Scholarly impact, as defined by academic productivity and scientific relevance, can be classified by the h-index and supplemented by the m and e-indices. This study has revealed well-defined differences in h, m, and e-indices with regard to academic rank among orthopaedic surgeons. Although the h, m, and e-indices may be of value as adjunct assessment devices for scholarly merit, careful consideration of their limitations must be maintained.
An accurate preoperative measurement of glenoid orientation is crucial for evaluating pathologies and successful total shoulder arthroplasty. Existing methods may be labor-intensive, observer-dependent, and sensitive to the misalignment between the scapula plane and CT scanning direction. In this study, we proposed a computation framework and performed an automated analysis of the glenoid orientation based on 3D surface data. Three-dimensional models of 12 scapulae were analyzed. The glenoid cavity and external anatomical features were automatically extracted from these 3D models. Glenoid version was calculated using the scapula plane and the fulcrum axis alternatively. Glenoid inclination was measured both relative to transverse axis of the scapula and the medial pole-inferior tip axis. The mean (AESD) of the fulcrum-based glenoid version was À0.55˚(AE4.17˚), while the scapular-plane-based glenoid version was À5.05˚(AE3.50˚). The mean (AESD) of glenoid inclinations based on the medial pole and inferior tip was 12.75( AE5.03˚) while the mean (AESD) of the glenoid inclination based on the medial pole and glenoid center was 4.63˚(AE4.86˚). Our computational framework was able to extract the reproducible morphological measures free of inter-and intra-observer variability. For the first time in 3D, we showed that the fulcrum axis was practically perpendicular to the glenoid plane normal (radial line), and thus extended the fulcrum-based glenoid version for quantifying 3D glenoid orientation. Keywords: glenoid orientation; fulcrum axis; version; inclination; morphometry Assessment of glenoid orientation is essential in evaluating pathologies such as degenerative wear and shoulder instability, 1 and for planning shoulder surgeries.2,3 Glenoid orientation characterizes the geometrical relationship between the glenoid cavity and the scapular body. It could be used for differentiating normal and pathological shoulders since shoulder pathologies are likely to damage the glenoid rim and alter the orientation of the glenoid cavity with respect to the scapular body.4 It has been shown that endstage glenohumeral arthritis may increase wearing of the posterior part of glenoid, thus causing increased retroversion. 5,6 In total shoulder arthroplasty, restoration of glenoid orientation can improve the chances of longer-term implant survival by balancing the forces across prosthetic glenoid components, 7,8 while failure in restoring glenoid orientation accurately can cause posterior displacement and glenoid implant loosening.6,9,10 Restoration of glenoid orientation close to a patient's native glenoid orientation is a goal at the time of surgery. 9,11 Unfortunately this goal is difficult to attain due to the extremely diverse morphology of glenoid. 8,9,[12][13][14][15] An accurate and reliable preoperative assessment of glenoid orientation is therefore vital for a successful intra-operative restoration of the shoulder joint. 8Glenoid orientation is usually quantified by glenoid version and inclination. 16,17 These two an...
Background: Reverse total shoulder arthroplasty (rTSA) in the presence of significant glenoid bone loss remains a challenge. This study presents preliminary clinical and radiographic outcomes of primary and revision rTSA using a patient-matched, 3-dimensionally printed custom metal glenoid implant to address severe glenoid bone deficiency. Methods: Between September 2017 and November 2018, 19 patients with severe glenoid bone deficiency underwent primary (n ¼ 9) or revision rTSA (n ¼ 10) using the Comprehensive Vault Reconstruction System (VRS) (Zimmer Biomet, Warsaw, IN, USA) at a single institution. Preoperative and postoperative values for the Disabilities of the Arm, Shoulder and Hand score, Constant score, American Shoulder and Elbow Surgeons score, Simple Shoulder Test score, Single Assessment Numeric Evaluation score, and visual analog scale pain score and active range of motion were compared using the Wilcoxon signed rank test with the level of statistical significance set at P < .05. Results: Complications occurred in 4 patients (21%), including a nondisplaced greater tuberosity fracture treated conservatively in 1, intraoperative cortical perforation during humeral cement removal treated with an allograft strut in 1, and recurrent instability and hematoma formation treated with humeral component revision in 1. One patient with an early periprosthetic infection was treated with component removal and antibiotic spacer placement at an outside facility and was subsequently lost to follow-up. Eighteen patients with 1-year minimum clinical and radiographic follow-up were evaluated (mean, 18.2 months; range, 12-27 months). Significant improvements were noted in the mean Disabilities of the Arm, Shoulder and Hand score (57.4 AE 16.5 vs. 29.4 AE 19.5, P < .001), mean Constant score (24.6 AE 10.2 vs. 60.4 AE 14.5, P < .001), mean American Shoulder and Elbow Surgeons score (32 AE 18.2 vs. 79 AE 15.6, P < .001), mean Simple Shoulder Test score (4.5 AE 2.6 vs. 9.3 AE 1.8, P < .001), mean Single Assessment Numeric Evaluation score (25.4 AE 13.7 vs. 72.2 AE 17.8, P < .001), mean visual analog scale pain score (6.2 AE 2.9 vs. 0.7 AE 1.3, P < .001), mean active forward flexion (53 AE 27 vs. 124 AE 23 , P < .001), and mean active abduction (42 AE 17 to 77 AE 15 , P < .001). Mean external rotation changed from 17 AE 19 to 32 AE 24 (P ¼ .06). No radiographic evidence of component loosening, scapular notching, or hardware failure was observed at last follow-up in any patient. Conclusion:The preliminary results of rTSA using the VRS to manage severe glenoid bone deficiency are promising, but longer followup is necessary to determine the longevity of this implant.Cedars-Sinai Institutional Review Board approved this study (no. STUDY00000028).
Background Acromioclavicular (AC) separations are commonly seen shoulder injuries. Numerous surgical reconstruction techniques have been described. In this study, we present a series of patients who underwent an anatomic reconstruction using a synthetic ligament and allograft construct. Methods We performed a retrospective review of patients with type IV or V AC separations who underwent primary or revision AC reconstruction with a luggage-tag synthetic ligament and a semitendinosus allograft placed through the anatomic insertion sites of the coracoclavicular ligaments. Patient-reported outcomes, as well as complication rates, were recorded at a minimum 2-year follow-up. Results Ten patients with a mean age of 44.2 ± 14.9 years were included in the study. The mean Disabilities of the Arm, Shoulder and Hand score was 15.5 ± 15.4; mean Single Assessment Numeric Evaluation score, 81.8 ± 12.1; mean Simple Shoulder Test score, 11.4 ± 1.1; mean American Shoulder and Elbow Surgeons score, 84.6 ± 15.7; mean Constant score, 82.5 ± 11.6; and mean visual analog scale score, 2 ± 2.6. Conclusion The technique using a luggage-tag synthetic ligament along with an anatomic allograft coracoclavicular ligament reconstruction is a safe, effective alternative to other techniques described in the literature.
Medial clavicle fracture are rare injuries associated with significant morbidity. Treated conservatively historically, operative management has been recommended to improve function and union rates. Optimal surgical fixation has not been described, particularly in revision cases following failed fixation. Previously described options include sternoclavicular fusion or partial claviculectomy. We describe a case of a 33-year-old female surgeon who had two failed surgeries treated with iliac crest tricortical grafting with dual plating using an anterior plate and an inverted distal clavicle plate. Postoperatively, she was instructed to use a bone stimulator and receive teriparatide treatment. At the 9 months follow up, patients pain and function improved, and she is back to working full time. Dual plating technique supplemented with bone stimulator use and teriparatide administration appears to be a good treatment option in the short-term.
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