By Gerald R. Williams Jr. MD, Ken Yamaguchi MD, Matthew L. Ramsey MD, Leesa M. Galatz MD

Written by means of the world's greatest shoulder and elbow surgeons, this quantity is the main complete, present reference on shoulder and elbow arthroplasty. The ebook offers state of the art info on implant layout and distinctive guidelines—including remedy algorithms—on particular arthroplasty approaches for arthritis, fractures, persistent dislocations, and different problems. greater than four hundred illustrations supplement the text.

Each major section—shoulder arthroplasty and elbow arthroplasty—has 3 subsections: implant issues, technical issues, and disease-specific concerns. Disease-specific chapters conceal surgical anatomy, pathophysiology, preoperative assessment, symptoms for surgical procedure, implant offerings, surgical recommendations, and postoperative rehabilitation. additionally incorporated are chapters on issues, revision arthroplasty, arthroplasty with bone loss and limb salvage, and choices to substitute arthroplasty. each bankruptcy features a "Chapter-at-a-Glance" precis for simple assessment of the bankruptcy content.

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Extra info for Shoulder and Elbow Arthroplasty

Example text

The humerus is reamed progressively using cylindrical reamers of increasing diameter that should be advanced up to the last ridge. qxd 11/19/04 12:22 PM Page 32 A B Figure 3-5 Theoretic errors possible while performing head osteotomy: cutting too much or too less superolaterally (A) or inferomedially (B). B A B Figure 3-6 Preparing the medullary canal. A: Locating the “hinge point”: the highest point of the cut (12 o’clock), posterior to the groove. B: Broaching the medullary canal with the cylindrical broaches of increasing diameter.

In an experimental set up comparing prosthetic reconstructions of varying radial mismatch under active conditions, a mismatch of 4 mm was found to produce translations (1 to 2 mm) that most closely reproduced those observed with the original anatomy (14). A highly conforming joint therefore may introduce problems for the glenoid. Rather than distribute the forces evenly across the polyethylene, physiologic translations may result in eccentric loading of the glenoid, challenging its fixation. Experimentally, tensile strain patterns on the keel are greater with increasing joint conformity (29).

Experimentally, tensile strain patterns on the keel are greater with increasing joint conformity (29). For large amounts of radial mismatch, however, one would expect increased point loading of the glenoid (precisely because the forces are distributed over a smaller area) and perhaps increased polyethylene wear from more frequent glenohumeral translations. A 2002 clinical report, however, found better radiographic durability (less radiolucent lines around the glenoid) for glenohumeral joints with greater than 6 mm radial mismatch, as compared to those with less (30).

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