2008 American Shoulder and Elbow Surgeons Open Meeting

2008 AMERICAN SHOULDER AND ELBOW SURGEONS OPEN MEETING 1 TREATMENT OF TRAUMATIC POSTERIOR 6; and malunion, 1. Visual analog pain score, Simple Shoulder STERNOCLAVICULAR DISLOCATION Test (SST), and American Shoulder and Elbow Surgeons (ASES) Michael A. Wirth, MD, David Groh, MD, Charles A. Rockwood scores were obtained. Revision surgery included conversion to Jr., MD, University of Texas Health Science Center, San Antonio, TX hemiarthroplasty, 6; revision ORIF, 2; and conversion to reverse Background: Traumatic posterior sternoclavicular joint injuries shoulder arthroplasty, 2. Results: Average pain values decreased are rare. However, complications associated with this entity are from 8.2 to 3.1. Average range of motion improved from 45.5 common and include brachial plexus compression, pneumothorax, to 100.1 forward elevation, 10 to 30.3 external rotation, and vascular compromise, esophageal rupture, and death. Although from L2 to T10 in internal rotation. Average SST scores improved many of these complications are observed at the time of injury, from 4.2 to 8.1, and ASES scores improved from 48.3 to 75.4. In- late appearing complications have also been noted with unreduced traoperative findings included locking screw pullout, articular sur- retrosternal injuries and highlight the importance of decompressing face penetration, glenoid screw penetration, glenohumeral the hilar structures by closed or open reduction techniques. arthrosis, and plate displacement. There was no evidence of infec- Methods: Between 1976 and 2005, 34 patients with a traumatic tion in any case. Conclusions: Despite successful outcomes with posterior sternoclavicular joint injury were treated at our institution. PHLP, complications do arise. Careful preoperative planning and Eight of these were displaced physeal fractures of the medial clav- technical application are important to good outcomes. Recognition icle and were excluded. Of the remaining 26 patients, 1 died and of failed reduction and fixation remains critical. Patient selection 4 were lost to follow-up, leaving 21 posterior sternoclavicular dislo- and bone quality may play a role in failure. Revision surgery re- cations for long-term follow-up (average, 5 years). Signs and symp- mains difficult with variable results. toms included dysphagia, ipsilateral extremity cyanosis and swelling, paresthesia, dyspnea, and shortness of breath. Associ- ated injuries included pulmonary and cardiac contusion, pneumothorax, subclavian artery and vein injury, and associated fractures. All patients underwent initial closed reduction, which was successful in 8 patients. The remaining 13 patients were 3 THE IMPORTANCE OF CENTERING OF THE HUMERAL treated with open reduction and sternoclavicular joint reconstruc- HEAD IN ACUTE FRACTURE ARTHROPLASTY RELATED TO THE tion. Results: Patients were evaluated with respect to pain, function, HEALING OF THE GREATER TUBEROSITY range of motion, strength, and patient satisfaction, according to Peter Habermeyer, MD, Sven Roessing, MD, Petra Magosch, MD, a modification of the University of California at Los Angeles Rating Sven Lichtenberg, MD, ATOS Clinic, Heidelberg, Germany Scale. Overall, 18 of the 21 patients were graded as good or ex- Aim: The aim of the study was to evaluate the centering of the cellent. Patients treated with either closed or open reduction com- prosthetic humeral head into the glenoid in dependence on the heal- pared favorably in terms of improvement in ratings for pain, ing of the greater tuberosity and to clarify its influence on the func- strength, motion, and the ability to perform work and sports. Con- tional outcome of shoulder arthroplasty for acute fractures. clusion: Our experience suggests that successful closed reduction Methods: Thirty patients of a prospective multicentric study, having compares favorably with open reduction. Moreover, once the joint received a primary humeral head replacement due to a 4-part frac- has been reduced closed, it is usually stable. In the present series, ture at a mean age of 72 years, were followed up after exactly 1 early recognition of injury, followed by closed reduction and figure- year by an independent observer with a clinical and standardized of-eight immobilization, was highly successful and obviated the radiographic examination in 3 planes and the gender- and age-re- risks of operation. Patients in whom closed reduction failed ob- lated Constant Score documenting the functional outcome. Results: tained good results with operative treatment aimed at reconstruc- The postoperative radiograph control revealed a centered pros- tion of the costoclavicular ligaments. thetic humeral head in 52%, an inferior position of the prosthetic humeral head in 23%, and the humeral head was positioned too high in 26%. After 1 year, only 36% of the patients showed a centered prosthetic humeral head, 61% showed an upward migration, and the prosthetic head was positioned too low in 4%. One year postop- eratively, the mean relative Constant Score was 65% (range, 10%- 2 COMPLICATIONS OF PROXIMAL HUMERAL LOCKED 99%). An anatomic healing of the greater tuberosity was observed PLATING in 47% of the cases. Resorption of the greater tuberosity was partial Anand M. Murthi, MD, Bryan Butler, MD, University of Maryland in 29% and complete in 20%. In 6% of the cases, a slight malposi- School of Medicine, Baltimore, MD tion of the greater tuberosity was observed. In patients with a cen- Introduction: Despite the global increase in proximal humerus tered prosthetic head, a mean head-tuberosity distance (HTD) of locked plating (PHLP) systems, significant complications with their 9 mm was observed, and patients with an upward migrated pros- use have been experienced. Methods: Between 2003 and 2005, thetic head had a mean HTD of 13 mm. Patients with a centered 10 patients (10 shoulders) treated with open reduction internal fix- prosthetic humeral head received a significantly (P ¼ .002) higher ation (ORIF) using a PHLP presented to our service with complica- Constant Score (85%) than patients presenting with an upward mi- tions related to the PHLP. There were 6 women and 4 men with grated prosthetic head (Constant Score, 54%). Patients with an an- an average age of 52.4 years. The average follow-up was 26 atomic healing of the greater tuberosity achieved a Constant Score months (range, 24-36 months). Preoperative and postoperative of 75%, whereas patients with a partially or totally resorption of the pain scores and range of motion were evaluated. All 10 patients greater tuberosity achieved a Constant Score of 58%. Conclusion: had an initial diagnosis of displaced 2- or 3-part proximal humeral The centering of the prosthetic humeral head into the glenoid is fractures. Diagnosis at presentation included PHLP hardware fail- strongly related to the postoperative functional result. We observed ure, 8; avascular necrosis, 8; posttraumatic arthritis, 2; nonunion, a progression of upward migration of the prosthetic head. In e1 e2 ASES Abstracts J Shoulder Elbow Surg contrast to the literature, we found a slight correlation between the ing on the effects of nanofiber organization on the response of cells centering of the prosthetic humeral head and the radiologic healing derived from human rotator cuff tendon. Specifically, cell attach- of the greater tuberosity. The centering of the prosthetic humeral ment, alignment, and matrix elaboration on both aligned and un- head and the Constant Score depends on the HTD. aligned poly(lactide-co-glycolide; PLGA) nanofiber scaffolds will be evaluated, and the effect of in vitro cell culture on matrix mechanical properties will be measured. It is hypothesized that cell attach- ment, alignment, and matrix elaboration will be regulated by fiber 4 NANOFIBER-BASED SCAFFOLD FOR ROTATOR CUFF organization. Methods: Scaffold fabrication: Aligned and un- REPAIR AND AUGMENTATION aligned nanofiber scaffolds composed of PLGA 85:15 (Lakeshore) Helen H. Lu, PhD, Kristen L. Moffat, MS, Jeffrey P. Spalazzi, MS, were produced by the electrospinning process.8 Briefly, a 35 vol% Stephen B. Doty, PhD, William N. Levine, MD, Columbia University, solution of PLGA in DMF (Sigma) and ethanol was electrospun at New York, NY 1.0 mL/h and 8-10 kV. A rotating collecting target was used to Introduction: Rotator cuff repair is one of the most commonly perform aligned fiber mesh. Cells and cell culture on nanofiber mesh: formed shoulder procedures in the United States,1 and the treatment Human rotator cuff fibroblasts were derived from explant cultures es- of rotator cuff tears and chronic degeneration represents significant tablished after rotator cuff surgery. Cultures were grown in DMEM clinical challenges. Augmentation of rotator cuff repair or substitu- +10% serum, 1% NEAA, 1% antibiotics. Scaffolds were sterilized tion with biologic or synthetic grafts has not resulted in substantial by ultraviolet irradiation for 30 minutes. Cells were seeded (3 Â improvement over traditional repair techniques.2 Consequently, al- 104 cells/cm2) on the aligned or unaligned scaffolds for 1, 7, and ternative grafts for improving rotator cuff repair are needed.2-4 14 days. Acellular scaffolds and monolayer culture served as con- The ideal graft for rotator cuff repair and augmentation must be trol groups. End point analyses: Structural properties of the as-fabri- biodegradable and biomimetic with physiologic mechanical prop- cated scaffolds were measured (Table I). Viability and cell erties. Nanofiber scaffolds are advantageous for tissue engineer- morphology

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