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Shoulder and Elbow Surgery: Current Hurdles and Future Perspectives
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Shoulder and Elbow Surgery: Current Hurdles and Future Perspectives

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (25 September 2024) | Viewed by 4370

Special Issue Editor

Dr. Raffaele Garofalo

E-Mail Website
Guest Editor
Department of Orthopaedics and Traumatology, Ente Ecclesiastico Ospedale "F. Miulli", Acquaviva delle Fonti, 70021 Bari, Italy
Interests: shoulder; elbow; sport medicine; joint infection; arthroscopy

Special Issue Information

Dear Colleagues,

Complex articular fractures associated with shoulder or elbow instability represent a serious challenge and a controversial topic. Technical advances in imaging modalities, such as CT (computed tomography) joint reconstruction, magnetic resonance imaging and 3D printing have offered novel perspectives in our understanding of the precise patho-anatomy regarding traumatized bone and soft tissue. Most of these patients need to undergo surgical reconstruction, and the options presented to the patients should take in account not only the pattern of lesion but also the features of the patients themselves. Some very specific cases could be treated conservatively; however, these patients should be closely followed to prevent any irreversible degenerative joint disease. Furthermore, technological innovations, such as minimally invasive arthroscopic surgery, significantly improved the prognosis of surgery in selected cases. This Special Issue of the Journal of Clinical Medicine focuses on recent imaging of and treatment options for this very challenging traumatic lesion.

Dr. Raffaele Garofalo
Guest Editor

Manuscript Submission Information

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Keywords

  • fracture
  • dislocation
  • elbow
  • shoulder
  • glenoid
  • coronoid
  • terrible triad

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Published Papers (3 papers)

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Research

13 pages, 10281 KiB  
Article
Residual Elbow Instability Treated with a Submuscular Internal Joint Stabilizer: Prospective and Consecutive Series with a Minimum Follow-Up of 12 Months
by Angelo De Crescenzo, Raffaele Garofalo and Andrea Celli
J. Clin. Med. 2024, 13(22), 6765; https://doi.org/10.3390/jcm13226765 - 10 Nov 2024
Viewed by 953
Abstract
Background: The management of residual elbow instability is a challenging and compelling issue for treating physicians. To overcome inherent drawbacks of dynamic external fixators, the internal joint stabilizer (IJS) has been developed, achieving successful results, but it can sometimes cause local tenderness [...] Read more.
Background: The management of residual elbow instability is a challenging and compelling issue for treating physicians. To overcome inherent drawbacks of dynamic external fixators, the internal joint stabilizer (IJS) has been developed, achieving successful results, but it can sometimes cause local tenderness or anesthetic concerns in the subcutaneous layer. In addition, a bulky anconeus can pull the hardware away from the axis of rotation with an increase in the lever arm and potential issues. To address these issues, an alternative approach has been recently described in which the internal device is covered by the anconeus muscle, becoming submuscular, rather than subcutaneous. The aim of this study was to evaluate the effectiveness of this alternative approach to the IJS application in maintaining a concentric elbow during and after device removal in both acute and chronic scenarios. Methods: Prospective data collection was performed with consecutive patients who had residual elbow instability treated with an IJS (Skeletal Dynamics, Miami, FL) covered by the anconeus from January 2022 and with a minimum follow-up of 12 months. Results: At a medium follow-up of 16 months, the 16 patients selected had a mean arc of flexion–extension of 123° (range: 0–140°) and a mean pronation-supination arc of 150° (range: 80–80°). The mean MEPS and DASH scores were 90.3 ± 6.2 and 6.3 ± 5.3, respectively. At the last follow-up, elbow stability and concentric reduction were confirmed with radiographic and clinical examinations. Conclusions: With a minimum follow-up of 12 months, the present study supports the safety and efficacy of the internal device in a submuscular layer. The clinical outcomes and the rate of recurrent instability are comparable to those achieved with a classic subcutaneous position. Similarly, the complication rate is not affected, and removal surgery is no more aggressive than the classic approach. Full article
(This article belongs to the Special Issue Shoulder and Elbow Surgery: Current Hurdles and Future Perspectives)
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10 pages, 2504 KiB  
Article
Reverse Shoulder Prosthesis for Proximal Humeral Fractures: Primary Treatment vs. Salvage Procedure
by Antonio Caldaria, Luca Saccone, Nicolò Biagi, Edoardo Giovannetti de Sanctis, Angelo Baldari, Alessio Palumbo and Francesco Franceschi
J. Clin. Med. 2024, 13(11), 3063; https://doi.org/10.3390/jcm13113063 - 23 May 2024
Viewed by 1745
Abstract
Background: The optimal treatment for complex proximal humerus fractures (PHFs) lacks consensus, with reverse total shoulder arthroplasty (RTSA) often being a final resort rather than a primary approach. This study aimed to compare outcomes and satisfaction rates of primary RTSA for PHFs versus [...] Read more.
Background: The optimal treatment for complex proximal humerus fractures (PHFs) lacks consensus, with reverse total shoulder arthroplasty (RTSA) often being a final resort rather than a primary approach. This study aimed to compare outcomes and satisfaction rates of primary RTSA for PHFs versus salvage RTSA for previously unsuccessful treatments. We hypothesized that primary RTSA would yield superior clinical outcomes, functional scores, and patient satisfaction. Methods: A retrospective analysis of RSA procedures between 2011 and 2021 was conducted, focusing on primary RTSA for PHFs or salvage RTSA for failed osteosynthesis. Patients meeting inclusion criteria underwent clinical and radiological follow-up for at least two years. Demographic characteristics, outcomes scores, and range of motion (ROM) were assessed. Results: Of 63 patients, 42 underwent primary RTSA and 21 underwent salvage RTSA. The median follow-up was 50 months. Statistically significant differences favored primary RTSA in forward flexion, abduction, internal rotation, and Constant shoulder score. Patient satisfaction levels did not significantly differ between groups. Complications occurred in 7.15% of primary RTSA cases and 14.28% of salvage RTSA cases. Conclusions: Primary RTSA may yield slightly better outcomes and lower complication rates compared to salvage RTSA. Further prospective studies are necessary to validate these findings. Full article
(This article belongs to the Special Issue Shoulder and Elbow Surgery: Current Hurdles and Future Perspectives)
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10 pages, 233 KiB  
Article
Surgical Treatment of Shoulder Pathologies in Professional Gymnasts: Findings, Treatment, and Clinical Outcomes
by Riccardo Ranieri, Matteo Illuminati, Marco Conti, Giacomo Delle Rose, Marco Minelli and Alessandro Castagna
J. Clin. Med. 2024, 13(8), 2183; https://doi.org/10.3390/jcm13082183 - 10 Apr 2024
Cited by 1 | Viewed by 1079
Abstract
Background: This study aims to investigate the impact of shoulder surgery on professional gymnasts through a case series, analyzing the mechanisms of injury and the shoulder lesion patterns, and reporting the clinical outcomes and return to sport. Methods: Twenty-nine surgically treated [...] Read more.
Background: This study aims to investigate the impact of shoulder surgery on professional gymnasts through a case series, analyzing the mechanisms of injury and the shoulder lesion patterns, and reporting the clinical outcomes and return to sport. Methods: Twenty-nine surgically treated shoulders in twenty-seven professional gymnasts were retrospectively analyzed. Patients were stratified based on predominant symptoms and anatomical lesions in painful or unstable shoulders. Demographic and injury data, pathological findings, surgical procedure information, and data on time and level of return to sport were collected. Results: The average age of participants was 20.2 ± 3.8 years. Acute traumatic onset was reported in 51.8% of cases. Shoulders were categorized as painful in 13 cases and unstable in 16 cases. The most common pathologies were capsulolabral injuries (72%), biceps injuries (48%), and rotator cuff injuries (40%). All of the athletes returned to training within an average of 7.3 months, while the return to competition rate was 56%, achieved in an average of 10.3 months. The sport-specific subjective shoulder value was 84.8% ± 16.6%. Half of the patients who stopped competition reported reasons related to symptom persistence, while the other half reported personal reasons. No significant difference in the return to sport was reported in the cases of painful or unstable shoulder. Conclusions: Professional gymnasts requiring shoulder surgery commonly present multiple and complex lesions. Returning to training was possible in all cases; however, the possibility of persisting symptoms and other personal factors which may compromise the return to competition should be discussed with the athlete to give them insights into the possible outcomes. Full article
(This article belongs to the Special Issue Shoulder and Elbow Surgery: Current Hurdles and Future Perspectives)
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