Semiconstrained total shoulder arthroplasty for glenohumeral arthritis and massive rotator cuff tearing.

Each of 6 patients (7 shoulders) underwent semiconstrained total shoulder arthroplasty for glenohumeral arthritis, subluxation, and extensive rotator cuff tearing to obtain a more balanced joint and achieve consistent pain relief. A hooded glenoid component (Neer 600%) was used to contain the humeral head within the joint. Patients were followed for an average of 69 months (range, 26-125 months) or to revision surgery and were assessed clinically and radiographically. All patients experienced improvement with respect to pain; on average, active elevation and external rotation decreased to 44 degrees and 43 degrees. On radiographic evaluation, 3 of the glenoid components were seen to have complete radiolucent lines and 1 case showed a shift in component position. Five shoulders had anterior-superior joint subluxation. According to the shoulder score rating system of Neer, all but 1 of the shoulders were rated as unsatisfactory or unsuccessful at final follow-up. Two patients have undergone revision surgery for subluxation or glenoid loosening. We cannot recommend this method of treatment.

Fishtail deformity following fracture of the distal humerus in children: historical review, case presentations, discussion of etiology, and thoughts on treatment.

Fishtail deformity is an uncommon complication of distal humeral fractures in children. This article reports four cases accompanied by premature closure of a portion of the distal humeral physis with resultant deformity, length retardation, decreased elbow motion, and functional impairment. The ages of the patients at time of injury ranged from 4 years 2 months to 6 years 1 month (average 5 years 4 months). The average length of follow-up was 9 years 9 months (range, 3 years 5 months to 18 years 10 months). The cause of the arrest is multifactorial and may be due to a gap in reduction of an intracondylar fracture, avascular necrosis of the epiphysis, or central premature physeal arrest (bar formation) without a fracture gap or avascular necrosis. If identified in a young child, surgical closure of the medial and lateral portion of the physis may prevent the deformity from progressing and would not cause significant additional humeral length discrepancy.