Postoperative rupture of the anterolateral deltoid muscle following reverse total shoulder arthroplasty in patients who have undergone open rotator cuff repair.

BACKGROUND: Postoperative ruptures of the antero-lateral deltoid in patients with reverse total shoulder arthroplasty utilizing the delto-pectoral approach following failed mini-open or open rotator cuff repairs have not been reported in the English literature. The incidence of this complication is unknown. MATERIALS AND METHODS: A retrospective review of 199 patients who underwent reverse total shoulder arthroplasty utilizing a deltopectoral approach was performed. These procedures were performed by 2 surgeons in 2 hospitals. There were 3 patients who had postoperative rupture of the deltoid. These ruptures occurred without any history of trauma to the patient. In all 3 patients, past surgical history was significant for a rotator cuff repair utilizing a mini-open or mini-open modified to open approach. Successful repair of the deltoid was achieved using a transosseous suture repair in all 3 patients. RESULTS: At most current follow-up (all >12 months), average forward elevation was 120°. A small residual anterior deltoid defect was present in all 3 patients, but pain was quantified as 0-4 out of 10 and radiographs demonstrated satisfactory position of the reverse arthroplasty implants. CONCLUSION: Postoperative ruptures of the antero-lateral deltoid can occur in patients who have undergone reverse total shoulder arthroplasty, utilizing the delto-pectoral approach following failed mini-open or open rotator cuff repairs. A supero-lateral approach during reverse total shoulder arthroplasty could be useful in assessing and possibly reinforcing a deltoid origin previously damaged or repaired during mini-open or open rotator cuff repair.

A technique for nailing severely shortened and displaced tibia fractures.

Previously described techniques using external fixators or large distractors can simplify the closed nailing of tibia fractures and nonunions. However, delayed intramedullary nailing can be especially challenging when significant shortening or translation has occurred. We present a modification of an old technique for external fixator-assisted closed tibial nailing in these difficult cases.