Hill-Sachs reconstruction and repair using a synthetic scaffold.

Dislocation of the shoulder joint is an unfortunate consequence of trauma to the shoulder girdle. It can occur in varying age groups with a complication of an impaction injury to the posterior aspect of the humeral head, termed a Hill-Sachs lesion. This can pose further problems leading to instability of the glenohumeral joint and recurrent dislocations. Varying surgical techniques have been developed to address this issue especially in young, active individuals. We describe another technique that can be used to treat Hill-Sachs lesions in patients with recurrent dislocations of the shoulder.

A modified Weaver-Dunn procedure without need for internal fixation.

The shoulder as the most mobile joint in the body has a complex anatomy providing it with an increased range of motion, at the expense of its stability. The complex of ligaments and tendons around the acromioclavicular joint (ACJ) is prone to injury especially during sporting activity or following falls onto the apex of the shoulder. The original classification of ACJ dislocations having been modified by Rockwood suggests that types III to VI injuries may benefit from surgical intervention. Many procedures have been described to correct the deformity in the ACJ and to reestablish its ligamentous support. We describe a modification to the Weaver-Dunn procedure, which aims to establish a stable reduction with bone-to-bone healing, provided by bone plug fixation with Ethibond suture.

Distal Tibial Fracture Fixation with Locking Compression Plate (LCP) Using the Minimally Invasive Percutaneous Osteosynthesis (MIPO) Technique.

BACKGROUND: Treatment of distal tibial fractures has always been a challenge. Distal tibia is more superficial, with less soft tissue coverage and blood supply. Therefore, operative treatment can lead to complications. We aim to see the results of the distal tibial fracture fixation with LCP using MIPO. PATIENTS AND METHODS: Twenty-one consecutive patients were prospectively reviewed. AO types 43A, 43B and 43C were included. Fourteen male and seven female patients with a mean age of 51 years were included. RESULTS: Mean time to union was 5.5 months (range 3-13 months). Seventeen fractures healed with good functional outcome. One patient had delayed union. One patient had nonunion and underwent revision; the fracture ultimately healed with good functional outcome. Two patients developed superficial wound infections but the fractures united completely. DISCUSSION: The MIPO technique for distal tibia has shown good results with many additional advantages over the conventional methods. Early mobilization without risk of secondary displacement helps to prevent stiffness and contracture.

Outcome of proximal humerus fractures treated by PHILOS plate internal fixation. Experience of a district general hospital.

Proximal humerus fractures have been a challenge to achieve stable fixation. PHILOS (Proximal Humerus internal locking system) is part of the latest generation of locking compression plates for proximal humeral fracture fixation. We aim to assess the clinical and functional outcome of proximal humeral fractures (2-part, 3-part and 4-part) treated with the PHILOS plate. We prospectively reviewed 50 patients who had a proximal humeral fracture treated with the PHILOS plate from September 2002 to September 2006 in our institution. Clinical outcome was measured using the patient-based Oxford shoulder and DASH scoring systems. Five patients died and four were lost to follow-up. Eleven patients had 2-part, eleven 3-part and eighteen 4-part fractures. Mean follow-up time was 21.7 months (range: 6-44 months). Radiological union was achieved within 8 weeks in 40/41 fractures; complications were noted in four cases. Better results were achieved in younger than in older patients, and in male than in female patients. The number of fracture fragments did not appear to affect the results, but associated dislocation of the humeral head was a pejorative factor. Our study has shown that the PHILOS plate is a reliable implant. A direct correlation was observed between Oxford shoulder and DASH scores.

Plate fixation of clavicle fractures: a comparative study between Reconstruction Plate and Dynamic Compression Plate.

This study aimed at comparing the results of clavicular fracture fixation with AO Reconstruction (Recon) plate and Dynamic Compression Plate (DCP). The case notes of 39 patients with 40 acute and chronic clavicular fractures were retrospectively reviewed. The indications for fixation for acute cases comprised open fractures, the presence of sufficient skin tenting to risk skin integrity, neurovascular compromise and severe lateral displacement or comminution. Cases of symptomatic atrophic non-union after at least 12 months conservative management or previous failed 1/3 tubular plate fixation were also included in the study. In total 24 fractures were fixed with Recon Plate and 16 with DCP. Mean time to union was 4.2 months for the Recon plate group and 5.4 months for the DCP group. Eight of the DCP group complained of plate prominence requiring plate removal. Recon plates should be used in preference to DCP whenever clavicular fracture fixation is indicated.

Osteonecrosis of the patella and prosthetic extrusion after total knee arthroplasty.

We report the occurrence of painless patella avascular necrosis and spontaneous prosthetic extrusion after total knee arthroplasty with lateral retinacular release, a previously unreported complication. The resultant wound was debrided and closed without complication or loss of knee function. We elected not to remove the fragments in this case because the patient remained asymptomatic, and the remaining patella almost certainly will reabsorb completely. We advise clinicians to pay careful attention to patella viability and prosthetic loosening when assessing postoperative radiographs of total knee arthroplasty, especially with lateral retinacular release.