scholarly journals Intrathoracic fracture-dislocation of the humeral head: A case report and review of the literature

2021 ◽  
Keyword(s):  
Shoulder Arthroplasty ◽  
Humeral Head ◽  
Early Stage ◽  
External Rotation ◽  
Reverse Shoulder Arthroplasty ◽  
Multidisciplinary Treatment ◽  
Fracture Dislocation ◽  
Range Of Movement ◽  
Multiple Fractures ◽  
Emergency Thoracotomy

Background: Intrathoracic displacement of a humeral head fracture is extremely rare. Only slightly more than 30 cases have been reported in this regard. Since few cases have been reported, there is no consensus on how to treat this injury. The etiology, injury mechanism, related lesions, and treatment of the injury are diverse. Case presentation: A 73-year-old female presented with multiple fractures of the left ribs, bilateral lung contusions, extensive emphysema of the anterior and posterior chest wall, massive left hemopneumothorax, fracture-dislocation of the proximal humerus, and intrathoracic displacement of the humeral head. The patient was sent to the operating room for emergency thoracotomy surgery. The head of the humerus was confirmed to be completely removed from the thoracic cavity during the operation. After discussion with the orthopedic surgeon, the humeral head was discarded considering avascular necrosis; moreover, open reduction and internal fixation were not performed. The orthopedic surgery team performed reverse shoulder arthroplasty three weeks later. During follow-up, the patient’s shoulder was free from pain, and its range of movement included 110° flexion, 70° abduction, 35° external rotation, and 50° internal rotation. Conclusion: Intrathoracic displacement of the humeral head due to proximal humeral fracture is a very rare and serious trauma that requires multidisciplinary treatment. Considering the extremely high risk of humeral head necrosis, actively removing broken bone fragments of the humeral head in the early stage is recommended, and we advocate for shoulder arthroplasty for elderly patients. Detailed preoperative evaluations and individualized operation plans should be made to achieve the best effect.

Intrathoracic Fracture-dislocation of the Humeral Head:A Case Report and Review of the Literature

2021 ◽  
Author(s):  
Ruifeng Yang ◽  
chong wang
Keyword(s):  
Humeral Head ◽  
Early Stage ◽  
External Rotation ◽  
Multidisciplinary Treatment ◽  
Humeral Fracture ◽  
Fracture Dislocation ◽  
Range Of Movement ◽  
Multiple Fractures ◽  
Emergency Thoracotomy ◽  
Humeral Head Necrosis

Abstract BackgroundIntrathoracic displacement of a humeral head fracture is extremely rare.Only slightly more than 30 cases have been reported. Because few cases have been reported, there is no consensus on how to treat this injury. The etiology, injury mechanism, related lesions and treatment of the injury are diverse.Case presentationA 73-year-old woman presented with multiple fractures of the left ribs, bilateral lung contusions, extensive emphysema of the anterior and posterior chest wall, massive left hemopneumothorax, fracture-dislocation of the proximal humerus and intrathoracic displacement of the humeral head.The patient was sent to the operating room for emergency thoracotomy surgery. The head of the humerus was confirmed to be completely removed from the thoracic cavity during the operation. After discussion with the orthopedic surgeon, the humeral head was discarded considering avascular necrosis, and open reduction and internal fixation were not performed.Three weeks later, the orthopedic surgery team performed reverse shoulder arthroplasty.During follow-up, the patient’s shoulder was free from pain, and its range of movement (ROM) included 110° flexion, 70° abduction, 35° external rotation and 50° internal rotation.ConclusionsIntrathoracic displacement of the humeral head due to proximal humeral fracture is a very rare and serious trauma that requires multidisciplinary treatment. Considering the extremely high risk of humeral head necrosis, actively removing broken bone fragments of the humeral head in the early stage is recommended, and we advocate for shoulder arthroplasty for elderly patients. Detailed preoperative evaluations and individualized operation plans should be made to achieve the best effect.

scholarly journals Glenoid loosening and migration in reverse shoulder arthroplasty

2019 ◽  
Vol 101-B (4) ◽  
pp. 461-469 ◽  
Author(s):  
A. Lädermann ◽  
A. J. Schwitzguebel ◽  
T. B. Edwards ◽  
A. Godeneche ◽  
L. Favard ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Shoulder Arthroplasty ◽  
External Rotation ◽  
Constant Score ◽  
Reverse Shoulder Arthroplasty ◽  
Multivariable Analysis ◽  
Range Of Movement ◽  
Original Cohort ◽  
Glenoid Loosening

Aims The aim of this study was to report the outcomes of different treatment options for glenoid loosening following reverse shoulder arthroplasty (RSA) at a minimum follow-up of two years. Patients and Methods We retrospectively studied the records of 79 patients (19 men, 60 women; 84 shoulders) aged 70.4 years (21 to 87) treated for aseptic loosening of the glenosphere following RSA. Clinical evaluation included pre- and post-treatment active anterior elevation (AAE), external rotation, and Constant score. Results From the original cohort, 29 shoulders (35%) were treated conservatively, 27 shoulders (32%) were revised by revision of the glenosphere, and 28 shoulders (33%) were converted to hemiarthroplasty. At last follow-up, conservative treatment and glenoid revision significantly improved AAE, total Constant score, and pain, while hemiarthroplasty did not improve range of movement or clinical scores. Multivariable analysis confirmed that conservative treatment and glenoid revision achieved similar improvements in pain (glenoid revision vs conservative, beta 0.44; p = 0.834) but that outcomes were significantly worse following hemiarthroplasty (beta -5.00; p = 0.029). Conclusion When possible, glenoid loosening after RSA should first be treated conservatively, then by glenosphere revision if necessary, and last by salvage hemiarthroplasty Cite this article: Bone Joint J 2019;101-B:461–469.

Glenosphere design affects range of movement and risk of friction-type scapular impingement in reverse shoulder arthroplasty

2018 ◽  
Vol 100-B (9) ◽  
pp. 1182-1186 ◽  
Author(s):  
B. S. Werner ◽  
J. Chaoui ◽  
G. Walch
Keyword(s):  
Internal Rotation ◽  
Shoulder Arthroplasty ◽  
External Rotation ◽  
Reverse Shoulder Arthroplasty ◽  
Large Diameter ◽  
Glenoid Component ◽  
Range Of Movement ◽  
Scapular Notching ◽  
Component Size ◽  
Centre Of Rotation

Aims Scapular notching is a frequently observed radiographic phenomenon in reverse shoulder arthroplasty (RSA), signifying impingement of components. The purposes of this study were to evaluate the effect of glenoid component size and glenosphere type on impingement-free range of movement (ROM) for extension and internal and external rotation in a virtual RSA model, and to determine the optimal configuration to reduce the incidence of friction-type scapular notching. Materials and Methods Preoperative CT scans obtained in 21 patients (three male, 18 female) with primary osteoarthritis were analyzed using modelling software. Two concurrent factors were tested for impingement-free ROM and translation of the centre of rotation: glenosphere diameter (36 mm vs 39 mm) and type (centred, 2 mm inferior eccentric offset, 10° inferior tilt). Results Glenosphere size was most predictive of increased extension and external rotation, whereas lateralization of the centre of rotation was the most predictive factor for internal rotation. A larger diameter of glenosphere combined with a 10° tilted configuration demonstrated superior values for extension and external rotation, whereas the eccentric component improved internal rotation by a mean 8.9° (standard deviation 2.7°) compared with a standard concentric glenosphere. Conclusion Glenosphere configuration can be modified to increase range of movement in RSA. Friction-type scapular notching was most effectively reduced by use of a large-diameter glenosphere with 10° inferior tilt. Cite this article: Bone Joint J 2018;100-B:1182–6.

scholarly journals Effect of critical shoulder angle, glenoid lateralization, and humeral inclination on range of movement in reverse shoulder arthroplasty

2019 ◽  
Vol 8 (8) ◽  
pp. 378-386 ◽  
Author(s):  
Alexandre Lädermann ◽  
Eileen Tay ◽  
Philippe Collin ◽  
Sébastien Piotton ◽  
Chih-Hao Chiu ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
External Rotation ◽  
Reverse Shoulder Arthroplasty ◽  
Subacromial Space ◽  
Range Of Movement ◽  
Neck Shaft Angle ◽  
Critical Shoulder Angle ◽  
Flexion Extension ◽  
The Impact ◽  
Shoulder Angle

Objectives To date, no study has considered the impact of acromial morphology on shoulder range of movement (ROM). The purpose of our study was to evaluate the effects of lateralization of the centre of rotation (COR) and neck-shaft angle (NSA) on shoulder ROM after reverse shoulder arthroplasty (RSA) in patients with different scapular morphologies. Methods 3D computer models were constructed from CT scans of 12 patients with a critical shoulder angle (CSA) of 25°, 30°, 35°, and 40°. For each model, shoulder ROM was evaluated at a NSA of 135° and 145°, and lateralization of 0 mm, 5 mm, and 10 mm for seven standardized movements: glenohumeral abduction, adduction, forward flexion, extension, internal rotation with the arm at 90° of abduction, as well as external rotation with the arm at 10° and 90° of abduction. Results CSA did not seem to influence ROM in any of the models, but greater lateralization achieved greater ROM for all movements in all configurations. Internal and external rotation at 90° of abduction were impossible in most configurations, except in models with a CSA of 25°. Conclusion Postoperative ROM following RSA depends on multiple patient and surgical factors. This study, based on computer simulation, suggests that CSA has no influence on ROM after RSA, while lateralization increases ROM in all configurations. Furthermore, increasing subacromial space is important to grant sufficient rotation at 90° of abduction. In summary, increased lateralization of the COR and increased subacromial space improve ROM in all CSA configurations. Cite this article: A. Lädermann, E. Tay, P. Collin, S. Piotton, C-H Chiu, A. Michelet, C. Charbonnier. Effect of critical shoulder angle, glenoid lateralization, and humeral inclination on range of movement in reverse shoulder arthroplasty. Bone Joint Res 2019;8:378–386. DOI: 10.1302/2046-3758.88.BJR-2018-0293.R1.

Anatomic versus reverse shoulder arthroplasty: a mid-term follow-up comparison

2020 ◽  
pp. 175857322092115
Author(s):  
Bradley S Schoch ◽  
Joseph J King ◽  
Joseph Zuckerman ◽  
Thomas W Wright ◽  
Chris Roche ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Patient Reported Outcomes ◽  
External Rotation ◽  
Reverse Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Reoperation Rate ◽  
Patient Reported ◽  
Total Shoulder Arthroplasties ◽  
Shoulder Arthroplasties

Background Anatomic total shoulder arthroplasty improves pain and function with a reported reoperation rate of approximately 1% per year. With improved glenoid fixation, reverse shoulder arthroplasty implants may outperform anatomic total shoulder arthroplasty. We evaluate the functional outcomes and reoperation rate of anatomic total shoulder arthroplasty versus reverse shoulder arthroplasty at a minimum eight-year follow-up or revision. Methods Between 2005 and 2010, 187 shoulders (137 anatomic total shoulder arthroplasty, 50 reverse shoulder arthroplasty) were retrospectively reviewed at a mean of 8.8 years. The mean age at surgery was 67 years. Females were more commonly treated with reverse shoulder arthroplasty. Both groups had similar body mass index and comorbidities. Outcome measures evaluated included abduction, forward elevation, external rotation, internal rotation, Simple Shoulder Test, Constant score, American Shoulder and Elbow Score, University of California Los Angeles Shoulder score, and Shoulder Pain and Disability Index. Results At follow-up, anatomic total shoulder arthroplasty demonstrated greater overhead range of motion and external rotation. All patient-reported outcomes remained similar between groups. Reverse shoulder arthroplasty patients were more likely to rate shoulders as much better or better after surgery (90% versus 67%, p = 0.004). Complications were observed in 24% of anatomic total shoulder arthroplasties and 8% of reverse shoulder arthroplasties (p = 0.02). Reoperation was more common in anatomic total shoulder arthroplasties (23% versus 4%, p = 0.003). Discussion At mid-to-long-term follow-up, reverse shoulder arthroplasties demonstrated significantly fewer complications and reoperations than anatomic total shoulder arthroplasties. Despite similar patient-reported outcomes, reverse shoulder arthroplasty patients were more likely to be satisfied with their shoulder.

scholarly journals Bony increased-offset reverse shoulder arthroplasty: A meta-analysis of the available evidence

2020 ◽  
pp. 175857322091684
Author(s):  
Richard Dimock ◽  
Mohamed Fathi Elabd ◽  
Mohamed Imam ◽  
Mark Middleton ◽  
Arnaud Godenèche ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Shoulder Arthroplasty ◽  
External Rotation ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Reverse Shoulder Arthroplasty ◽  
Case Series ◽  
Autogenous Bone ◽  
Radiographic Outcomes ◽  
Outcome Scores

Background Reverse shoulder arthroplasty (RSA) has revolutionized the management of many shoulder pathologies. Lateralization has become favourable to combat complications (e.g. notching, compromised external rotation), using a metallic, or autogenous bone-graft baseplates – bony increased-offset reverse shoulder arthroplasty (BIO-RSA). We systematically reviewed the literature to determine: Does BIO-RSA improve range of motion and outcome scores? Are notching rates decreased? Does the graft heal? Methods All available prospective studies, trials and case series reporting on BIO-RSA were included. Outcomes were grouped into outcome scores, range of motion and radiographic outcomes. Data were pooled and statistical analysis performed. Results Eight studies reported on 385 RSA – 235 BIO-RSA and 150 standard-RSA (STD-RSA). Follow-up was 20–36 months; average age 74 years. Outcome scores: Constant-Murley and SSV scores showed statistically significant post-operative benefit of BIO-RSA (mean-difference 4.0 (95% confidence interval (CI): 0.79,7.1) and 6.8 (95% CI: 3.8, 9.9)). No Minimal Clinically Importance Difference was surpassed. Range of motion: No difference was found in any direction. Notching: Notching was less likely with BIO-RSA (odds ratio 0.19 (95% CI: 0.10, 0.38)). Healing and loosening: 92% grafts fully healed/incorporated. Loosening rate was 2.4%. Conclusions Literature on BIO-RSA is limited with only one randomised controlled trial (RCT). Weak evidence exists for improved outcome scores. Range of motion is equivocal. Notching rates are significantly lower in BIO-RSA. The graft usually heals.

“Shaped” humeral head autograft reverse shoulder arthroplasty

2017 ◽  
Vol 46 (12) ◽  
pp. 1045-1054 ◽  
Author(s):  
S. Harmsen ◽  
D. Casagrande ◽  
T. Norris
Keyword(s):  
Shoulder Arthroplasty ◽  
Humeral Head ◽  
Reverse Shoulder Arthroplasty
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