Antonio M Foruria - Academia.edu (original) (raw)
Uploads
Papers by Antonio M Foruria
Journal of Experimental Orthopaedics, Dec 21, 2023
Fractures around the elbow are often challenging to treat and in most cases require an extensive ... more Fractures around the elbow are often challenging to treat and in most cases require an extensive approach. Since the development of elbow arthroscopy, most authors have pointed out the potential advantages of a less invasive technique that can be useful for visualization and reduction of the articular fragments with an eventual percutaneous fixation. Arthroscopic techniques provide a limited exposure that may lead to a faster wound healing, lower rate of complications and thus, better recovery of range of motion. However, elbow arthroscopy is also a demanding technique, especially in a swollen and fractured joint, and it is not exempt of risks. The overall rate of complications has been rated from 1.5% to 11% and nerve injury rates from 1.26-7.5%. The objective of this review is to present the arthroscopic setup and general surgical technique for the management of elbow trauma and to define some clear indications. Patient positioning and operating room display is key in order to obtain success. In addition to the arthroscopic equipment, fluoroscopy is almost always necessary for percutaneous fixation and precise preparation is mandatory. In the last decade, literature regarding new portals or surgical tips for arthroscopic treatment of elbow fractures have been published. The main indications for fracture arthroscopic-assisted fixation are those articular fractures involving the coronoid, distal humerus shear fractures in the coronal plane (trochlear and capitellum fractures) and, more controversially, those affecting the radial head. The treatment of these type of fractures all arthroscopically is exponentially demanding as it might also require ligament repair. For coronoid fractures, it can be useful in Morrey type II and III, and O´Driscoll anteromedial facet fractures associated to a posteromedial instability pattern that also require a repair of the LCL. Although excellent results have been published, comparative series are scarce. Radial head fractures can also be approached arthroscopically in simple non-comminute fractures that can be fixed percutaneously. In conclusion, arthroscopy of the elbow is an excellent tool to better understand and visualize articular fractures of the elbow. However, despite the advances in surgical technique, whether it improves clinical and radiological results is still to be proven.
Knee Surgery, Sports Traumatology, Arthroscopy, May 2, 2023
Orthopaedic Proceedings, Sep 1, 2009
Year Book of Hand and Upper Limb Surgery, 2011
Year Book of Hand and Upper Limb Surgery, 2010
Year Book of Hand and Upper Limb Surgery, 2010
Background.-Biological glenoid resurfacing with prosthetic humeral head replacement has been sugg... more Background.-Biological glenoid resurfacing with prosthetic humeral head replacement has been suggested as a means to avoid the potential complications of polyethylene use in younger patients with glenohumeral arthritis. The purposes of this report were (1) to describe a technique that was developed to facilitate biological resurfacing of the glenoid with use of meniscal allograft tissue and (2) to report the effectiveness of hemiarthroplasty in conjunction with meniscal allograft glenoid resurfacing. Methods.-Thirty patients (thirty shoulders) with glenohumeral arthritis were treated with hemiarthroplasty and lateral meniscal allograft resurfacing of the glenoid. Clinical assessments were performed at regular intervals with use of visual analog scales for pain, shoulder comfort, and function and with use of patient self-assessments including the American Shoulder and Elbow Surgeons score and the Simple Shoulder Test. A detailed radiographic analysis was performed to evaluate glenohumeral subluxation, glenoid bone loss, and the glenohumeral joint space. Results.-Twenty-seven patients (twenty-seven shoulders) were followed for a minimum of two years. The mean duration of follow-up was three years. For the Simple Shoulder Test and the visual analog scale measures for level of pain, pain at rest, and pain with strenuous activity, the results at the final follow-up evaluation were significantly better than the preoperative results. Similarly, all ten functions of the American Shoulder and Elbow Surgeons questionnaire were significantly improved at the time of the latest follow-up. Over the time frame of the study, there was radiographic evidence of glenohumeral joint-space narrowing. Conclusions.-Lateral meniscal allograft resurfacing of the glenoid can protect the glenoid from erosion, can minimize glenohumeral subluxation, and is associated with significant pain relief and improved function for two to five years when used in conjunction with hemiarthroplasty in younger patients with glenohumeral arthritis. However, the progressive decrease in glenohumeral joint space noted radiographically raises concern for
Year Book of Hand and Upper Limb Surgery, 2012
To assess the effect of platelet-rich plasma fibrin matrix (PRPFM) construct augmentation on post... more To assess the effect of platelet-rich plasma fibrin matrix (PRPFM) construct augmentation on postoperative tendon healing as determined by magnetic resonance imaging (MRI) and clinical outcome of arthroscopic rotator cuff repair. Methods: A comparative series of patients undergoing arthroscopic rotator cuff repair was studied. Two matched groups of patients (20 each) were included: rotator cuff repairs without PRPFM augmentation (group 1) and rotator cuff repairs augmented with 2 sutured platelet-rich plasma (PRP) constructs (group 2). A single-row cuff repair to the normal footprint without tension or marrow vents was performed by a single surgeon. Postoperative rehabilitation was held constant. Postoperative MRI scans were used to evaluate rotator cuff healing. Outcome measures included American Shoulder and Elbow Surgeons, Rowe, Single Assessment Numeric Evaluation, Simple Shoulder Test, and Constant scores. Results: We followed up 40 patients (2 matched groups with 20 patients each) with a mean age of 57 years (range, 44 to 69 years) for a mean of 31 months (range, 24 to 44 months). Postoperative MRI studies showed persistent full-thickness tendon defects in 60% of controls (12 of 20) and 30% of PRPFM-augmented repairs (6 of 20) (P ϭ .03). Of the control group tears measuring less than 3 cm in anteroposterior length, 50% (7 of 14) healed fully, whereas 86% of the PRPFM group tears measuring less than 3 cm in anteroposterior length (12 of 14) healed fully (P Ͻ .05). There was no significant difference between groups 1 and 2 in terms of American Shoulder and Elbow Surgeons (94.7 and 95.7, respectively; P ϭ .35), Single Assessment Numeric Evaluation (93.7 and 94.5, respectively; P ϭ .37), Simple Shoulder Test (11.4 and 11.3, respectively; P ϭ .41), and Constant (84.7 and 88.1, respectively; P ϭ .19) scores. The Rowe scores (84.8 and 94.9, respectively; P ϭ .03) were statistically different. Conclusions: The addition of 2 PRPFM constructs sutured into a primary rotator cuff tendon repair resulted in lower retear rates identified on MRI than repairs without the constructs. Other than the Rowe scores, there was no postoperative clinical difference by use of standard outcome measures. Level of Evidence: Level III, case-control study.
Current Reviews in Musculoskeletal Medicine
Revista Española de Cirugía Ortopédica y Traumatología, Mar 1, 2023
Journal of Shoulder and Elbow Surgery, May 1, 2023
EFORT Open Reviews
Latarjet modifies the anatomy of the shoulder, and subsequent revision surgery is challenging. It... more Latarjet modifies the anatomy of the shoulder, and subsequent revision surgery is challenging. It is mandatory to determine the cause of recurrence in order to select the best treatment option. A CT scan is needed to measure glenoid track and evaluate coracoid graft status: position, degree of consolidation, and osteolysis. Conservative management can be advocated in selected patients in whom the instability level does not interfere with the activities they wish to perform. Surgical treatment is based on the glenoid track measurement and coracoid graft suitability. The coracoid graft is considered suitable if it preserves the conjoint tendon insertion, does not show osteolysis, and is large enough to reconstruct the glenoid surface. Adding a remplissage is recommended for those cases with a coracoid graft insufficient to convert large off-track Hill–Sachs lesions into on-track. If the coracoid graft is suitable to reconstruct bone defects in terms of size and viability but is poorly...
Journal of Shoulder and Elbow Surgery
Revista Española de Cirugía Ortopédica y Traumatología
Background: Total Elbow Arthroplasty is becoming an increasingly popular and challenging reconstr... more Background: Total Elbow Arthroplasty is becoming an increasingly popular and challenging reconstructive procedure due to improvements in surgical technique, implant design and good to excellent clinical outcomes reported. To our best knowledge, complication such as a brachial artery pseudoaneurysm after primary or revision surgery of total elbow arthroplasty hasn´t been described in the literature so far. Case presentation: We present a case of a 81-year-old female patient who underwent elbow hemiarthroplasty in 2014 at our institution after suffering a comminuted intra-articular distal humerus fracture. In 2019 she presented at our emergency department after a fall from standing height. On the X-ray a periprosthetic fracture of the humerus was observed. The patient underwent a total elbow revision arthroplasty with bone stock augmentation. After 24 hour of an uncomplicated evolution she complained of a significant pain and progressive swelling on her right upper limb with persistin...
Morrey's the Elbow and its Disorders
Journal of Experimental Orthopaedics, Dec 21, 2023
Fractures around the elbow are often challenging to treat and in most cases require an extensive ... more Fractures around the elbow are often challenging to treat and in most cases require an extensive approach. Since the development of elbow arthroscopy, most authors have pointed out the potential advantages of a less invasive technique that can be useful for visualization and reduction of the articular fragments with an eventual percutaneous fixation. Arthroscopic techniques provide a limited exposure that may lead to a faster wound healing, lower rate of complications and thus, better recovery of range of motion. However, elbow arthroscopy is also a demanding technique, especially in a swollen and fractured joint, and it is not exempt of risks. The overall rate of complications has been rated from 1.5% to 11% and nerve injury rates from 1.26-7.5%. The objective of this review is to present the arthroscopic setup and general surgical technique for the management of elbow trauma and to define some clear indications. Patient positioning and operating room display is key in order to obtain success. In addition to the arthroscopic equipment, fluoroscopy is almost always necessary for percutaneous fixation and precise preparation is mandatory. In the last decade, literature regarding new portals or surgical tips for arthroscopic treatment of elbow fractures have been published. The main indications for fracture arthroscopic-assisted fixation are those articular fractures involving the coronoid, distal humerus shear fractures in the coronal plane (trochlear and capitellum fractures) and, more controversially, those affecting the radial head. The treatment of these type of fractures all arthroscopically is exponentially demanding as it might also require ligament repair. For coronoid fractures, it can be useful in Morrey type II and III, and O´Driscoll anteromedial facet fractures associated to a posteromedial instability pattern that also require a repair of the LCL. Although excellent results have been published, comparative series are scarce. Radial head fractures can also be approached arthroscopically in simple non-comminute fractures that can be fixed percutaneously. In conclusion, arthroscopy of the elbow is an excellent tool to better understand and visualize articular fractures of the elbow. However, despite the advances in surgical technique, whether it improves clinical and radiological results is still to be proven.
Knee Surgery, Sports Traumatology, Arthroscopy, May 2, 2023
Orthopaedic Proceedings, Sep 1, 2009
Year Book of Hand and Upper Limb Surgery, 2011
Year Book of Hand and Upper Limb Surgery, 2010
Year Book of Hand and Upper Limb Surgery, 2010
Background.-Biological glenoid resurfacing with prosthetic humeral head replacement has been sugg... more Background.-Biological glenoid resurfacing with prosthetic humeral head replacement has been suggested as a means to avoid the potential complications of polyethylene use in younger patients with glenohumeral arthritis. The purposes of this report were (1) to describe a technique that was developed to facilitate biological resurfacing of the glenoid with use of meniscal allograft tissue and (2) to report the effectiveness of hemiarthroplasty in conjunction with meniscal allograft glenoid resurfacing. Methods.-Thirty patients (thirty shoulders) with glenohumeral arthritis were treated with hemiarthroplasty and lateral meniscal allograft resurfacing of the glenoid. Clinical assessments were performed at regular intervals with use of visual analog scales for pain, shoulder comfort, and function and with use of patient self-assessments including the American Shoulder and Elbow Surgeons score and the Simple Shoulder Test. A detailed radiographic analysis was performed to evaluate glenohumeral subluxation, glenoid bone loss, and the glenohumeral joint space. Results.-Twenty-seven patients (twenty-seven shoulders) were followed for a minimum of two years. The mean duration of follow-up was three years. For the Simple Shoulder Test and the visual analog scale measures for level of pain, pain at rest, and pain with strenuous activity, the results at the final follow-up evaluation were significantly better than the preoperative results. Similarly, all ten functions of the American Shoulder and Elbow Surgeons questionnaire were significantly improved at the time of the latest follow-up. Over the time frame of the study, there was radiographic evidence of glenohumeral joint-space narrowing. Conclusions.-Lateral meniscal allograft resurfacing of the glenoid can protect the glenoid from erosion, can minimize glenohumeral subluxation, and is associated with significant pain relief and improved function for two to five years when used in conjunction with hemiarthroplasty in younger patients with glenohumeral arthritis. However, the progressive decrease in glenohumeral joint space noted radiographically raises concern for
Year Book of Hand and Upper Limb Surgery, 2012
To assess the effect of platelet-rich plasma fibrin matrix (PRPFM) construct augmentation on post... more To assess the effect of platelet-rich plasma fibrin matrix (PRPFM) construct augmentation on postoperative tendon healing as determined by magnetic resonance imaging (MRI) and clinical outcome of arthroscopic rotator cuff repair. Methods: A comparative series of patients undergoing arthroscopic rotator cuff repair was studied. Two matched groups of patients (20 each) were included: rotator cuff repairs without PRPFM augmentation (group 1) and rotator cuff repairs augmented with 2 sutured platelet-rich plasma (PRP) constructs (group 2). A single-row cuff repair to the normal footprint without tension or marrow vents was performed by a single surgeon. Postoperative rehabilitation was held constant. Postoperative MRI scans were used to evaluate rotator cuff healing. Outcome measures included American Shoulder and Elbow Surgeons, Rowe, Single Assessment Numeric Evaluation, Simple Shoulder Test, and Constant scores. Results: We followed up 40 patients (2 matched groups with 20 patients each) with a mean age of 57 years (range, 44 to 69 years) for a mean of 31 months (range, 24 to 44 months). Postoperative MRI studies showed persistent full-thickness tendon defects in 60% of controls (12 of 20) and 30% of PRPFM-augmented repairs (6 of 20) (P ϭ .03). Of the control group tears measuring less than 3 cm in anteroposterior length, 50% (7 of 14) healed fully, whereas 86% of the PRPFM group tears measuring less than 3 cm in anteroposterior length (12 of 14) healed fully (P Ͻ .05). There was no significant difference between groups 1 and 2 in terms of American Shoulder and Elbow Surgeons (94.7 and 95.7, respectively; P ϭ .35), Single Assessment Numeric Evaluation (93.7 and 94.5, respectively; P ϭ .37), Simple Shoulder Test (11.4 and 11.3, respectively; P ϭ .41), and Constant (84.7 and 88.1, respectively; P ϭ .19) scores. The Rowe scores (84.8 and 94.9, respectively; P ϭ .03) were statistically different. Conclusions: The addition of 2 PRPFM constructs sutured into a primary rotator cuff tendon repair resulted in lower retear rates identified on MRI than repairs without the constructs. Other than the Rowe scores, there was no postoperative clinical difference by use of standard outcome measures. Level of Evidence: Level III, case-control study.
Current Reviews in Musculoskeletal Medicine
Revista Española de Cirugía Ortopédica y Traumatología, Mar 1, 2023
Journal of Shoulder and Elbow Surgery, May 1, 2023
EFORT Open Reviews
Latarjet modifies the anatomy of the shoulder, and subsequent revision surgery is challenging. It... more Latarjet modifies the anatomy of the shoulder, and subsequent revision surgery is challenging. It is mandatory to determine the cause of recurrence in order to select the best treatment option. A CT scan is needed to measure glenoid track and evaluate coracoid graft status: position, degree of consolidation, and osteolysis. Conservative management can be advocated in selected patients in whom the instability level does not interfere with the activities they wish to perform. Surgical treatment is based on the glenoid track measurement and coracoid graft suitability. The coracoid graft is considered suitable if it preserves the conjoint tendon insertion, does not show osteolysis, and is large enough to reconstruct the glenoid surface. Adding a remplissage is recommended for those cases with a coracoid graft insufficient to convert large off-track Hill–Sachs lesions into on-track. If the coracoid graft is suitable to reconstruct bone defects in terms of size and viability but is poorly...
Journal of Shoulder and Elbow Surgery
Revista Española de Cirugía Ortopédica y Traumatología
Background: Total Elbow Arthroplasty is becoming an increasingly popular and challenging reconstr... more Background: Total Elbow Arthroplasty is becoming an increasingly popular and challenging reconstructive procedure due to improvements in surgical technique, implant design and good to excellent clinical outcomes reported. To our best knowledge, complication such as a brachial artery pseudoaneurysm after primary or revision surgery of total elbow arthroplasty hasn´t been described in the literature so far. Case presentation: We present a case of a 81-year-old female patient who underwent elbow hemiarthroplasty in 2014 at our institution after suffering a comminuted intra-articular distal humerus fracture. In 2019 she presented at our emergency department after a fall from standing height. On the X-ray a periprosthetic fracture of the humerus was observed. The patient underwent a total elbow revision arthroplasty with bone stock augmentation. After 24 hour of an uncomplicated evolution she complained of a significant pain and progressive swelling on her right upper limb with persistin...
Morrey's the Elbow and its Disorders