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Biomedical subjects

T R Norris

Publications and source records attributed to T R Norris.

12 recordsLinked to original sources
PubMed2001

Long-term results of total shoulder arthroplasty following bone-grafting of the glenoid.

BACKGROUND: The marked loss of glenoid bone volume or alteration of glenoid version can affect glenoid component fixation in patients undergoing total shoulder arthroplasty. The purpose of this study was to evaluate the long-term results associated with the use of bone-grafting for restoration of glenoid volume and version at the time of total shoulder arthroplasty. METHODS: Twenty-one shoulders received an internally fixed, corticocancellous bone graft for the restoration of peripheral glenoid bone stock at the time of total shoulder arthroplasty between 1980 and 1989. Grafting was indicated when glenoid bone stock was insufficient to maintain adequate version or fixation of the prosthesis. Seventeen shoulders were available for follow-up; the average duration of follow-up for the thirteen shoulders that did not have prosthetic failure within the first two years was seventy months. Total shoulder arthroplasty was performed because of osteoarthritis in five shoulders, chronic anterior fracture-dislocation in five, capsulorrhaphy arthropathy in three, inflammatory arthritis in two, recurrent dislocation in one, and failure of a previous arthroplasty in one. All patients had some form of anterior or posterior instability preoperatively. There were five anterior and twelve posterior glenoid defects. Bone from the resected humeral head was used for grafting in fifteen shoulders, and bicortical iliac-crest bone was used in two. RESULTS: The average glenoid version after grafting was 4 degrees of retroversion, with an average correction of 33 degrees. The graft failed to maintain the original correction in three shoulders due to nonunion, dissolution, or shift. Five total shoulder replacements failed, necessitating glenoid revision at two to ninety-one months postoperatively. The failures were associated with recurrent massive cuff tears (one shoulder), persistent instability (two shoulders), improper component placement (one shoulder), and loss of graft fixation (one shoulder). There were no humeral component failures. According to the criteria of Neer et al., the functional result was rated as excellent in three shoulders, satisfactory in six, and unsatisfactory in eight. CONCLUSIONS: Despite the finding that eight shoulders had an unsatisfactory functional result at the time of longterm follow-up, corticocancellous grafting of the glenoid successfully restored glenoid version and volume in fourteen of the seventeen shoulders in the present study. Patients with glenoid deficiency often have associated glenohumeral instability, which may affect the results of total shoulder arthroplasty. Bone-grafting of the glenoid is a technically demanding procedure that can restore bone stock in patients with structural defects.

Adult↗
PubMed1998

Operative treatment of malunion of a fracture of the proximal aspect of the humerus.

We retrospectively reviewed the medical records, operative reports, and preoperative and postoperative radiographs of thirty-nine patients who had been managed operatively for malunion of a fracture of the proximal aspect of the humerus. The malunions were categorized according to the presence of osseous abnormalities, including malposition of the greater or lesser tuberosity (type I; twenty-eight patients), incongruity of the articular surface (type II; twenty-six patients), and malalignment of the articular segment (type III; sixteen patients). Soft-tissue abnormalities, such as soft-tissue contracture, a tear of the rotator cuff, and impingement, were also recorded. At an average of forty-four months (range, twelve to fifty-three months) postoperatively, the patients were assessed for pain relief, the range of motion of the shoulder, and the ability to perform activities of daily living. The result was satisfactory for twenty-seven patients (69 per cent) and unsatisfactory for the remaining twelve (31 per cent) at the latest follow-up evaluation. Of the twenty-seven patients who had a satisfactory result, twenty-six (96 per cent) had had complete operative correction of all osseous and soft-tissue abnormalities. Of the twelve patients who had an unsatisfactory result, four had had complete operative correction of these abnormalities (p < 0.0001). Twenty-six patients (67 per cent) had incongruity of the glenohumeral joint at the time of presentation. Twenty-three of these patients had the incongruity corrected with prosthetic arthroplasty (twenty-two) or arthrodesis of the glenohumeral joint (one); the result was satisfactory for seventeen (74 per cent). In contrast, the result was unsatisfactory for all three patients in whom the incongruity had not been corrected at the time of the operation (p = 0.01). Eleven patients had malposition of the greater or lesser tuberosity but a congruent joint surface preoperatively. Ten patients in this group were managed with either osteotomy of the tuberosity or acromioplasty, and nine of them had a satisfactory result at the latest follow-up evaluation. The result was unsatisfactory for one patient who was managed with only correction of a soft-tissue contracture (that is, no treatment of the malposition) (p = 0.05). Both osseous and soft-tissue abnormalities were identified as the cause of pain and stiffness in patients who had malunion of a fracture of the proximal aspect of the humerus. We concluded that operative management of these patients is successful only if all osseous and soft-tissue abnormalities are corrected at the time of the operation.

Acromion↗
PubMed1998

Management of the unstable prosthetic shoulder arthroplasty.

Instability is the most common complication of shoulder arthroplasty. An understanding of the predisposing factors for developing instability is critical to the avoidance of this complication. Soft-tissue balance and proper component positioning must be attained during the index procedure to minimize the risk of developing postoperative instability. Once the shoulder does become unstable, the reason for the instability must be determined. Is the instability secondary to soft-tissue imbalance, component malposition, bony deformity, or a combination of these? Next, a decision must be made as to how to treat the instability. Nonsurgical treatment may be tried if no obvious cause is present. However, if the instability fails to resolve or recurs, surgical intervention should be undertaken early. If the instability is not treated, it may result in loosening of the prosthesis and early wear of the components. Once surgical intervention is undertaken, all elements of the instability must be recognized and treated.

Arthroplasty, Replacement↗
PubMed1994

Imaging techniques for glenohumeral arthritis and glenohumeral arthroplasty.

A thorough history and physical examination can usually determine the cause of a painful shoulder. In most cases, the diagnosis and cause of glenohumeral arthritis are fairly obvious. Imaging studies such as radiographs, computed tomography (CT), arthrography, ultrasonography, and magnetic resonance (MR) imaging are used to confirm and further define the pathologic process. Early in the development of glenohumeral arthrosis, subtle radiographic findings may suggest the diagnosis when the symptoms are mild. Later in the progression of joint destruction, imaging studies are crucial to the planning of prosthetic arthroplasty. Subsequent to arthroplasty, imaging studies can identify existing or potential problems that might correlate with the clinical course. Recent advances in musculoskeletal imaging, such as CT, ultrasound, and MR imaging, enable the physician to confirm or document anatomic pathology that was previously only inferred. There has been a corresponding increase in the use of imaging modalities. Concurrently, cost has become a major concern, and its limitation or reduction a priority of current and future medical care. Consequently, the knowledge gained from further research, education, and clinical experience must promote appropriate use and enable doctors to avoid sophisticated imaging when the results will not influence the course of treatment. The radiographic evaluation of glenohumeral arthrosis the use of imaging techniques in planning prosthetic glenohumeral arthroplasty, and the role of imaging in followup evaluations of prosthetic arthroplasty are discussed. The preferred approaches to these subjects are presented and clinical cases are used to highlight the important and interesting principles.

Arthritis, Rheumatoid↗
PubMed1989

The efficacy of intraoperative autologous transfusion in major shoulder surgery.

Perioperative blood loss associated with 36 cases of major shoulder surgery in which an intraoperative autologous transfusion device was used was compared with a control group of 36 shoulder surgery patients to determine the effectiveness of intraoperative autologous transfusion (IAT). Total blood loss in this retrospective review was evaluated by assessing the volume of transfused banked blood and the change in hematocrit. All surgical cases were performed by the same surgeon. The procedures considered in the study were humeral head and total shoulder replacement. Use of an intraoperative autotransfusion device was associated with fewer units of transfused banked blood and similar or smaller drops in hematocrit. While shoulder surgery can involve substantial blood loss, the authors recommend intraoperative autologous transfusion for revision of failed shoulder surgery, arthrodesis, joint replacement, or repairs of massive cuff tears when mobilization and tendon transfers are anticipated. The risk of disease transmission through banked blood, especially of acquired immune deficiency syndrome (AIDS) and hepatitis viruses, has increased the need for a heightened awareness and use of alternative blood sources such as IAT.

Acquired Immunodeficiency Syndrome↗
PubMed1983

Evaluation of sensibility and function with microsurgical free tissue transfer of the great toe to the hand for thumb reconstruction.

Detailed evaluation of sensibility and function on 10 patients was carried out on an average of 42 months after thumb reconstruction by microsurgical free tissue transfer. Sensibility based on modified two-point discrimination and ridge criteria was found to be directly related to the patient's age at time of neurosuture. The plantar aspect of the distal 2 cm of the normal toe showed two-point value averaging 6 mm in 20 normal shoe-wearing adults, compared to values of 12 mm when the toe was tested over the plantar surface of the proximal half of the distal phalanx. Metacarpophalangeal joint motion and interphalangeal joint motion were limited when compared with the opposite normal thumb and unoperated great toe. Grip strength and pinch strength reflected the degree of associated injuries in the hand. Cold intolerance was present in all patients. Patients' subjective assessment of their ability to use their hand as compared to their hand prior to injury was rated at less than 10% preoperatively compared to 52% to 87% postoperatively. None of the patients perceived a problem of social acceptance after the surgery. Postoperative studies of the feet revealed concentration of weight bearing between the second and third metatarsal heads on Harris mat studies and slowing of the forward and medial progression of the center of pressure on gait analysis. Some weakness in push-off and cutting maneuvers in sports activities was reported in half of the patients. None of the patients experienced difficulty when running long distances on level ground. All the patients returned to gainful employment postoperatively.

Adolescent↗
PubMed1977

Delayed flexor tendon repair in no man's land.

Thirty seven digital flexor tendon injuries in 31 patients were treated by closure of the skin and delayed repair from 24 hours to 21 days later. All skin wounds healed without serious complication, and there were no infections. On examination at a minium of 4 months after repair, 36% had total active motion (TAM) of 220 degrees, 32% from 200 degrees to 220 degrees, 6% from 180 degrees to 200 degrees and 26% with less than 180 degrees. Under proper conditions, repair of flexor tendons can be carried out with the expectation of results comparable to more complex reconstruction procedures.

Adolescent↗
PubMedDate not supplied

Late prosthetic shoulder arthroplasty for displaced proximal humerus fractures.

Twenty-three shoulders in 23 patients with failed treatment of three- and four-part proximal humerus fractures subsequently treated with prosthetic arthroplasty were reviewed. The initial treatment was closed in 10 cases and open in 13. The complications of treatment included malunions in 17, nonunions in four, traumatic arthritis in 14, avascular necrosis in nine, humeral shortening in six, and deltoid paresis in four. In 20 cases prosthetic arthroplasty was performed an average of 15.8 months after injury. Three other cases had arthroplasty 19, 20, and 22 years after the original fracture. Seventeen were treated with a total shoulder arthroplasty, and six had a humeral head replacement. Thirteen had a tuberosity osteotomy, and eight had lengthening of the subscapularis tendon. Prosthetic arthroplasty reduced the shoulder pain in 22 (95%). Average active forward elevation increased from 68 degrees to 92 degrees, and active external rotation increased from 6 degrees to 27 degrees. After arthroplasty 53% of the patients were able to do activities at or above shoulder level compared with 15% before arthroplasty. Late surgery for failed early treatment is technically difficult, and the results are inferior to those reported for acute humeral head replacement. These findings should be considered when treatment is selected for acute three- and four-part proximal humerus fractures. Nonetheless late arthroplasty is a satisfactory reconstructive option when primary treatment of proximal humerus fractures fails.

Adolescent↗
PubMedDate not supplied

Periprosthetic humeral fractures: mechanisms of fracture and treatment options.

In 20 patients, 21 periprosthetic humeral fractures were reviewed retrospectively. The mean follow-up time was 27.1 months. Mild osteopenia was present in 45% of the patients, whereas 30% had severe osteopenia. Five mechanisms of fracture were identified, including 3 intraoperative causes that are avoidable. Treatment with stable intramedullary fixation utilizing the humeral stem and cerclage wiring provided superior results in terms of time to union, adverse effect on rehabilitation, and occurrence and severity of surgical complications. Diaphyseal fractures that were treated with standard stem arthroplasty with or without supplemental fixation had a longer time to fracture union, a higher complication rate, and prolonged rehabilitation. Fractures of the proximal humeral metaphysis can be treated with standard stem arthroplasty and cerclage wiring if the stem extends distal to the fracture site by at least 3 cortical diameters. Anatomic reduction of fractures treated by surgical means results in shorter healing times. Cast or brace immobilization can be used for management of postoperative fractures that occur distal to a well-fixed and stable prosthetic stem. Cast or brace immobilization results in fracture union but rehabilitation may be greatly impaired, and there is an increased risk of complications associated with immobilization of the extremity. Long-stem intramedullary fixation with cerclage wiring is the preferred surgical option for treatment of unstable humeral shaft fractures.

Adult↗
PubMedDate not supplied

Shoulder arthroplasty for advanced glenohumeral arthritis after anterior instability repair.

We retrospectively reviewed 19 patients (19 shoulders) in whom advanced glenohumeral arthritis developed after anterior instability repair. The anterior instability repairs included 4 Bristow, 4 Putti-Platt (2 in combination with other procedures), 4 Magnuson-Stack, 2 Bankart, and 5 other anterior capsulorrhaphies. Seventeen of the shoulders were treated with arthroplasty: 15 with total shoulder replacement and 2 with humeral head replacement, at a mean age of 45 years (range, 32-69 years). Two patients did not have surgical treatment. The mean internal rotation contracture was 58 degrees (15 degrees -125 degrees ). Eleven patients (65%) required subscapularis lengthening and anterior capsular release to correct a severe internal rotation contracture. Three (18%) had glenoid bone grafting, and one had glenoidplasty to correct severe posterior glenoid wear. The results were evaluated after a mean follow-up of 62 months (range, 24-167 months). Arthroplasty reduced the level of pain in 16 cases (94%). Active forward elevation increased 21 degrees to 120 degrees, active external rotation increased 38 degrees to 41 degrees, and passive internal rotation increased a mean of 3 vertebral levels to T12. There was improvement in functional use of the upper extremity in all cases except one. Subjectively, 12 shoulders were rated as much better, 4 as better, and 1 as worse than preoperatively. Three underwent revision arthroplasty procedures. Advanced glenohumeral arthritis is a rarely reported late sequela of anterior instability surgery. It is more common after nonanatomic repairs, presents in patients at younger ages than typical glenohumeral osteoarthritis, and is characterized by severe internal rotation contracture and posterior glenoid wear. Prosthetic arthroplasty, although technically challenging, effectively reduced pain and improved function in our series.

Adult↗
PubMedDate not supplied

Isolated fracture of the humeral capitellum.

Twenty-nine patients with fractures of the capitellum of the humerus were treated at the New York Orthopaedic Hospital during 15-year period; 17 were available for follow-up assessment. A classification based upon the specific nature of the fracture and the degree of trochlear involvement is a suggested guide to treatment and prognosis. Long-term follow-up studies compare resection, replacement with fixation, and closed reduction. Choice of treatment should be selective and individualized depending on age, character of the bone, and type of fracture.

Adolescent↗