BACKGROUND: The purpose of this study was to determine if capsular repair used in conjunction with the Latarjet procedure results in significant alterations in glenohumeral rotational range of motion and translation. METHODS: Glenohumeral rotational range of motion and translation were measured in eight cadaveric shoulders in 90degrees of abduction in both the scapular and coronal planes under the following four conditions: intact glenoid, 20% bony Bankart lesion, modified Latarjet without capsular repair, and modified Latarjet with capsular repair. RESULTS: Creation of a 20% bony Bankart lesion led to significant increases in anterior and inferior glenohumeral translation and rotational range of motion (p < 0.005). The Latarjet procedure restored anterior and inferior stability compared to the bony Bankart condition. It also led to significant increases in glenohumeral internal and external rotational range of motion relative to both the intact and bony Bankart conditions (p < 0.05). The capsular repair from the coracoacromial ligament stump to the native capsule did not significantly affect translations relative to the Latarjet condition; however it did cause a significant decrease in external rotation in both the scapular and coronal planes (p < 0.005). CONCLUSIONS: The Latarjet procedure is effective in restoring anteroinferior glenohumeral stability. The addition of a capsular repair does not result in significant added stability; however, it does appear to have the effect of restricting glenohumeral external rotational range of motion relative to the Latarjet procedure performed without capsular repair.
Biomechanical Phenomena/*physiology ; Female ; Humans ; Humerus/physiology/surgery ; Male ; Middle Aged ; Range of Motion, Articular/*physiology ; Scapula/physiology/surgery ; Shoulder Joint/*physiology/*surgery

Upper limb length discrepancy is a rare occurrence. Humerus shortening may need specialized treatment to restore the functional and cosmetic status of upper limb. We report a case of humerus lengthening of 9 cm with a monorail external fixator and the result was observed during a 2-year follow-up. Humerus lengthening needs specialized focus as it is not only a cosmetic issue but also a functional demand. The monorail unilateral fixator is more functional and cosmetically acceptable, and thus becomes an effective treatment option.
Adult ; Bone Lengthening ; instrumentation ; External Fixators ; Female ; Humans ; Humerus ; physiology ; surgery ; Range of Motion, Articular ; Surgery, Plastic ; instrumentation

OBJECTIVETo compare the clinical efficacies of humeral head prosthesis and internal fixation in the treatment of comminuted proximal humeral fractures.

METHODSThe clinical data were analyzed for the patients with comminuted proximal humeral fractures undergoing surgeries for humeral head replacement or open reduction plus internal fixation in our hospital between January 2002 and January 2009. Constant scores were used to determine the excellent clinical outcome rates in the two groups, and the operating time, blood loss and postoperative motor scores of the shoulder were compared.

RESULTSForty patients in the humeral head replacement group were evaluated. According to the Constant scores, excellent outcomes were achieved in 16 patients, good outcomes in 18 patients, moderate in 3 patients, and poor in 3 patients, with an excellent outcome rate of 85%. In the 40 cases receiving open reduction plus internal fixation, excellent outcomes were achieved in 11 cases, good in 13 cases, moderate in 8 cases, and poor in 8 cases, with an excellent clinical outcome rate of 60%. Compared with open reduction plus internal fixation, humeral head replacement was associated with shortened operating time, reduced blood loss and better motor function recovery of the shoulder.

CONCLUSIONSReplacement of humeral head prosthesis produces better clinical outcomes than open reduction and internal fixation in patients with comminuted proximal humeral fractures, and can promote the short-term functional recovery of the shoulder with minimal surgical complications.

Aged ; Arthroplasty, Replacement ; Female ; Fracture Fixation, Internal ; methods ; Fracture Healing ; physiology ; Fractures, Comminuted ; etiology ; surgery ; Humans ; Humerus ; surgery ; Joint Prosthesis ; Male ; Middle Aged ; Prosthesis Implantation ; Shoulder Fractures ; surgery

This study was performed to evaluate the effect of betatricalcium phosphate and poly L-lactide-co-glycolide-coepsilon- caprolactone (TCP/PLGC) membrane in the repair of partial bone defects in canine proximal humerus. Three adult mixed-breed dogs were used during the experimental period. The length of the defect was quarter of the full length of humerus, and width of the defect was quarter of middle diameter of the lateral aspect of humerus. The humeri of each dog were divided into treatment (TCP/ PLGC) and control groups. The defect was covered with TCP/PLGC membrane in treatment group. To evaluate regeneration of the bone, computerized tomography (CT) and histopathologic examination were performed. The radiopaque lines were appeared at the original defect sites in TCP/PLGC group but below the original site in control at 4th week. Radiopacity and thickness of the defect sites, and radiopaque lines were more increased at 8th week than those of 4th week. Histopathologic findings revealed fibrous connective tissue migration into the defect and the migration inhibited the structure of new cortex to be placed in the original level in control whereas new cortex growth was found in the level of original line in TCP/ PLGC group. However, the new cortical bone in the TCP/ PLGC group was thinner and less organized than the adjacent intact cortex, and the amount of new cancellous bones were also scanty. The result suggested that TCP/ PLGC membrane is a good guided bone regeneration material to restore the original morphology of humerus in partial defect.
Absorbable Implants/veterinary ; Animals ; Bone Regeneration/*drug effects ; Calcium Phosphates/*pharmacology ; Dogs/*surgery ; Guided Tissue Regeneration/methods/*veterinary ; Histocytochemistry/veterinary ; Humerus/*surgery ; Male ; Polyesters/*pharmacology ; Tomography, X-Ray Computed/veterinary ; Wound Healing/physiology