ISSN:0885-9698    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0885-9698    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0885-9698    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Summary:Acromioplasty is a well accepted technique recommended for treatment of rotator cuff disease. Arthroscopic acromioplasty can accomplish the same surgical result with less morbidity and be performed on an out-patient basis. The technique here described consistently achieves an acromioplasty which converts a pathological acromion into a Type I, or flat acromion, releases the coracoacromial ligament and allows inspection and access to the acromio-clavicular joint. Techniques of controlling bleeding during the procedure are also described.

ISSN:0885-9698    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0885-9698    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Summary:Tears of the subscapularis tendon are infrequent though not rare, and diagnosis can be difficult. Surgical treatment is a technical challenge, though timely repair can result in a good outcome.

ISSN:0885-9698    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Summary:The indications for surgical management of acute complete acromioclavicular dislocations are controversial. The modified Weaver-Dunn technique provides satisfactory results in 76% of chronic acromioclavicular dislocations and in 96% of acute reconstructions for those patients requiring a power arm in sports or manual labor. Failures of surgical treatment are secondary to early loss of fixation due to inappropriate active use or acromioclavicular arthritis secondary to insufficient distal clavicle resection. The modified Weaver-Dunn technique provides reliable and consistent results in acute cases and is a satisfactory salvage procedure in symptomatic patients with chronic injuries.

ISSN:0885-9698    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Summary:Large and massive tears of the rotator cuff are usually long-standing and may be technically difficult to repair secondary to bursal scarring, tendon retraction, and poor tissue quality. Several surgical maneuvers have been introduced in the past several years to aid in the repair of these difficult tears. These maneuvers are carried out as part of the four basic steps of rotator cuff repair: the approach, the decompression, the repair of the cuff tear, and postoperative rehabilitation. In the approach phase, the deltoid split is centered over the greater tuberosity in the area of the middle deltoid fibers. This more postero-lateral approach allows better access to the posterior cuff tissue for improved mobilization. The decompression is then performed in such a way as to preserve the acromial insertion of the deltiod while eliminating the source of impingement at the inferior surface of the anterior acromion. The repair is then performed after mobilization and release of the retracted torn rotator cuff tendons. Mobilization is greatly improved by the use of an “interval slide” in which the anterior portion of the supraspinatus is completely released to the medial aspect of the base of the coracoid, restored to its original length, and realigned at the rotator interval. The tendons are then securely repaired to bone with the arm at the side. Passive range of motion exercises are begun immediately to preserve glenohumeral motion. Using these techniques, adequate pain relief and the ability to raise the arm above the horizontal can be expected in the majority of patients with large or massive tears.

ISSN:0885-9698    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Summary:Results of open reduction and internal fixation of two- and three-part proximal humerus fractures can be maximized with a thorough understanding of shoulder anatomy, accurate fracture classification based on quality radiographs in three planes, strict attention to detail, and minimizing further injury to the soft tissues at the time of surgery. Almost all of these fractures can be managed by one of two surgical approaches, the deltoid-splitting or deltopectoral, both of which leave the deltoid origin intact. Minimal osteosynthesis fixation in the form of heavy, nonabsorbable suture or wire incorporating the strong rotator cuff tendons, tuberosities, and shaft is a sound method of achieving both rigid fixation and fracture healing. Ender nails used in conjunction with figure-of-eight suture or wire in a tension band configuration gives additional longitudinal and rotational stability in surgical neck fractures, especially if comminution exists. The use of this limited internal fixation minimizes the complications of soft-tissue stripping and loss of fixation in osteoporotic bone seen with the use of plates and screws, while allowing an early passive rehabilitation program. A physician-supervised rehabilitation program for at least 1 full year is required for optimum results.

ISSN:0885-9698    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Summary:In the treatment of acute proximal humerus fractures, primary prosthetic humeral replacement arthroplasty is employed for four-part fractures and fracture dislocations, selected three-part fractures in older patients with soft bone, head splitting fractures, and head impression fractures involving >40% of the articular surface. A muscle-sparing deltopectoral approach, proper soft-tissue length, correct prosthetic height and version, meticulous tuberosity repair, and early postoperative passive range of motion are all vital to successful reconstruction. Our institutional experience over 40 years with 174 reported cases of humeral head replacement for acute fracture has had a high proportion of satisfactory results. The most significant factor associated with failure is lack of patient compliance with aftercare.

ISSN:0885-9698    

出版商:OVID    

年代:1994

数据来源: OVID