Acromial fracture after reverse total shoulder arthroplasty: a systematic review.

BACKGROUND: The reverse total shoulder arthroplasty has become the most common method of arthroplasty of the shoulder. The complication of acromial or scapular stress fracture deserves consideration to describe incidence and determine whether prosthetic design or patient factors act as risk factors. METHODS: A systematic review of the literature was performed including the EMBASE, Medline and the Cochrane Library in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: The search returned 565 articles. After exclusion, 25 papers remained. In total, 208 fractures were reported in the literature, with an overall incidence of 5% and stress fractures were more common than post-traumatic ones; 24 fractures underwent osteosynthesis and there were nine revision arthroplasty surgeries. Outcomes worsened after fracture - whether treated with surgery or not. In patients with scapular base fractures, there was an improvement in functional outcome scores after surgery. Heterogeneous reporting of the risk factors prior to fractures, treatment methods and outcomes made recommendations weak. DISCUSSION: Acromial stress fracture after reverse total shoulder arthroplasty occurs relatively commonly but is poorly reported in the literature. It is unclear whether immobilisation, fixation or revision arthroplasty is the best treatment, although fixation may offer a better outcome. In future, reports should aim for greater consistency to allow a better understanding of this condition.

Humeral shaft fractures: union outcomes in a large cohort.

BACKGROUND: Humeral shaft fractures can be managed conservatively or operatively. Fracture characteristics were analyzed to identify patients who would benefit from early operative fixation. METHODS: We performed a retrospective cohort study of 126 consecutive humeral shaft fractures (2008-2015). Fractures were classified according to fracture type, location, separation, and comminution. RESULTS: Of 126 patients, 96 were managed conservatively. In 54%, union occurred before 26 weeks, and 13% had delayed union after 26 weeks, whereas 33% did not achieve union. Of 30 patients managed surgically, 63% had union before 26 weeks, 33% had delayed union, and 4% did not achieve union. A statistically significant difference favored operative management. This difference was maintained in specific fracture patterns (simple and spiral fractures) and locations (proximal- or distal-third humeral fractures). Early surgery had a significantly higher union rate than delayed surgery. No difference was present between plate and nail fixation regarding union or neurologic injury. Separation of fragments, open injury, and comminution were not associated with nonunion. A psychiatric history (including psychotic disorders, bipolar disorder, multiple involuntary psychiatric admissions, or dementia) was significantly associated with nonunion after conservative management (P = .016). Two patients with dementia died after their conservatively managed fractures progressed to open injuries. CONCLUSION: This study found high rates of delayed union and nonunion with conservative management. Patients with a significant psychiatric history may benefit from consideration of operative intervention.

Sigmoid notch osteotomy for posttraumatic dorsal dislocation of the distal radioulnar joint: A case report.

Instability of the distal radioulnar joint (DRUJ) is associated most commonly with injury to the soft-tissue restraints of that joint, particularly the triangular fibrocartilage complex. The dorsal rim of the sigmoid notch, however, also plays an important role as a bony restraint to dorsal subluxation. We report a case of posttraumatic dorsal dislocation of the DRUJ associated with a depressed fracture of the dorsal rim of the sigmoid notch. This was treated with soft-tissue release and corrective osteotomy of the dorsal rim of the sigmoid notch to restore DRUJ stability and congruency.