Faculty Bibliography

Total shoulder arthroplasty is a common treatment for glenohumeral arthritis. One of the most common failure modes of total shoulder arthroplasty is glenoid loosening, causing postoperative pain, limitation of function, and potentially, the need for revision surgery. The literature has devoted considerable attention to the design of the glenoid component; efforts to better understand the biomechanics of the reconstructed glenohumeral joint and identify factors that contribute to glenoid component loosening are ongoing. This article reviews the current state of knowledge about the glenoid in total shoulder arthroplasty, summarizing the anatomic parameters of the intact glenoid, variations in component design and fixation, the mechanisms of glenoid loosening, the outcomes of revision surgery in the treatment of glenoid component failure, and alternative treatments for younger patients

SUMMARY: The purpose of this study was to evaluate the role of reverse shoulder design parameters on performance. A computer analysis was conducted on the Grammont reverse shoulder to quantify the effect of varying design parameters on functional measurements during humeral abduction/adduction. The Grammont reverse shoulder impinged inferiorly and superiorly on the glenoid at 30.75 degrees and 95 degrees of humeral abduction, with an average jump distance of 10 mm. Several linear relationships were identified. To demonstrate the application of these relationships, a novel prosthesis was designed. The proposed 38-, 42-, and 46-mm reverse shoulder designs impinged inferiorly and superiorly on the glenoid at 7.25 degrees /87.5 degrees , 1 degrees /87.5 degrees , and 0 degrees /89.25 degrees of humeral abduction with an average jump distance of 11.7, 13.5, and 14.1 mm, respectively. The results of this study demonstrate that subtle changes in design parameters can minimize inferior glenoid impingement and offer the potential for dramatic functional improvements in range of motion (39%) and jump distance (36%)

Treatment of intertrochanteric hip fracture is based on patient medical condition, preexisting degenerative arthritis, bone quality, and the biomechanics of the fracture configuration. A critical review of the evidence-based literature demonstrates a preference for surgical fixation in patients who are medically stable. Stable fractures can be successfully treated with plate-and-screw implants and with intramedullary devices. Although unstable fractures may theoretically benefit from load-sharing intramedullary implants, this result has not been demonstrated in the current evidence-based literature

During the past 10 years, there has been a worldwide effort in all medical fields to base clinical health care decisions on available evidence as described by thorough reviews of the literature. Hip fractures pose a significant health care problem worldwide, with an annual incidence of approximately 1.7 million. Globally, the mean age of the population is increasing, and the number of hip fractures is expected to triple in the next 50 years. One-year mortality rates currently range from 14% to 36%, and care for these patients represents a major global economic burden. Surgical options for the management of femoral neck fractures are closely linked to individual patient factors and to the location and degree of fracture displacement. Nonsurgical management of intracapsular hip fractures is limited. Based on a critical, evidence-based review of the current literature, we have found minimal differences between implants used for internal fixation of displaced fractures. Cemented, unipolar hemiarthroplasty remains a good option with reasonable results. In the appropriate patient population, outcomes following total hip arthroplasty are favorable and appear to be superior to those of internal fixation

The evaluation and management of chronic glenohumeral dislocations can be challenging. By definition, chronic glenohumeral dislocations represent injuries that were not identified at the time of injury. Therefore, the primary goal is to avoid circumstances in which these injuries are not recognized. This includes undertaking a comprehensive clinical evaluation as well as appropriate imaging studies to understand the pathoanatomic changes-specifically, the humeral head impression fracture and any associated glenoid changes. The size of the impression fracture and duration of the dislocation are important factors in determining the appropriate treatment approach. Satisfactory outcomes can be achieved by using a variety of techniques, including open reduction combined with tendon transfers, allograft reconstruction, disimpaction and bone grafting and prosthetic replacement. Equally important, however, is recognizing patients in whom successful outcomes can be achieved with nonsurgical management

BACKGROUND: The implementation of Section 405 of the New York State Public Health Code and the adoption of similar policies by the Accreditation Council for Graduate Medical Education in 2002 restricted resident work hours to eighty hours per week. The effect of these policies on operative volume in an orthopaedic surgery residency training program is a topic of concern. The purpose of this study was to evaluate the effect of the work-hour restrictions on the operative experiences of residents in a large university-based orthopaedic surgery residency training program in an urban setting. METHODS: We analyzed the operative logs of 109 consecutive orthopaedic surgery residents (postgraduate years 2 through 5) from 2000 through 2006, representing a consecutive interval of years before and after the adoption of the work-hour restrictions. RESULTS: Following the implementation of the new work-hour policies, there was no significant difference in the operative volume for postgraduate year-2, 3, or 4 residents. However, the average operative volume for a postgraduate year-5 resident increased from 274.8 to 348.4 cases (p = 0.001). In addition, on analysis of all residents as two cohorts (before 2002 and after 2002), the operative volume for residents increased by an average of 46.6 cases per year (p = 0.02). CONCLUSIONS: On the basis of the findings of this study, concerns over the potential adverse effects of the resident work-hour polices on operative volume for orthopaedic surgery residents appear to be unfounded

A prospective study was undertaken to determine if patients recover pre-injury level of shoulder function 1 year after 1 part proximal humeral fractures. Of the 67 patients enrolled, 43 were female and 24 male with an average age of 64.8 years (range, 25-90 years). All patients underwent a similar treatment protocol consisting of early therapy for range of shoulder motion and strengthening. Baseline demographics and functional assessment, including the American Shoulder and Elbow Surgeons (ASES) evaluation form and the SF-36, were obtained at the time of injury. Functional and demographic data were evaluated with a Student's t test. Fifty-four patients (80%) completed a 1-year follow-up. By 3 months, all patients attained radiographic and clinical evidence of union and no loss of reduction. At 1 year, the ASES score was similar to pre-injury status (93.7 vs 99.1; P = .12). The range of shoulder motion of the affected side was diminished compared to the unaffected extremity in internal rotation (P < .001) and external rotation (P < .001) but not forward flexion. Patients, who sustain minimally displaced proximal humeral fractures treated nonoperatively, largely returned to preoperative functional status at 1-year follow-up. Patients should be counseled and made aware of the decreased range of shoulder motion following this fracture