Joseph W. Galvin

Purpose: Operative management of proximal humerus fractures with glenohumeral dislocation is often delayed until a shoulder specialist is available. This study aims to assess whether time from presentation to operative intervention impacts incidence of neurologic injury in the preoperative waiting period. Methods: Retrospective review was performed for patients undergoing operative management of a proximal humerus fracture dislocation at a level 1 trauma center. Patient charts were reviewed for patient factors, injury characteristics, neurologic status, and postoperative complications. Statistical analysis comparing patients undergoing operative intervention ≤ 5 and > 5 days from injury was performed (α ≤ 0.05). Results: Of 52 proximal humerus fracture dislocations, 14% had a neurologic deficit at presentation, and 1.9% had a change in neurologic status prior to operative intervention. 32 injuries (61.5%) underwent operative intervention ≤ 5 days from presentation and 20 (38.5%) > 5 days. There was no difference in neurologic deficit at time of presentation (18.8% vs. 10.0%, p =.077), incidence of preoperative neurologic exam change (0% vs. 5.0%, p =.38), or residual neurologic deficit at final follow-up (9.4% vs. 5.0%, p = 1.0) for the ≤ 5 or > 5 day cohorts, respectively. Conclusion: Through this exploratory retrospective study, no differences were identified for rates of neurologic injury development in the preoperative waiting period between patients undergoing operative intervention ≤ 5 days or > 5 days from presentation for proximal humerus fractures with glenohumeral dislocation, however, this is limited by only 1 patient experiencing a preoperative neurologic change in the > 5 days group. Given the rarity of neurologic injury in the preoperative waiting period and low power of this study, future larger prospective studies are needed to better define the impact of waiting for operative intervention for these injuries. Level of Evidence: Level IV Case Series.

Acromion fractures are challenging injuries to manage. Nonoperative treatment for nondisplaced fractures can yield satisfactory outcomes for most patients. Displaced acromion fractures can be difficult to manage given the vector of displacement and limited bone for fixation. There is no consensus on surgical approach to these fractures as they are rare. Acromion fractures in native shoulders are rarer as most acromion fractures are secondary to altered mechanics and decreased bone mineral density following reverse shoulder arthroplasty. The acromion is a thin and flat bone making plate and screw fixation challenging. This technical note describes a technique for open reduction and internal fixation of a lateral acromion fracture in a native shoulder utilizing Nice knot suture cerclage.

» There is a poor understanding of the significance of biomarkers in the blood, synovial fluid, and tissue in patients with shoulder instability and posttraumatic osteoarthritis (PTOA). » Identification of biomarkers associated with injury severity in shoulder instability may provide prognostic information to help guide surgical treatment algorithms. » Current evidence suggests that the biomarkers of periostin, tumor necrosis factor-alpha, IL1B, and cartilage oligomeric matrix protein are associated with injury severity in patients with recurrent anterior shoulder instability. » There is limited information on genetic, transcriptomic, and protein biomarkers which may indicate individuals who are at more risk for development of shoulder instability. » An improved understanding of the local biomolecular tissue response to first-time and recurrent anterior shoulder instability may contribute to the development of novel therapeutic strategies for gene and protein targets to halt the early cascade of PTOA.