Podcast
Questions and Answers
How much variable angulation of screw placement is provided by the locking bushings in the proximal humeral fracture suture plate?
How much variable angulation of screw placement is provided by the locking bushings in the proximal humeral fracture suture plate?
60
When cementing the univers shoulder fracture system stem, which statement is correct?
When cementing the univers shoulder fracture system stem, which statement is correct?
- After reaming, the stem is up-sized by 1 before implantation.
- The reaming, the stem is down-sized by 1 before implantation. (correct)
- The univers shoulder fracture system stem is not indicated for cemented implantation.
- The humerus is reamed line to line with the size of the stem to be implanted.
What is the correct recommendation for arm position in abduction for SCR to obtain appropriate tensioning of the graft?
What is the correct recommendation for arm position in abduction for SCR to obtain appropriate tensioning of the graft?
20-30 deg
What is the thickness of the recommended AFLEX dermal allograft for the SCR technique?
What is the thickness of the recommended AFLEX dermal allograft for the SCR technique?
Prior to uploading to VIP, CT scans must be compressed.
Prior to uploading to VIP, CT scans must be compressed.
Why would a CA humeral head be indicated instead of RTSA?
Why would a CA humeral head be indicated instead of RTSA?
All of the following are mandatory information for the new VIP case except:
All of the following are mandatory information for the new VIP case except:
Which of the legs of the VIP targeted overhang the glenoid surface?
Which of the legs of the VIP targeted overhang the glenoid surface?
How many cage screw lengths are available in the Eclipse system?
How many cage screw lengths are available in the Eclipse system?
Preparation of the humeral canal for the univers shoulder fracture system stem includes?
Preparation of the humeral canal for the univers shoulder fracture system stem includes?
What is the turnaround time to receive the glenoid targeted coordinates after approval for the VIP plan?
What is the turnaround time to receive the glenoid targeted coordinates after approval for the VIP plan?
The adjustable height of the Arthrex univers FX system stem is best described as providing?
The adjustable height of the Arthrex univers FX system stem is best described as providing?
Wolff's law regarding bone states?
Wolff's law regarding bone states?
Which patient would NOT be a good candidate for percutaneous pinning of a proximal humeral fracture?
Which patient would NOT be a good candidate for percutaneous pinning of a proximal humeral fracture?
Humeral articular cartilage makes up how much of the humeral head sphere?
Humeral articular cartilage makes up how much of the humeral head sphere?
Is there a constant ratio between the humeral head diameter of the sphere and the height of the articular cartilage?
Is there a constant ratio between the humeral head diameter of the sphere and the height of the articular cartilage?
Where is the approximate line of humeral head osteotomy?
Where is the approximate line of humeral head osteotomy?
How many degrees of retroversion occur anatomically and where?
How many degrees of retroversion occur anatomically and where?
What are the 4 main glenoid morphological considerations?
What are the 4 main glenoid morphological considerations?
What can cause changes to the 4 main morphological considerations?
What can cause changes to the 4 main morphological considerations?
What does the Walch Classification describe?
What does the Walch Classification describe?
What does Walch Classification A represent?
What does Walch Classification A represent?
What does Walch Classification A1 indicate?
What does Walch Classification A1 indicate?
What does Walch Classification A2 indicate?
What does Walch Classification A2 indicate?
What does Walch Classification B represent?
What does Walch Classification B represent?
What does Walch Classification B1 indicate?
What does Walch Classification B1 indicate?
What does Walch Classification B2 indicate?
What does Walch Classification B2 indicate?
What does Walch Classification C signify?
What does Walch Classification C signify?
What is the most common glenoid wear pattern in shoulder osteoarthritis (OA)?
What is the most common glenoid wear pattern in shoulder osteoarthritis (OA)?
What are the hallmarks of osteoarthritis (OA) visible on X-rays?
What are the hallmarks of osteoarthritis (OA) visible on X-rays?
What is the most common type of shoulder arthritis?
What is the most common type of shoulder arthritis?
What is the most common surgical approach for total shoulder arthroplasty (TSA) or reverse TSA (RTSA)?
What is the most common surgical approach for total shoulder arthroplasty (TSA) or reverse TSA (RTSA)?
What are the hallmarks of rotator cuff arthropathy?
What are the hallmarks of rotator cuff arthropathy?
When the humeral head was not positioned anatomically, the glenoid was 6.6 times more likely to require removal.
When the humeral head was not positioned anatomically, the glenoid was 6.6 times more likely to require removal.
Glenoid implant failure is dependent on the position of the humeral component and can change survival from 13 years when positioned anatomically to 8 years when positioned otherwise.
Glenoid implant failure is dependent on the position of the humeral component and can change survival from 13 years when positioned anatomically to 8 years when positioned otherwise.
What is retroversion?
What is retroversion?
What is anteversion?
What is anteversion?
Inclination is also called what?
Inclination is also called what?
What is the inclination range?
What is the inclination range?
What is the inclination sweet spot?
What is the inclination sweet spot?
What is the anatomic average inclination?
What is the anatomic average inclination?
Superior Escape is the result of what dysfunctional muscle/tendon?
Superior Escape is the result of what dysfunctional muscle/tendon?
Anterior Escape is the result of what dysfunctional muscle/tendon?
Anterior Escape is the result of what dysfunctional muscle/tendon?
What causes posterior escape?
What causes posterior escape?
What is humeral head escape?
What is humeral head escape?
What is version?
What is version?
Where is the center of rotation (COR) for the humeral head?
Where is the center of rotation (COR) for the humeral head?
What kind of location does the humeral head COR have?
What kind of location does the humeral head COR have?
Arthrex Univers II gelons have a ____ offset because of ____?
Arthrex Univers II gelons have a ____ offset because of ____?
What is Glenohumeral Mismatch?
What is Glenohumeral Mismatch?
What is the Varus (Latin for crooked) implant?
What is the Varus (Latin for crooked) implant?
What are the main points of the Univers II & Apex system regarding 3-dimensional anatomic adaptability in the humeral canal?
What are the main points of the Univers II & Apex system regarding 3-dimensional anatomic adaptability in the humeral canal?
What is the material used for glenoid poly?
What is the material used for glenoid poly?
What are the 3 options for TSA glenoid poly?
What are the 3 options for TSA glenoid poly?
What are the characteristics of keeled TSA glenoid poly?
What are the characteristics of keeled TSA glenoid poly?
What is the size, thickness and keel length of keeled TSA glenoid poly?
What is the size, thickness and keel length of keeled TSA glenoid poly?
What material is pegged TSA glenoid poly made of?
What material is pegged TSA glenoid poly made of?
What are the benefits of Vaultlock glenoid poly?
What are the benefits of Vaultlock glenoid poly?
What is the significance of the radius of curvatures in Vaultlock glenoid poly?
What is the significance of the radius of curvatures in Vaultlock glenoid poly?
What is the glenoid vault's role in TSA?
What is the glenoid vault's role in TSA?
What is the average length of a TSA stem measured by?
What is the average length of a TSA stem measured by?
What is the common issue with TSA?
What is the common issue with TSA?
What is the goal of a stem in TSA?
What is the goal of a stem in TSA?
What are the sizes of Univers apex stems?
What are the sizes of Univers apex stems?
How is the length of a stem defined?
How is the length of a stem defined?
What group of prior surgeries is the most common cause of capsulorraphy arthropathy?
What group of prior surgeries is the most common cause of capsulorraphy arthropathy?
What is the average humeral retroversion that is reproduced during shoulder arthropathy?
What is the average humeral retroversion that is reproduced during shoulder arthropathy?
What are the 3 hallmarks of OA seen on X-ray?
What are the 3 hallmarks of OA seen on X-ray?
What vascular structure is found at the deltopectoral interval?
What vascular structure is found at the deltopectoral interval?
What nerve innervates the deltoid muscle?
What nerve innervates the deltoid muscle?
Which muscle/tendon can be incised 1-1.5cm to help expose during shoulder arthroscopy?
Which muscle/tendon can be incised 1-1.5cm to help expose during shoulder arthroscopy?
What is the offset of the heads in the Univers II total shoulder?
What is the offset of the heads in the Univers II total shoulder?
Which of the following is a key feature of the Univers II and Apex TSA systems?
Which of the following is a key feature of the Univers II and Apex TSA systems?
All of the following are hallmarks of RTC arthropathy, except:
All of the following are hallmarks of RTC arthropathy, except:
What is the neck-shaft angle range for Univers II and Apex?
What is the neck-shaft angle range for Univers II and Apex?
What is the goal of the screw in TSA?
What is the goal of the screw in TSA?
All of the following are requirements for SCR except:
All of the following are requirements for SCR except:
Study Notes
Humeral and Glenoid Anatomy
- Humeral articular cartilage constitutes 1/3 of the humeral head sphere.
- There is a constant ratio between the humeral head diameter and the height of the articular cartilage.
- The anatomic neck is the approximate line for humeral head osteotomy.
- Humeral retroversion occurs at approximately 30 degrees, divided into 10 degrees at the elbow and 20 degrees at the humeral head.
Glenoid Morphology
- Key morphological considerations of the glenoid include depth, version, inclination, and anatomical position relative to the scapula.
- Arthritis can alter these four morphological features.
- Walch Classification categorizes glenoid arthritic changes.
Walch Classification Overview
- Classification A indicates humeral heads centered in the glenoid.
- A1 denotes no glenoid erosion with humeral head centered.
- A2 involves a centered humeral head with significant glenoid erosion.
- Classification B shows posterior subluxation of the humeral head.
- B1 indicates narrowing of the glenohumeral joint due to posterior subluxation.
- B2 features posterior glenoid erosion with retroversion leading to paleo-glenoid and neo-glenoid.
- Classification C involves over 25 degrees of retroversion and dysplastic glenoid.
Osteoarthritis (OA) Insights
- The most common wear pattern in shoulder OA is posterior wear/retroversion.
- Hallmarks of OA visible on X-rays include osteophytes, subchondral cysts, and joint space narrowing.
Surgical Approaches and Techniques
- The deltopectoral approach is the most common for total shoulder arthroplasty (TSA) and reverse TSA (RTSA).
- Rotator cuff arthropathy features severe muscle atrophy, humeral head elevation, intact nerve conduction, and decreased acromio-humeral distance.
Glenoid Polyethylene and Fixation
- Glenoid poly material is UHMWPE with options for pegged, keeled, and vault lock designs for fixation.
- Vault lock glenoid design promotes immediate fixation and reduces OR time while enhancing long-term survivorship through bony interdigitation.
Implant Design and Features
- Univers II and Apex systems allow inclination variability of 125-140 degrees and retroversion variability of ±10 degrees.
- Distal dip diameter is critical when selecting TSA stem sizes.
- Apex stems are designed for less post-operative pain and faster recovery by using shorter stems and similar geometry to standard models.
Specific Functional Elements
- Stability for glenoid poly is achieved through subchondral bone interactions, essential in TSA.
- Screw angulation in proximal humeral fracture suture plates allows up to 60 degrees of variability.
Clinical Guidelines and Indications
- Requirements for superior capsular reconstruction (SCR) include large irreparable rotator cuff tears and a functional deltoid muscle.
- CA heads are indicated for deltoid insufficiency instead of RTSA, highlighting the importance of muscle integrity in surgical planning.
Storage and Preparation
- AFLEX dermal allografts must be used promptly after being kept frozen, providing a thickness of 3.0 mm for specific techniques.
Radiographic Evaluation
- CT scans must be compressed before uploading to the VIP system, ensuring efficient data handling in surgical planning.### Humeral Canal Preparation
- Preparation involves reaming to the appropriate size and implantation of the stem for the univers shoulder fracture system.
Glenoid Targeted Coordinates
- Turnaround time for receiving glenoid targeted coordinates after VIP plan approval is 48 hours.
Adjustable Height in Arthrex Univers FX System
- The adjustable height feature of the Arthrex univers FX system stem allows for a height adjustment of +/- 7.5mm.
Wolff's Law
- Wolff's Law indicates that changes in stress on a bone result in adaptations, suggesting bones remodel in response to the forces exerted on them.
Candidate Selection for Percutaneous Pinning
- A patient with a high likelihood for avascular necrosis (AVN) is not a good candidate for percutaneous pinning of a proximal humeral fracture.
Studying That Suits You
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Description
Test your knowledge on key concepts related to the humeral head in Total Shoulder Arthroplasty (TSA) with these flashcards. Each card presents vital information on cartilage structure, ratios, and osteotomy lines that are essential for understanding shoulder anatomy and surgical procedures.
