The treatment of recurrent anterior shoulder dislocation by the modified Bristow-Helfet procedure.

South African orthopaedic surgeons have been in the forefront of the development of reconstructive procedures performed for recurrent anterior shoulder dislocation. In addition to the Johannesburg stapling operation described by G. T. du Toit and D. Roux, Professor A. Helfet of Cape Town was the first to describe the coracoid transplantation operation in 1958. A modified form of this operation was performed on 31 patients between August 1975 and February 1981. Patients were followed up for a mean period of 38 months, and no recurrences were encountered in patients who had had true involuntary recurrent subluxation or dislocation. The operative technique is described in detail as it is considered that adequate exposure and accurate placement of the coracoid process are very important factors in obtaining a satisfactory result and in the prevention of complications. It has been postulated that this operation, which does not attempt to shorten the capsular structures or subscapularis tendon, affords a superior result in respect of patients who participate in throwing sports. It has been noted that patients who play cricket, baseball and basketball have encountered problems in regaining their ability to throw overhand after having had operations such as the Putti-Platt procedure, which entails intentional shortening of the capsular structures and subscapularis tendon.

Avulsion of the insertion of the pectoralis major muscle. A case report.

Avulsion of the insertion of the pectoralis major muscle is a rare injury but should always be considered when asymmetry of the anterior axillary fold is noted after injury to the shoulder region. This case report describes the clinical findings, findings at operation, operative treatment and anatomical considerations.

Treatment of solitary bone cysts by diaphysectomy and bone grafting.

Total diaphysectomy and grafting for solitary bone cysts would appear to produce considerably less recurrence than is found after simple curettage of the lesion and grafting. Three patients with solitary bone cysts, one a primary lesion of the upper humerus and two recurrent lesions involving the intertrochanteric regions, were successfully treated by radical excision of the cyst-bearing region and bone grafting. The operative technique is described as well as the measures taken to prevent discrepancy in limb length or angular deformity ensuing in lesions involving weight-bearing bones such as the femur.