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At least 1,351 records · Page 75Linked to original sources
PubMed2004

Arthroscopically assisted core decompression of the proximal humerus for avascular necrosis.

Abstract Core decompression has been described as an effective treatment for early stage avascular necrosis of the humeral head. This article describes the technique for arthroscopically assisted core decompression of the humeral head using a transtibial anterior cruciate ligament guide. This technique provides an advantage over the open procedure by avoiding soft-tissue stripping or damaging the biceps tendon or ascending branch of the anterior humeral circumflex artery, as well as providing accurate and safe placement of the core biopsy tract and the ability to address other intra-articular pathology.

Arthroscopy↗
PubMed2005

Arthroscopic repair of rotator cuff tears associated with large bone cysts of the proximal humerus: compaction bone grafting technique.

Large bone cysts associated with symptomatic rotator cuff tears may pose significant treatment problems. Bone loss associated with these cysts or with implant removal in cases of revision rotator cuff surgery may be so large that secure suture anchor fixation cannot be achieved with traditional techniques. This report describes how to arthroscopically bone graft these defects with a compaction technique that creates a densely packed bone bed into which suture anchors can be securely placed.

Arthroscopy↗
PubMed2006

Locked vs. unlocked plate osteosynthesis of the proximal humerus - a biomechanical study.

BACKGROUND: Locked plates (internal fixators) have been found to be an optimal method for the fixation in proximal humeral fractures. In a biomechanical cadaver study the difference between locked and non-locked osteosyntheses was investigated. METHODS: Paired humeri were harvested, bone density measured. Locked internal fixators were mounted on one specimen; identical plate-screw-systems without locking mechanism applied to the contralateral specimen for comparison. After that, a transverse subcapital osteotomy was performed. With 7 pairs of humeri static tests with increasing axial loads and with 5 pairs dynamic tests with 10 N preload and 80 N maximal axial load for up to 1 million cycles were performed. RESULTS: In the static experiments the elastic stiffness of the construct was 74% higher in the locked group (median 80 N/mm, quartile range 77-86 N/mm) compared with the non-locked group (46 N/mm, 35.5-56.5 N/mm). The difference was statistically significant (Wilcoxon test for paired samples, P<0.05). Similarly, the linear range until failure was definitely extended in the locked group by 64% (92 N, 89-98 N vs. 56 N, 36.5-73.5 N, P<0.05). Under dynamic loading the non-locked group showed fixation failures between 97,000 and 500,000 cycles. In the locked group no failure was observed until the end of the experiment at 1 million cycles (P<0.0.5). The final deformation was found to be 1 mm (median, quartil range 1.0-1.2 mm) in the non-locked group and 0.3 mm (0.2-0.3 mm) in the locked group (P<0.05). The differences were found equally in lower as well as in higher bone density specimen. INTERPRETATION: Because of the optimal load transfer between implant and cancellous bone, a locked screw plate interface will reduce fixation failure in proximal humeral fractures.

Biomechanical Phenomena↗
PubMedDate not supplied

A cadaveric study on the anatomy of the deltoid insertion and its relationship to the deltopectoral approach to the proximal humerus.

Elevation of the deltoid insertion (DI) has been recommended, but little is known about its anatomy or importance for deltoid function. The purpose of this study is to determine the dimensions of the DI with specific reference to the deltopectoral approach. The deltoid was exposed and detached at its origin in 36 cadaveric shoulders. The morphology of the DI was documented, and its relationship with the pectoralis major insertion and the axillary and radial nerves was recorded. The anterior, middle, and posterior deltoid muscle fibers entered into the DI in a V-shaped tendinous confluence with a broad posterior band and a narrow separate anterior band, which accounted for the anterior one fifth of the DI (0.44 cm). The deltoid insertion was separated from the pectoralis major insertion by as little as 2 mm in 31 of 36 specimens. The distance between the axillary nerve and the DI averaged 5.6 cm anteriorly and 4.5 cm posteriorly. The distance between the radial nerve and posterior deltoid insertion averaged 2.4 cm proximally and 1.6 cm distally. Exposure during the deltopectoral approach is most limited by the close proximity of the deltoid and pectoralis major insertions. Our study would suggest that partial anterior DI release (greater than one fifth) could compromise the anterior deltoid. The axillary and radial nerves are not at significant risk when operating in the region of the anterior DI.

Brachial Plexus↗