Classification of non-unions of the proximal humerus.

A classification of non-unions of the proximal humerus is proposed based on a group of 21 cases. Suggestions for treatment are given.

Surgical treatment of acute and chronic posterior fracture-dislocation of the shoulder.

Seventy-three shoulders (66 patients) with posterior fracture-dislocation of the shoulder were treated. Thirty patients were treated during the acute phase. One case was classified as subspinous, and 56 were considered subacromial; 4 cases had posterior fracture-dislocation in three parts, 3 in four parts, and 9 at the anatomic neck. Treatment consisted of closed reduction and immobilization in the emergency department, McLaughlin's procedure, hemiarthroplasty, total shoulder, open reduction with internal fixation, arthroplastic resection, and arthrodesis. Ten shoulders were treated conservatively. The University of California-Los Angeles rating score was used to analyze 56 shoulders during a mean follow-up period of 32.7 months. Good and excellent results can be achieved in those cases that are treated up to 2 years of the lesion; after 2 years results tend to be fair. We do not suggest total shoulder arthroplasty as a treatment option for those surgeons without the necessary expertise.

Subscapularis muscle enervation: the effect of arm position.

Extensive subscapularis muscle release is common in major shoulder reconstructive surgery, and manipulation of the muscle's anterior surface may damage its enervation. The subscapularis nerves and their points of entry into the muscle have rarely been described. The objective of this study was to define these points of entry into the subscapularis muscle and the possible modifications that may occur in such points according to the common positions in which the arm is placed during shoulder surgery, that is, internal, neutral, and external rotation. Twenty-five cadaver's shoulders were studied by an extensive anterior approach. The nerves were dissected and marked at their points of entry into the muscle. Measurements were taken of the distances of these nerves in the three previously mentioned arm positions. The points of entry of the subscapularis nerves into the muscle may be very close to the surgical field (as close as 1 cm from the glenoid border). Therefore extensive release of the anterior surface of the subscapularis muscle may cause damage to the subscapularis nerves. The risk can be potentially increased by the position of the arm, especially for the upper nerve when the arm is in external rotation.

Tratamento cirúrgico da luxaçäo recidivante anterior do ombro pela técnica da capsuloplastia associada com a reparaçäo da lesäo de Bankart / Surgical treatment of recurrent anterior dislocation of the shoulder using the capsular shift technique associated to Bankart's lesion repair

Entre julho de 1987 e fevereiro de 1993, 178 pacientes foram operados pelo Grupo de Ombro do Departamento de Ortopedia e Traumatologia da Santa Casa de Misericørdia de Sao Paulo ("Pavilhäo Fernandinho Simonsen") para o tratamento da instabilidade âtero-inferior, involuntária do ombro. Os autores analisam e discutem os resultados de 92 ombros em 92 pacientes comseguimento mínimo de 24 meses e médio de 32 meses. A técnica utilizada foi a da capsuloplastia ântero-inferior, como descrita por Neer em 1980, associada a uma eventual correçäo da "lesao de Bankart", quando esta está presente. Obtiveram índices de bons resultados de 93,5 por cento, com relaçäo à satisfaçäo dos pacientes e prevençäo das recidivas de luxaçao. Concluem que a técnica utilizada, apesar de ser um pouco trabalhosa e exigir alguns instrumentos especiais, tem como grande cr,dito a reconstruçäo da anatomia normal do ombro, o que leva a índices bastante satisfatørios de contensäo da instabilidade e pouca ou nenhuma limitaçäo da amplitude final de movimentos do ombro, principalmente rotaçäo externa.