The Experts below are selected from a list of 198 Experts worldwide ranked by ideXlab platform
Marius M. Scarlat - One of the best experts on this subject based on the ideXlab platform.
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Treatment of chronic dislocations of the Shoulder by reverse total Shoulder arthroplasty: a clinical study of six cases
European Journal of Orthopaedic Surgery & Traumatology, 2009Co-Authors: Marinel Drignei, Marius M. ScarlatAbstract:Introduction Chronic Shoulder dislocation is a disabling pathology that aggravates with the age of the lesion and with recurrences after failed open or closed reduction. The severe alteration of the anterior rim of the glenoid and of the subscapularis tendon limits the therapeutic options. This study presents an original operative procedure for stabilization by means of a constrained reverse arthroplasty, with a minimum follow-up of 12 months, in six cases. Materials and methods In 2005 and 2006, six patients were referred to our Shoulder Service for irreducible Shoulder Fracture–dislocations that recurred after closed or open reduction at 4 and 78 months from the original injury. The patient’s age ranged between 58 and 82 years. There were no neurological complications and the deltoid was functional in all cases. All the patients were treated surgically. In all cases, the destruction of the glenoid, the bone defect of the humeral head and the poor quality of the subscapularis compromised all attempts for a conservative surgery. The option of treatment was for a retentive reverse total Shoulder arthroplasty (RTSA) associated with a subscapularis release and repair. Results Shoulder stabilization by retentive RTSA generated an improvement of the mobility, stability and of the Shoulder scores, and the quality of the daily living in all the cases presented. The procedure resulted in important pain relief and in the stabilization of the joint. The eventual restrictions in the range of motion are perfectly accepted by the subjects as an alternative to a preoperative “no-win” situation. Discussion Chronic Shoulder dislocations are rare. The option of the constraint RTSA in these cases may be an acceptable solution when the bone stock is limited and when the subscapularis tendon is affected, retracted, shortened or compromised. A preoperative bone scanner is useful for defining the glenoid morphology and for planning the orientation of the implant and/or an eventual bone grafting. The number of cases in this study is small, but the originality of this option makes this idea suitable for debate.
David J Torgerson - One of the best experts on this subject based on the ideXlab platform.
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the profher proximal Fracture of the humerus evaluation by randomisation trial a pragmatic multicentre randomised controlled trial evaluating the clinical effectiveness and cost effectiveness of surgical compared with non surgical treatment for proxi
Health Technology Assessment, 2015Co-Authors: Helen Handoll, Stephen Brealey, Amar Rangan, Ada Keding, B Corbacho, Laura Jefferson, Linghsiang Chuang, L Goodchild, Catherine Hewitt, David J TorgersonAbstract:Abstract Proximal humeral Fractures account for 5-6% of all Fractures in adults. There is considerable variation in whether or not surgery is used in the management of displaced Fractures involving the surgical neck. To evaluate the clinical effectiveness and cost-effectiveness of surgical compared with non-surgical treatment of the majority of displaced Fractures of the proximal humerus involving the surgical neck in adults. A pragmatic parallel-group multicentre randomised controlled trial with an economic evaluation. Follow-up was for 2 years. Recruitment was undertaken in the orthopaedic departments of 33 acute NHS hospitals in the UK. Patient care pathways included outpatient and community-based rehabilitation. Adults (aged ≥ 16 years) presenting within 3 weeks of their injury with a displaced Fracture of the proximal humerus involving the surgical neck. The choice of surgical intervention was left to the treating surgeons, who used techniques with which they were experienced. Non-surgical treatment was initial sling immobilisation followed by active rehabilitation. Provision of rehabilitation was comparable in both groups. The primary outcome was the Oxford Shoulder Score (OSS) assessed at 6, 12 and 24 months. Secondary outcomes were the 12-item Short Form health survey, surgical and other Shoulder Fracture-related complications, secondary surgery to the Shoulder or increased/new Shoulder-related therapy, medical complications during inpatient stay and mortality. European Quality of Life-5 Dimensions data and treatment costs were also collected. The mean age of the 250 trial participants was 66 years and 192 (77%) were female. Independent assessment using the Neer classification identified 18 one-part Fractures, 128 two-part Fractures and 104 three- or four-part Fractures. OSS data were available for 215 participants at 2 years. We found no statistically or clinically significant differences in OSS scores between the two treatment groups (scale 0-48, with a higher score indicating a better outcome) over the 2-year period [difference of 0.75 points in favour of the surgery group, 95% confidence interval (CI) -1.33 to 2.84; p = 0.479; data from 114 surgery and 117 non-surgery participants] or at individual time points. We found no statistically significant differences between surgical and non-surgical group participants in SF-12 physical or mental component summary scores; surgical or Shoulder Fracture-related complications (30 vs. 23 respectively); those undergoing further Shoulder-related therapy, either surgery (11 vs. 11 respectively) or other therapy (seven vs. four respectively); or mortality (nine vs. five respectively). The base-case economic analysis showed that, at 2 years, the cost of surgical intervention was, on average, £1780.73 more per patient (95% CI £1152.71 to £2408.75) than the cost of non-surgical intervention. It was also slightly less beneficial in terms of utilities, although this difference was not statistically significant. The net monetary benefit associated with surgery is negative. There was only a 5% probability of surgery achieving the criterion of costing
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the profher proximal Fracture of the humerus evaluation by randomisation trial a pragmatic multicentre randomised controlled trial evaluating the clinical effectiveness and cost effectiveness of surgical compared with non surgical treatment for proxi
Health Technology Assessment, 2015Co-Authors: Helen Handoll, Stephen Brealey, Amar Rangan, Ada Keding, B Corbacho, Laura Jefferson, Linghsiang Chuang, L Goodchild, Catherine Hewitt, David J TorgersonAbstract:BACKGROUND: Proximal humeral Fractures account for 5-6% of all Fractures in adults. There is considerable variation in whether or not surgery is used in the management of displaced Fractures involving the surgical neck. OBJECTIVE: To evaluate the clinical effectiveness and cost-effectiveness of surgical compared with non-surgical treatment of the majority of displaced Fractures of the proximal humerus involving the surgical neck in adults. DESIGN: A pragmatic parallel-group multicentre randomised controlled trial with an economic evaluation. Follow-up was for 2 years. SETTING: Recruitment was undertaken in the orthopaedic departments of 33 acute NHS hospitals in the UK. Patient care pathways included outpatient and community-based rehabilitation. PARTICIPANTS: Adults (aged ≥ 16 years) presenting within 3 weeks of their injury with a displaced Fracture of the proximal humerus involving the surgical neck. INTERVENTIONS: The choice of surgical intervention was left to the treating surgeons, who used techniques with which they were experienced. Non-surgical treatment was initial sling immobilisation followed by active rehabilitation. Provision of rehabilitation was comparable in both groups. MAIN OUTCOME MEASURES: The primary outcome was the Oxford Shoulder Score (OSS) assessed at 6, 12 and 24 months. Secondary outcomes were the 12-item Short Form health survey, surgical and other Shoulder Fracture-related complications, secondary surgery to the Shoulder or increased/new Shoulder-related therapy, medical complications during inpatient stay and mortality. European Quality of Life-5 Dimensions data and treatment costs were also collected. RESULTS: The mean age of the 250 trial participants was 66 years and 192 (77%) were female. Independent assessment using the Neer classification identified 18 one-part Fractures, 128 two-part Fractures and 104 three- or four-part Fractures. OSS data were available for 215 participants at 2 years. We found no statistically or clinically significant differences in OSS scores between the two treatment groups (scale 0-48, with a higher score indicating a better outcome) over the 2-year period [difference of 0.75 points in favour of the surgery group, 95% confidence interval (CI) -1.33 to 2.84; p = 0.479; data from 114 surgery and 117 non-surgery participants] or at individual time points. We found no statistically significant differences between surgical and non-surgical group participants in SF-12 physical or mental component summary scores; surgical or Shoulder Fracture-related complications (30 vs. 23 respectively); those undergoing further Shoulder-related therapy, either surgery (11 vs. 11 respectively) or other therapy (seven vs. four respectively); or mortality (nine vs. five respectively). The base-case economic analysis showed that, at 2 years, the cost of surgical intervention was, on average, £1780.73 more per patient (95% CI £1152.71 to £2408.75) than the cost of non-surgical intervention. It was also slightly less beneficial in terms of utilities, although this difference was not statistically significant. The net monetary benefit associated with surgery is negative. There was only a 5% probability of surgery achieving the criterion of costing < £20,000 to gain a quality-adjusted life-year, which was confirmed by extensive sensitivity analyses. CONCLUSIONS: Current surgical practice does not result in a better outcome for most patients with displaced Fractures of the proximal humerus involving the surgical neck and is not cost-effective in the UK setting. Two areas for future work are the setting up of a national database of these Fractures, including the collection of patient-reported outcomes, and research on the best ways of informing patients with these and other upper limb Fractures about initial self-care. TRIAL REGISTRATION: Current Controlled Trials ISRCTN50850043. FUNDING: This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 24. See the NIHR Journals Library website for further project information.
Elias Panagiotopoulos - One of the best experts on this subject based on the ideXlab platform.
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Posterior Shoulder Fracture–dislocation: an update with treatment algorithm
European Journal of Orthopaedic Surgery & Traumatology, 2017Co-Authors: Zinon T. Kokkalis, Ilias D. Iliopoulos, Georgia Antoniou, Thekla Antoniadou, Andreas F. Mavrogenis, Elias PanagiotopoulosAbstract:Posterior Shoulder Fracture–dislocation is a rare injury accounting for approximately 0.9 % of Shoulder Fracture–dislocations. Impression Fractures of the articular surface of the humeral head, followed by humeral neck Fractures and Fractures of the lesser and grater tuberosity, are the more common associated Fractures. Multiple mechanisms have been implicated in the etiology of this traumatic entity most commonly resulting from forced muscle contraction as in epileptic seizures, electric shock or electroconvulsive therapy, major trauma such as motor vehicle accidents or other injuries involving axial loading of the arm, in an adducted, flexed and internally rotated position. Despite its’ scarce appearance in daily clinical practice, posterior Shoulder dislocation is of significant diagnostic and therapeutic interest because of its predilection for age groups of high functional demands (35–55 years old), in addition to high incidence of missed initial diagnosis ranging up to 79 % in some studies. Several treatment options have also been proposed to address this type of injury, ranging from non-surgical methods to humeral head reconstruction procedures or arthroplasty with no clear consensus over definitive treatment guidelines, reflecting the complexity of this injury in addition to the limited evidence provided by the literature. To enhance the literature, this article aims to present the current concepts for the diagnosis, evaluation and treatment of the patients with posterior Fracture–dislocation Shoulder, and to present a treatment algorithm based on the literature review and our own experience.
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posterior Shoulder Fracture dislocation an update with treatment algorithm
European Journal of Orthopaedic Surgery and Traumatology, 2017Co-Authors: Zinon T. Kokkalis, Ilias D. Iliopoulos, Georgia Antoniou, Thekla Antoniadou, Andreas F. Mavrogenis, Elias PanagiotopoulosAbstract:Posterior Shoulder Fracture–dislocation is a rare injury accounting for approximately 0.9 % of Shoulder Fracture–dislocations. Impression Fractures of the articular surface of the humeral head, followed by humeral neck Fractures and Fractures of the lesser and grater tuberosity, are the more common associated Fractures. Multiple mechanisms have been implicated in the etiology of this traumatic entity most commonly resulting from forced muscle contraction as in epileptic seizures, electric shock or electroconvulsive therapy, major trauma such as motor vehicle accidents or other injuries involving axial loading of the arm, in an adducted, flexed and internally rotated position. Despite its’ scarce appearance in daily clinical practice, posterior Shoulder dislocation is of significant diagnostic and therapeutic interest because of its predilection for age groups of high functional demands (35–55 years old), in addition to high incidence of missed initial diagnosis ranging up to 79 % in some studies. Several treatment options have also been proposed to address this type of injury, ranging from non-surgical methods to humeral head reconstruction procedures or arthroplasty with no clear consensus over definitive treatment guidelines, reflecting the complexity of this injury in addition to the limited evidence provided by the literature. To enhance the literature, this article aims to present the current concepts for the diagnosis, evaluation and treatment of the patients with posterior Fracture–dislocation Shoulder, and to present a treatment algorithm based on the literature review and our own experience.
Daniel Kendoff - One of the best experts on this subject based on the ideXlab platform.
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High Rates of Occult Infection After Shoulder Fracture Fixation: Considerations for Conversion Shoulder Arthroplasty
HSS Journal ®, 2015Co-Authors: Till O. Klatte, Reza Sabihi, Daniel Guenther, Atul F. Kamath, Johannes M. Rueger, Thorsten Gehrke, Daniel KendoffAbstract:Background Existing hardware may contribute to increased risk of bacterial contamination and subsequent periprosthetic joint infection (PJI) in conversion Shoulder arthroplasty performed for failed Fracture fixation. Questions/Purposes This study examined the incidence of positive pre-operative aspiration and inflammatory marker data, along with correlation of pre-operative positive aspiration or inflammatory markers and subsequent infection following conversion Shoulder arthroplasty for failed open reduction and internal fixation (ORIF) and the need for re-operation at 4.6-year follow-up. Methods Twenty-eight patients who underwent conversion to Shoulder arthroplasty for any reason after Fracture fixation were retrospectively reviewed in a single center. A pre-operative aspiration was done in 17 patients; all patients had intra-operative tissue sampling. All procedures were single-stage removal of hardware and performance of the arthroplasty. In cases of pre-operative positive bacterial growth, a single-stage procedure was performed according to the septic ENDO-Klinik protocol. Results In 4 of 17 pre-operative joint aspirations, bacterial growth was detected; one pre-operative negative aspiration demonstrated bacterial growth in intra-operative sampling. In three of them, the infection has been validated through intra-operatively results. Pre-operative aspiration showed a sensitivity of 75% and specificity of 92% ( p
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high rates of occult infection after Shoulder Fracture fixation considerations for conversion Shoulder arthroplasty
HSS Journal, 2015Co-Authors: Till O. Klatte, Reza Sabihi, Daniel Guenther, Atul F. Kamath, Johannes M. Rueger, Thorsten Gehrke, Daniel KendoffAbstract:Background Existing hardware may contribute to increased risk of bacterial contamination and subsequent periprosthetic joint infection (PJI) in conversion Shoulder arthroplasty performed for failed Fracture fixation.
Marinel Drignei - One of the best experts on this subject based on the ideXlab platform.
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Treatment of chronic dislocations of the Shoulder by reverse total Shoulder arthroplasty: a clinical study of six cases
European Journal of Orthopaedic Surgery & Traumatology, 2009Co-Authors: Marinel Drignei, Marius M. ScarlatAbstract:Introduction Chronic Shoulder dislocation is a disabling pathology that aggravates with the age of the lesion and with recurrences after failed open or closed reduction. The severe alteration of the anterior rim of the glenoid and of the subscapularis tendon limits the therapeutic options. This study presents an original operative procedure for stabilization by means of a constrained reverse arthroplasty, with a minimum follow-up of 12 months, in six cases. Materials and methods In 2005 and 2006, six patients were referred to our Shoulder Service for irreducible Shoulder Fracture–dislocations that recurred after closed or open reduction at 4 and 78 months from the original injury. The patient’s age ranged between 58 and 82 years. There were no neurological complications and the deltoid was functional in all cases. All the patients were treated surgically. In all cases, the destruction of the glenoid, the bone defect of the humeral head and the poor quality of the subscapularis compromised all attempts for a conservative surgery. The option of treatment was for a retentive reverse total Shoulder arthroplasty (RTSA) associated with a subscapularis release and repair. Results Shoulder stabilization by retentive RTSA generated an improvement of the mobility, stability and of the Shoulder scores, and the quality of the daily living in all the cases presented. The procedure resulted in important pain relief and in the stabilization of the joint. The eventual restrictions in the range of motion are perfectly accepted by the subjects as an alternative to a preoperative “no-win” situation. Discussion Chronic Shoulder dislocations are rare. The option of the constraint RTSA in these cases may be an acceptable solution when the bone stock is limited and when the subscapularis tendon is affected, retracted, shortened or compromised. A preoperative bone scanner is useful for defining the glenoid morphology and for planning the orientation of the implant and/or an eventual bone grafting. The number of cases in this study is small, but the originality of this option makes this idea suitable for debate.
