty operation. Based on the data, there is linear regression and correlation between Constant-Murley score and age, while there is no linear relationship between status of tuberosity and the function of the shoulder joint. Our present analyses reveal that our protocol is personalized, easy, effective and feasible.Trial registration: https://doi.org/10.1186/ISRCTN28175069.

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Reconstruction of Coracoclavicular Ligament with Endobutton and Sutures to Stabilize Acromioclavicular Joint: A Retrospective Clinical Study and Finite Element Analysis

10.21203/rs.3.rs-241606/v1 ◽

2021 ◽

Author(s):

kai ding ◽

wen zhang ◽

xi chen ◽

yi-ge zhang ◽

wen ge ding

Keyword(s):

Finite Element Analysis ◽

Finite Element ◽

Shoulder Joint ◽

Acromioclavicular Joint ◽

Coracoclavicular Ligament ◽

Element Analysis ◽

Group A ◽

The Difference ◽

The Stability ◽

Group B

Abstract Acromioclavicular joint dislocation is a common sports injury disease, surgical treatment to restore the acromioclavicular joint stability, including stability and vertical stability level. However, vertical stability is often neglected. So we did a retrospective study enrolled 38 patients using Endobutton reconstruction and suture repair (Group A) with those using single Endobutton (Group B). The perioperative assessments contained coracoclavicular distance (CCD), Constant-Murley shoulder joint score, University of California at Los Angeles (UCLA) shoulder joint score and the difference between bilateral CCD 12 months postoperatively. The evaluation of group A was significantly better than group B. Constant-Murley scores and UCLA shoulder scores preoperatively were significantly higher than those after operation. The postoperative CCD of the two groups was lower than that before surgery. CCD between the affected shoulder and another postoperatively was no difference in group A, but was different in group B. The difference of postoperative CCD of the two groups was different. Afterward, we evaluated the stress and deformation around the acromioclavicular joint by finite element analysis and found that the stress dispersion and displacement reduction enhanced the stability of acromioclavicular joint. Thus, reconstruction of coracoclavicular ligament with Endobutton and sutures repair can increase the stability of acromioclavicular joint.

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Assessing the required glenoid peg penetration in native scapula when bone graft is used during primary and revision shoulder arthroplasty

Shoulder & Elbow ◽

10.1177/1758573220987557 ◽

2021 ◽

pp. 175857322098755

Author(s):

Daoud Makki ◽

Basel Balbisi ◽

Mohammed S Arshad ◽

Puneet Monga ◽

Steven Bale ◽

...

Keyword(s):

Bone Graft ◽

Shoulder Arthroplasty ◽

Iliac Crest ◽

Revision Arthroplasty ◽

Native Bone ◽

Revision Shoulder Arthroplasty ◽

The Mean ◽

Glenoid Baseplate ◽

The Stability

Aims Achieving purchase in native glenoid bone is essential for the stability of the glenoid baseplate when bone graft is used to address bone loss in both primary and revision shoulder arthroplasty procedures. The aim of this study is to assess the required depth of the baseplate peg in native bone when bone graft is used to result in satisfactory integration. Patients and methods The CT scans of patients who underwent either primary or revision arthroplasty procedures with bone graft using the SMR Axioma Trabecular Titanium (TT) Metal Backed glenoid system were assessed. We measured the depth of the glenoid peg in native glenoid bone. Measurements were taken by two authors separately. Results The scans of 53 patients (mean age 68 years) with a minimum follow-up of two years were reviewed. Implants included 12 anatomical and 41 reverse geometry prostheses. There were 17 primaries and 36 revisions: hemiarthroplasties (20) total (14) and reverse (2) implants. Bone grafts were from humeral head (15), iliac crest (34) and allograft (4). The mean depths were 8.8 mm (first assessor) and 9.10 mm (second assessor). The glenoid peg violated the glenoid vault in 32 patients and this did not adversely affect the outcome. There were three failures of implants all of which were aseptic failures and had peg penetration of less than 6 mm. Conclusions The mean depth of glenoid peg in native bone was 9 mm (variation between 0.2 and 0.52 mm at 95% confidence interval). Aseptic loosening was seen with peg penetration less than 6 mm in native bone. Glenoid vault violation was not associated with loosening.

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Benefits of an anatomical reconstruction of the humeral head during shoulder arthroplasty: a finite element analysis

Clinical Biomechanics ◽

10.1016/j.clinbiomech.2003.09.009 ◽

2004 ◽

Vol 19 (1) ◽

pp. 16-23 ◽

Cited By ~ 38

Author(s):

P. Büchler ◽

A. Farron

Keyword(s):

Finite Element Analysis ◽

Finite Element ◽

Shoulder Arthroplasty ◽

Humeral Head ◽

Anatomical Reconstruction ◽

Element Analysis

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The base of coracoid process as a reference for glenoid reconstruction in primary or revision reverse shoulder arthroplasty: CT-based anatomical study

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-020-03642-w ◽

2020 ◽

Author(s):

Nadine Ott ◽

Jan-Dirk Kieback ◽

Kristan Welle ◽

Christian Paul ◽

Christof Burger ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

Reverse Shoulder Arthroplasty ◽

Anatomical Study ◽

Coracoid Process ◽

Glenoid Reconstruction

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Is it the coracobrachialis superior muscle, or is it an unidentified rare variant of coracobrachialis muscle?

Surgical and Radiologic Anatomy ◽

10.1007/s00276-021-02773-y ◽

2021 ◽

Author(s):

Łukasz Olewnik ◽

Nicol Zielinska ◽

Łukasz Gołek ◽

Paloma Aragonés ◽

Jose Ramon Sanudo

Keyword(s):

Case Report ◽

Rare Variant ◽

Shoulder Joint ◽

Biceps Brachii ◽

Coracoid Process ◽

Biceps Brachii Muscle ◽

Shoulder Region

AbstractThe coracobrachialis muscle (CBM) originates from the apex of the coracoid process, in common with the short head of the biceps brachii muscle, and from the intermuscular septum. The CBM demonstrates variability in both the proximal and distal attachment, with some extremely rare varieties, such as the coracobrachialis superior, coracobrachialis longus and coracocapsularis muscle. This case report describes an extremely rare variant of the coracobrachialis superior muscle, or a very rare variant of the CBM. Our findings highlight the importance of muscle variants in the shoulder region, especially the coracoid region, and are significant for radiologists, anatomists, physiotherapists and surgeons specializing in the shoulder joint.

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