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Technique Spotlight: Arthroscopic Latarjet

Indications for Arthroscopic Latarjet Contraindications to arthroscopic Latarjet include presence of breast implants (due to the position and trajectory of the M portal) and prior coracoid harvest. The procedure is more challenging after prior open shoulder surgery due to the scar tissue but, with experience, can be performed safely in such a setting as well. Once a detailed history, clinical examination, and radiological investigations are performed,…

Technique Spotlight: Technical Aspects of the Arthroscopic Remplissage

Introduction The treatment of the significant Hill-Sachs lesion (HSL) continues to evolve. One option that has gained popularity is a transfer of the infraspinatus/posterior capsule directly into the Hill-Sachs defect. Originally described by Connolly in 1972 as an open procedure, the transferred infraspinatus and capsule may exclude the defect from the intra-articular aspect of the joint and effectively prevent engagement of the HSL with the glenoid.…

Technique Spotlight: Arthroscopic Labral Repair: Anterior and Posterior

Introduction Owing to the unique anatomy and range-of-motion (ROM) demands of the shoulder, coordination of several static and dynamic stabilizers is necessary to maintain shoulder stability. This coordination can be disrupted, most commonly secondary to acute traumatic dislocation or atraumatic laxity of the shoulder. As a result, glenohumeral instability of the shoulder is a commonly treated condition in orthopedic clinics, with reported incidence rates in the…

Anterior Glenohumeral Instability: Evaluation and Decision-Making

Introduction Anterior instability represents over 70% of glenohumeral instability with a yearly incidence approaching 3% in high-risk populations. , Males sustain 70%–80% of instability episodes with subluxations being more common than frank dislocations. , About half (47%) of all dislocations occur in individuals between 15 and 29 years of age. A fall represents the most common cause (59%) of a dislocation with half (48%) occurring during…

Scapulothoracic Dissociation

Introduction Scapulothoracic dissociation is a rare and devastating injury of the shoulder girdle. Originally described by Oreck et al. in 1984, the injury was defined as a complete separation of the acromioclavicular (AC) joint with lateral displacement of the scapula and disruption of the brachial plexus and subclavian vessels with intact skin. It is most often the result of high-energy trauma to the shoulder girdle with a…

The Superior Shoulder Suspensory Complex, Floating Shoulder Injuries, and Other Segmental Injuries to the Shoulder Girdle

Introduction Segmental injury patterns about the shoulder have earned the name “floating shoulder” and “double disruptions” of the shoulder suspensory complex because they frequently consist of two radiographically distinct skeletal and/or ligamentous injuries about the shoulder girdle. The cumulative instability from two colocalized injuries has made this injury pattern difficult to conceptualize, and its clinical significance and optimal treatment remain controversial. The goal of this chapter…

Technique Spotlight: ORIF Scapula

Introduction This chapter builds on a new perspective of operative intervention in cases of marked displacement of scapular fractures, based on surgical indications covered in the last chapter ( Table 16.1 ). These surgical indications should be assessed with measurements obtained on three-dimensional computed tomography (3D CT) scans for accurate reading, and of course applied to the patient’s context including age and comorbidities, baseline and desired…

The Scapula—Body, Glenoid and Process Fractures

Introduction Scapula fractures are receiving unprecedented attention in the orthopedic community, as illustrated by a simple PubMed search for “scapula fracture.” Search results provide only 82 publications in the 150 years from 1818 to 1967, followed by the 30-year span from 1968 until 1999, a period dubbed as the dark ages of scapula fracture care when these injuries were largely treated with benign neglect, and new…

Technique Spotlight: Anatomic Coracoclavicular Ligament Reconstruction

Indications High-grade acromioclavicular (AC) joint injuries (Rockwood types IV, V, and VI) are usually treated operatively due to considerable morbidity associated with a persistently dislocated AC joint and severe soft tissue disruption. , In some type IV–VI injuries, primary conservative treatment may be considered; however, if the patient remains chronically symptomatic, surgical intervention to improve range of motion (ROM), strength, and pain control is recommended. ,…

Technique Spotlight: Arthroscopically Assisted Stabilization for Acute and Chronic High-Grade Acromioclavicular Joint Dislocations

Indications Combined coraco- and acromioclavicular stabilization using a low-profile single TightRope (Arthrex, Naples, FL, USA) device and an additional FiberTape (Arthrex) cerclage is indicated in acute high-grade bidirectional acromioclavicular (AC) joint instabilities (Rockwood type IV–VI dislocations), and depending on the patient’s functional requirements, for select type IIIb separations. Chronic lesions, on the other hand, should initially be addressed conservatively and surgery should be reserved for patients…

The Acromioclavicular Joint: Anatomy, Injury, Pathoanatomy, and Treatment Options

The clavicle functions as an anterior strut supporting the upper limb. The distal aspect of the clavicle articulates with the acromion, thus forming the acromioclavicular (AC) joint, via a posterolaterally oriented facet. The acromion has a reciprocal facet, which is oriented anteromedially. The AC joint is a diarthrodial joint and includes a capsule, articular cartilage, and synovium ( Fig. 12.1 ). An intra-articular disc is typically…

Technique Spotlight: Arthoscopic-Assisted Reduction and Internal Fixation of Distal Clavicle Fractures

Indications Clavicle fractures account for 2.6%–4% of all adult fractures, with 10%–30% of these occurring in the distal third of the clavicle. The stability and displacement of the fracture determine whether surgery is indicated as the coracoclavicular (CC) ligaments (conoid and trapezoid) can be affected in these injuries. , Essentially, fractures of the lateral third of the clavicle in adult patients where the coracoid no longer…

Technique Spotlight: Hook Plate Fixation Technique for Displaced Distal Clavicle Fractures

Indications The most common indications for use of the hook plate are for cases of displaced distal clavicle fractures in which the coracoclavicular (CC) ligaments (trapezoid and conoid) provide insufficient connection between the coracoid and the clavicle, thus allowing the medial clavicle to elevate and the weight of the arm to displace the distal fragment(s) inferiorly ( Fig. 10.1 ). Distal clavicle fractures, as characterized by…

Distal Clavicle Fractures

Introduction Distal clavicle fractures, also known as lateral clavicle fractures, account for approximately 25% of all clavicle fractures, the second most common subset after midshaft fractures. This fracture is unique because of its high potential for nonunion, potential effects on scapulothoracic motion, and cosmetic deformity. Distal clavicle fractures have a predilection for elderly and middle-aged individuals, due to an overall decrease in bone mineral density. The…

Technique Spotlight: Intramedullary Fixation of Clavicle Fractures

Introduction Recent literature recommends consideration of surgical treatment for completely displaced and/or significantly shortened middle-third clavicle fractures. In certain fracture patterns, intramedullary clavicle fracture fixation has been shown to be an effective option for treatment while offering the potential advantages of reduced soft tissue irritation and a relative paucity of potentially bone-weakening screw holes when compared with traditional plate constructs. While plate constructs are widely used…

Technique Spotlight: ORIF Midshaft Clavicle Fracture with Plate and Screws

Indications Indications for clavicle fixation include open fractures, skin tenting or soft tissue compromise, significant displacement >2 cm, shortening >2 cm, clinical deformity, significantly associated scapular winging from malrotation, segmental fractures, “floating shoulder” injuries and those with significant comminution. Patient factors are also important considerations including patient activity status and motivation to rapidly return to sport or work or polytrauma injuries with the need for early…

Midshaft Clavicle Fractures

Introduction Clavicle fractures are among the most common bony injuries in the body, representing 2.5%–10% of all adult fractures and over 40% of shoulder girdle fractures. , Common injury mechanisms include skiing, mountain biking, American football, soccer/European football, as well as higher energy mechanisms like motor vehicle accidents. Due to the small bone diameter and limited soft tissue attachments, approximately 70%–80% of clavicle fractures occur in…

Technique Spotlight: Medial Hook Plate

Indications The authors prefer this technique for symptomatic medial clavicular nonunions type 1 or acute displaced fractures (relative indication) (type 1B) (see Chapter 4 , Fig. 4.4 ). For this fracture morphology, the hook plate provides resistance to the anterior deforming forces of the clavicular head of the pectoralis major even though the amount of bone on the medial aspect of the fracture is insufficient to…

Medial Clavicle Fractures

Relevant Anatomy The clavicle is the first long bone to ossify. However, the epiphysis at the medial end of the clavicle is the last of the long bones to appear and is the last epiphysis to close. It does not ossify until 18–20 years of age. The epiphysis does not fuse with the shaft of the clavicle until age 23–25 years. Until then, the growth plate…

Technique Spotlight: Sternal Docking Technique for Sternoclavicular Joint Instability

Indications Sternoclavicular joint dislocations occur secondary to trauma or develop spontaneously in patients with collagen disorders, such as Ehler-Danlos syndrome. They are anatomically classified as either anterior or posterior, and further classified as acute or chronic. Joint reconstruction is generally indicated for patients with acute posterior dislocations, which have failed closed reduction, and for patients with chronic instability who have failed nonoperative management. Occasionally, medial clavicle…