Controversies in Orthopedic Surgery of The Upper Limb

Description

This book comprehensively discusses existing controversies in orthopedic and trauma surgery of the upper limb, i.e. of the shoulder, humerus, elbow, wrist and hand. Real-world examples by experts from leading institutions equip the reader with the necessary knowledge and insights to address controversial issues and clinical presentations. The volume is subdivided into 5 sections, each of which discusses the most relevant controversies related to each joint, such as surgical versus conservative interventions, resection vs. prosthetic arthroplasty and more generally if, when and how to intervene in diverse pathologic conditions. This comprehensive guide is a valuable resource for all orthopedic surgeons, residents and fellows practicing in the field of upper limb surgery. Preface Contents 1: Displaced Proximal Humeral Fractures in the Elderly: Conservative Treatment Versus Open Reduction and Internal Fixation Versus Hemiarthroplasty Versus Reverse Shoulder Arthroplasty 1.1 Introduction 1.2 Epidemiology, Pathoanatomy, and Fracture Classification 1.2.1 Epidemiology 1.2.2 Pathoanatomy 1.2.3 Classification 1.3 Diagnosis: Clinical Presentation and Imaging 1.3.1 Clinical Presentation 1.3.2 Imaging 1.4 Treatment 1.4.1 Nonoperative Treatment 1.4.2 Operative Treatment 1.4.2.1 Open Reduction and Internal Fixation (ORIF) Technique 1.4.2.2 Intramedullary Nailing (IMN) 1.4.2.3 Arthroplasty Hemiarthroplasty (HA) Reverse Shoulder Arthroplasty (RSA) Outcomes 1.5 Postoperative Rehabilitation 1.6 Outcomes Evaluation 1.6.1 Health Questionnaires 1.6.2 Functional Scales 1.7 Overall Complications 1.8 Mortality 1.9 Conclusions References 2: Surgical Versus Conservative Interventions for Treating Acromioclavicular Dislocation of the Shoulder in Adults 2.1 Introduction 2.2 Epidemiology and Classification 2.3 Diagnosis 2.4 Treatment and Results 2.5 Surgical Treatment 2.6 Acute Injuries 2.7 Chronic Injuries 2.8 Conclusions References 3: Calcific Tendinopathy of the Rotator Cuff in Adults: Operative Versus Nonoperative Management 3.1 Introduction 3.2 Pathogenesis 3.3 Imaging 3.4 Treatment 3.4.1 Ultrasound-Guided Percutaneous Irrigation of Rotator Cuff Calcific Tendinopathy (US-PICT) 3.4.1.1 US-Guided Percutaneous Irrigation of Calcific Tendinopathy of the Rotator Cuff in Patients with or Without Previous External Shockwave Therapy 3.4.1.2 Efficacy of Ultrasound-Guided Percutaneous Treatment of the Rotator Cuff Calcific Tendinopathy with Double Needle Technique 3.4.1.3 US-PICT: Redefining Predictors of Treatment Outcome 3.4.2 External Shock Wave Therapy (ESWT) 3.4.2.1 Focused, Radial, and Combined ESWT 3.4.2.2 Effectiveness of Focused Shockwave Therapy Versus Radial Shockwave Therapy for Noncalcific Rotator Cuff Tendinopathies: A Randomized Clinical Trial 3.4.3 Platelet-Rich Plasma (PRP) 3.4.4 Needle Aspiration 3.4.5 Dextrose Prolotherapy 3.4.6 Sodium Thiosulfate 3.4.7 Surgical Treatment 3.5 Comparative Studies 3.5.1 Operative Versus Nonoperative Management 3.5.2 Radial ESWT Versus Ultrasound Therapy 3.5.3 Comparing Ultrasound-Guided Needling Combined with a Subacromial Corticosteroid Versus High-Energy ESWT 3.5.4 Comparison of Radial Extracorporeal Shockwave Therapy and Traditional Rehabilitation Medicine 3.6 Conclusions References 4: Recurrent Anterior Shoulder Instability in Adults: Bankart or Latarjet? 4.1 Introduction 4.2 Bankart Procedure 4.2.1 Open Bankart Repair 4.2.2 Arthroscopic Bankart Repair 4.3 Latarjet Procedure 4.3.1 Modified Open Latarjet 4.3.2 Arthroscopic Latarjet 4.3.3 Open Latarjet Vs. Arthroscopic Latarjet 4.3.4 Latarjet vs. Anterior Glenoid Reconstruction Using Fresh Distal Tibia Allograft (DTA) 4.3.5 Latarjet After Failed Arthroscopic Bankart Repair 4.4 Comparative Studies: Bankart Vs. Latarjet 4.4.1 Arthroscopic Bankart vs. Open Bristow-Latarjet 4.4.2 Arthroscopic Bankart vs. Open Bristow-Latarjet in Patients Older than 40 4.4.3 Arthroscopic Bankart Repair with Remplissage vs. Open Latarjet 4.4.4 Arthroscopic Bankart Repair vs. Open Latarjet vs. Capsular Shift 4.5 Conclusions Appendix 1: WOSI Score References 5: Controversies in Shoulder Arthroplasty 5.1 Introduction 5.2 Rotator Cuff Arthropathy 5.2.1 Young Patients 5.2.2 Humeral Cut Neck-Shaft Angle of Less than 155 Degrees 5.2.3 Studies that Compare the RSA with or Without Lateralization with Bone Graft 5.2.4 Degree of Lowering of the Center of Rotation 5.2.5 Size of the Glenosphere 5.3 Glenohumeral Osteoarthritis 5.3.1 Comparison Between HA and TSA 5.3.2 Thinned Supraspinatus Tendon with a Partial Tear 5.3.3 Young Patients with Glenohumeral Osteoarthritis 5.3.4 Resurfacing Arthroplasty (Stemless Shoulder Arthroplasty) 5.3.5 Primary Osteoarthritis Patients with Joint Impingement, Posterior Erosion, and Posterior Subluxation of the Humeral Head 5.3.6 Reverse Prosthesis in Young Patients 5.4 Failed Anatomic Shoulder Arthroplasties 5.5 Proximal Humeral Fractures 5.6 Glenoid Bone Defects 5.6.1 Reverse Shoulder Arthroplasty 5.6.2 Total Shoulder Arthroplasty 5.7 Short-Stem Shoulder Arthroplasty 5.8 Complications of Shoulder Arthroplasties 5.8.1 Complications of RSA 5.8.1.1 Acromion and Scapula Spine Fractures 5.8.1.2 Instability 5.8.2 Complications of Total Anatomic Arthroplasty 5.9 Conclusions References 6: Clavicle Fractures: To Operate or Not? 6.1 Introduction 6.2 Fractures of the Middle Third of the Clavicle 6.3 Fractures of the Distal Third of the Clavicle 6.4 Fractures of the Proximal Third of the Clavicle 6.5 Conclusions References 7: Massive Rotator Cuff Tears: When and How to Repair 7.1 Introduction 7.2 Epidemiology 7.3 Anatomy and Biomechanics 7.4 Natural History of Rotator Cuff Disease 7.5 Rotator Cuff Tears Classification: Definition of Massive Rotator Cuff Tear 7.6 Massive Rotator Cuff Tears: When to Repair 7.6.1 Clinical Factors 7.6.2 Imaging Factors 7.6.3 Intraoperative Factors 7.7 Massive Rotator Cuff Tears: How to Repair 7.8 Conclusions References 8: Humeral Shaft Fixation in Adults: Plate Fixation, Intramedullary Nail, or Nonoperative? 8.1 Introduction 8.2 Anatomy 8.3 Classification of Diaphyseal Humeral Fractures 8.4 Initial Patient Assessment 8.5 Treatment 8.5.1 Conservative Treatment 8.5.2 Intramedullary Nailing 8.5.2.1 Results 8.5.3 Internal Fixation with Plate 8.5.3.1 Surgical Approaches 8.5.3.2 Type and Placement of Plates 8.5.3.3 Results 8.5.3.4 MIPO (Minimally Invasive Plate Osteosynthesis) Technique 8.5.4 External Fixator 8.6 Comparison of Treatment Options 8.7 Conclusions References 9: Controversies in the Management of Intra-Articular Distal Humerus Fractures in Adults 9.1 Introduction 9.2 Clinical Assessment 9.3 Anatomy and Classification 9.4 Imaging 9.5 Treatment 9.5.1 Nonoperative Management 9.5.2 Surgical Management 9.5.3 Surgical Approaches 9.5.3.1 Universal Posterior Incision 9.5.3.2 Bilaterotricipital Approach (Alonso-Llames) 9.5.3.3 Triceps-Reflecting Approach (Bryan-Morrey) 9.5.3.4 Triceps-Reflecting Anconeus Pedicle Flap (TRAP) 9.5.3.5 Triceps-Splitting Approach (Campbell Approach) 9.5.3.6 Olecranon Osteotomy 9.5.4 Implants 9.5.5 Fixation Methods 9.5.5.1 Reduction and Temporary Fixation 9.5.5.2 Definitive Fixation 9.5.6 Management of Ulnar Nerve 9.6 Postoperative Management 9.7 Complications of Surgical Management 9.7.1 Stiffness 9.7.2 Nonunion 9.7.3 Heterotopic Ossification 9.7.4 Ulnar Neuropathy 9.7.5 Other Complications [33] 9.8 Outcomes 9.9 Elbow Arthroplasty 9.10 Conclusions References 10: Controversies in the Management of Radial Head Fractures in Adults 10.1 Introduction 10.1.1 Epidemiology 10.1.2 Anatomy and Biomechanics 10.1.3 Classification 10.2 Diagnosis 10.2.1 Clinical Examination 10.2.2 Radiological Tests 10.2.3 Associated Injuries 10.3 Management and Treatment 10.3.1 Nonsurgical Treatment 10.3.2 Surgical Treatment 10.3.2.1 Surgical Approach and Arthroscopic Techniques 10.3.2.2 Open Reduction and Internal Fixation (ORIF) 10.3.2.3 Excision of Radial Head 10.3.2.4 Radial Head Arthroplasty (RHA) 10.4 Conclusions References 11: Controversies in the Surgical Treatment of Distal Biceps Tendon Ruptures in Adults: To Fix or Not to Fix? Single Versus Double Incision? 11.1 Introduction 11.2 Anatomy and Pathophysiology 11.3 Types of Injuries 11.4 Diagnosis 11.4.1 Clinical Diagnosis 11.4.2 Imaging Tests 11.5 Treatment 11.5.1 Partial Ruptures 11.5.1.1 Partial Rupture of the Short Head of the Biceps 11.5.2 Acute Complete Rupture 11.5.2.1 Surgical Technique Anesthesia and Positioning Single-Incision Technique (Author’s Preferred Method) Approach Tuberosity Preparation Tendon Preparation Fixation and Wound Closure Double-Incision Technique Postoperative Protocol 11.5.3 Chronic Rupture 11.6 Conclusions References 12: Controversies in Tennis Elbow in Adults: Should We Ever Operate? 12.1 Introduction 12.2 Epidemiology 12.3 Etiology and Pathogenesis 12.4 Clinical Symptoms 12.4.1 Posterolateral Instability 12.4.2 Posterolateral Plica 12.4.3 Posterior Interosseous Nerve (PIN) Compression 12.4.4 Other Pathologies 12.5 Diagnosis 12.6 Conservative Treatment 12.6.1 Rest and Postural Reeducation 12.6.2 Exercises 12.6.3 Orthoses 12.6.4 Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) 12.6.5 Shock Waves 12.6.6 Injections 12.6.6.1 Corticosteroid (CS) Injections 12.6.6.2 Autologous Blood Injections 12.6.6.3 Platelet-Rich Plasma (PRP) Injections 12.6.6.4 Stem Cell Injections 12.6.6.5 Botulinum Toxin A Injections 12.6.6.6 Prolotherapy 12.6.6.7 Percutaneous Radiofrequency 12.7 Surgical Treatment 12.7.1 Open Techniques 12.7.2 Percutaneous Release 12.7.3 Arthroscopic Technique 12.8 Results 12.8.1 Surgical Versus Nonsurgical 12.8.2 Open Versus Arthroscopic 12.8.3 Open Versus Arthroscopic Versus Percutaneous 12.9 Conclusions References 13: Total Elbow Arthroplasty 13.1 Introduction 13.2 Primary TEA 13.2.1 Biomechanics 13.2.2 Patient Selection 13.2.3 Preoperative Planning 13.2.4 Surgical Approaches for TEA 13.2.5 Outcomes of TEA 13.2.5.1 Thirty-Day Readmissions and Reoperations After TEA 13.2.5.2 Long-Term Outcomes of TEA 13.2.5.3 Risk Factors for Reoperation After TEA 13.2.5.4 Mid- to Long-Term Survivorship of Cemented Semiconstrained “Discovery” TEA 13.2.6 Complications After TEA 13.2.6.1 Periprosthetic Infection: Resection Arthroplasty 13.2.6.2 Heterotopic Ossification Following TEA 13.2.6.3 Component Fracture After TEA 13.2.6.4 Humeral Amputation Following TEA 13.2.7 Inpatient Versus Outpatient TEA 13.2.8 Elective TEA Versus TEA for Fracture in Elderly Patients 13.2.9 TEA in Rheumatoid Arthritis Patients 13.2.10 TEA in Juvenile Idiopathic Arthritis (Juvenile Rheumatoid Arthritis) Patients 13.2.11 TEA in Osteoarthritis Patients 13.2.12 TEA in Posttraumatic Arthritis 13.2.13 Outcomes Following TEA for Rheumatoid Arthritis Versus Posttraumatic Conditions 13.2.14 Primary Versus Secondary TEA for Distal Humerus Fractures 13.3 Revision TEA 13.3.1 Outcomes After Revision TEA 13.3.2 Revision TEA: Comparison of Infected and Noninfected TEA 13.3.3 Outcomes Following Revision of the Revision TEA 13.4 Conversion of a Surgical Elbow Arthrodesis to TEA 13.5 The Future for TEA 13.6 Conclusions References 14: Distal Radius Fractures in the Elderly: Current Controversies 14.1 Introduction 14.2 Conservative Treatment 14.2.1 Objective Outcome Measures Continue to Improve from 6 to 12 Months 14.3 Surgical Treatment 14.3.1 Preoperative Planning 14.3.2 Percutaneous Pinning Fixation 14.3.3 Dorsal Bridge Plate 14.3.4 IlluminOss System 14.3.5 Volar Locking Plate Preserving Pronator Quadratus Through the Minimally Invasive Approach 14.3.6 Bridge Plating with Bone Graft Substitutes in Combination with Systemic Romosozumab Administration 14.3.7 Combined Palmar and Dorsal Plating of Four-Part Distal Radius Fracture 14.3.8 Cobra Prosthesis in Complex Distal Radius Fractures 14.4 Do We Need to Restore Anatomy to Have Satisfactory Clinical Result? 14.5 Treatment of Malunited Distal Radius Fracture 14.5.1 Corrective Osteotomy: 2D Imaging Techniques for Preoperative Alignment Planning Versus a Novel Patient-Specific Plate Which Features Navigation and Fixation of Bone Segments As Preoperatively Planned in 3D 14.5.2 Corrective Osteotomy Through Planning with Prototyping in 3D Printing 14.6 Comparative Studies 14.6.1 Comparison of Surgical Effects Between Extension and Flexion Type of Distal Radius Fracture 14.6.2 A Comparison of Six Outcome Measures Across the Recovery Period After Distal Radius Fixation: Which to Use and When? 14.6.3 Surgical Plating Versus Closed Reduction 14.6.4 Plaster Immobilization Versus Anterior Plating for Dorsally Displaced Distal Radius Fractures 14.6.5 5 Cast Immobilization Versus Volar Locking Plate 14.6.6 Open Reduction and Volar Locking Plate Versus External Fixation with or Without Supplementary Pinning Versus Percutaneous Pinning 14.6.7 Variable-Angle Volar Plate Versus Bridging External Fixator with K-Wire Augmentation in Comminuted Distal Radius Fractures 14.6.8 Bilateral Distal Radius Fractures: External Fixation Versus Plate-Screw Treatment 14.7 Predictors of Management of Distal Radius Fractures in Patients Aged >65 Years 14.8 Conclusions References 15: Scapholunate Dissociation 15.1 Introduction: Anatomy and Histology 15.2 Pathomechanics 15.3 Diagnosis 15.3.1 Physical Exams 15.3.2 Radiological Examination 15.3.2.1 Advance Imaging 15.3.2.2 Arthroscopic Examination 15.4 Principles of Treatment 15.4.1 Stage I: Partial SLIL Injury 15.4.1.1 Arthroscopic Debridement and Electrothermal Ligament Shrinkage 15.4.1.2 Reeducation of Wrist Proprioception 15.4.2 Stage II: Complete SLIL Injury, Repairable 15.4.2.1 Open Reduction and Dorsal SL Ligament Repair 15.4.2.2 Arthroscopic Repair and Capsular Reinforcement 15.4.3 Stage III: Complete SLIL Lesion, Non-Repairable, No Malalignment 15.4.4 Stage IV: Complete, Irreparable SLIL Injury, Reducible Malalignment 15.4.4.1 SLIL Ligamentoplasty Using a Tendon Graft 15.4.4.2 Arthroscopic Scapholunate Ligamentoplasty 15.4.4.3 Arthroscopically Assisted Ligament Reconstruction 15.4.4.4 Reduction-Association of the SL Joint (RASL) Procedure 15.4.5 Stage V: Chronic SL Injury with Irreducible Malalignment and Normal Joint Cartilage 15.4.5.1 Scapholunate Arthrodesis 15.4.5.2 Scaphoid-Trapezium-Trapezoid Arthrodesis 15.4.5.3 Radioscaphoid-Lunate Arthrodesis 15.4.6 Stage VI: Chronic SL Injury with Irreducible Malalignment and Cartilage Damage 15.4.6.1 SLAC 1 Treatment 15.4.6.2 SLAC 2 Treatment 15.4.6.3 Stage III SLAC Treatment 15.4.6.4 Stage IV SLAC Treatment 15.5 Authors’ Preferred Treatment 15.6 Conclusions References 16: Wrist Arthritis: Total Versus Limited Fusion Versus Arthroplasty 16.1 Introduction 16.2 Treatment Algorithm for the Surgical Management of Wrist Arthritis 16.3 Normal Wrist Motion and Biomechanics and Its Importance in the Surgical Management of Wrist Arthritis 16.4 Partial/Limited Wrist Fusion 16.4.1 Radiolunate Fusion (Chamay Fusion) 16.4.2 Radioscapholunate (RSL) Fusion 16.4.3 Four-Corner Fusion 16.5 Total Wrist Arthroplasty 16.6 Total Wrist Fusion 16.7 TWA Versus TWF 16.7.1 Indications and Patient Selection 16.7.2 Quality Assessment of Studies and Outcomes Reporting Tools 16.7.3 Motion, Function and Satisfaction After TWA and TWF 16.7.4 Financial Factors Influencing the Choice Between TWA and TWF 16.7.5 Changing Complication Rates Between TWA and TWF 16.8 Conclusions References 17: Controversies in Carpal Tunnel Syndrome in Adults: Endoscopic Versus Open Carpal Tunnel Release 17.1 Introduction 17.2 Clinical Results 17.3 Recurrence/Reoperation 17.4 Major Complications 17.4.1 Transient Neurapraxias 17.4.2 Major Nerve Injuries 17.4.3 Tendon and Artery Injuries 17.5 Minor Complications 17.6 Return to Work 17.7 Reporting Bias/Learning Curve 17.8 Costs 17.9 Conclusions References 18: Distal Radioulnar Joint: Resection Arthroplasty or Prosthetic Arthroplasty 18.1 Introduction 18.2 Distal Radioulnar Joint (DRUJ) Anatomy 18.3 DRUJ Biomechanics 18.4 Management of Distal Radioulnar Joint Arthritis 18.4.1 Resection Arthroplasty 18.4.1.1 Darrach Procedure Description and History Intended Benefits Potential Complications Outcomes Tips Summary Similar Procedures 18.4.1.2 Sauvé-Kapandji Procedure Description and History Intended Benefits Potential Complications Outcomes Tips Summary 18.4.1.3 Comparison of the Darrach Versus Sauvé-Kapandji Procedure 18.4.2 Prosthetic Arthroplasty 18.4.2.1 Partial or Complete Ulnar Head Replacement Description and History Intended Benefits Potential Complications Outcomes Tips Summary 18.4.2.2 Total DRUJ Arthroplasty Description and History Intended Benefits Potential Complications Outcomes Tips Summary 18.4.3 Authors’ Preferred Treatment Methods 18.4.4 Conclusions References 19: Controversies in the Treatment of Fingertip Amputations in Adults: Conservative Versus Surgical Reconstruction 19.1 Introduction 19.2 Nonoperative Management 19.2.1 Occlusive Dressing 19.2.2 Semiocclusive Dressing and Splint Caps 19.3 Surgical Treatment 19.3.1 Primary Closure 19.3.2 Grafts 19.3.2.1 Composite Grafting 19.3.2.2 Skin Grafts 19.3.3 Flap Reconstruction 19.3.3.1 Volar V-Y Plasty 19.3.3.2 Advancement Flap 19.3.3.3 Cross-Finger Flap and Thenar Flap 19.3.3.4 Vascular and Neurovascular Island Flap 19.3.3.5 Reverse Homodigital Artery Flap Coverage 19.3.4 Purse-String Suture as a Complementary Technique with Conventional Flaps in Repairing Fingertip Amputation 19.3.5 The Palmar Pocket Method 19.3.6 Fingertip Replantation 19.4 Do We Need to Repair the Nerves When Replanting Distal Finger Amputations? 19.5 Digit Tip Regeneration 19.6 Conclusions References 20: Metacarpophalangeal (MCP) and Proximal Interphalangeal (PIP) Joint Arthroplasty 20.1 Introduction 20.2 Metacarpophalangeal (MCP) Joint Arthroplasty 20.2.1 Primary MCP Joint Arthroplasty 20.2.1.1 Unconstrained MCP Joint Arthroplasties Pyrocarbon MCP Joint Arthroplasty in Noninflammatory Arthritis 20.2.1.2 Silicone MCP Arthroplasty 20.2.1.3 Surface Replacement Arthroplasty (SRA) 20.2.1.4 Dorsal Capsule Interpositional Arthroplasty of the MCP Joint 20.2.2 Revision MCP Arthroplasty 20.3 PIP Joint Arthroplasty 20.3.1 Emergency Arthroplasty of the PIP Joint for Complex Fractures with Silicone Implant 20.3.2 Surface-Replacing Implant Arthroplasty 20.3.3 Complications After Surface-Replacing and Silicone PIP Arthroplasty 20.3.4 Lateral Stability in Healthy PIP Joints Versus Surface Replacement and Silicone Arthroplasty 20.3.5 Pyrolytic Carbon PIP Arthroplasty 20.4 Autologous Tissue for Small Joint Arthroplasty 20.5 Prevalence of Complications and Cost of Small Joint Arthroplasty for Hand Osteoarthritis and Posttraumatic Arthritis 20.6 Conclusions References