Approaching the Humerus, Elbow, and Proximal Forearm Using the Trimano Arm Holder.

Upper limb surgeons frequently encounter complex cases involving the proximal humerus, elbow joint, and proximal forearm, both in trauma and elective practice. Given the diverse pathology in these areas, various surgical approaches have been described, each with its advantages, limitations, and specific patient positioning requirements. We describe an operative technique that modifies the use of an existing, commercially available, dynamic pneumatic limb positioner, the TRIMANO FORTIS® (Arthrex, Maquet GmbH), for open and arthroscopic procedures of the elbow, proximal forearm, midshaft, and distal humerus. This technique offers simplicity, reproducibility, and enhanced surgical efficiency.

How to Deal With an Unreconstructable Distal Radius Fracture.

The most prevalent long bone fracture is that of the distal radius, and it affects all age groups. These fractures can present after low-energy or high-energy trauma, and their configuration often varies depending on the mechanism of injury. Their management can be operative or non-operative, and the scientific literature is abundant in studies comparing these two treatment modalities. There is also a healthy scientific debate as to the indications that should guide surgery for these injuries. A male patient sustained a high-energy fracture to his distal radius and presented to our unit soon after the injury. His fracture presented significant surgical challenges due to its complexity. It was stabilised surgically, and the patient recovered good function after rehabilitation. This case aims to demonstrate a surgical treatment protocol and the relevant surgical considerations when dealing with significant injuries, such as the one presented in this paper, where traditional fixation techniques may not yield a satisfactory outcome.

A Unique Presentation of the Glenoid, Coracoid, and Proximal Humerus Fractures.

Fractures of the proximal humerus are common injuries with a bimodal age distribution. They usually present in younger patients after high-energy trauma and in elderly patients after lower-energy trauma. Fractures of the proximal humerus are rarely associated with concomitant fractures of the glenoid, and this is a complex injury pattern that indicates the presence of significant instability. Such injuries are usually treated surgically. Even more rarely, patients may present with proximal humerus fractures and fractures of the coracoid process. A male patient presented to our emergency department (ED) after a fall off the loading platform of his heavy goods vehicle (HGV), resulting in a right shoulder injury. During his initial assessment in ED, a computerised tomography (CT) scan demonstrated the presence of a comminuted proximal humerus fracture, a comminuted anterior glenoid wall fracture, and a coracoid process displaced fracture. Surgical fixation of all three fractures was undertaken in the same sitting. This is the first case described in the literature with a combination of the above injuries and serves as a reminder that as trauma complexity and incidence continue to increase, we should maintain a high index of diagnostic suspicion when dealing with such patients. Furthermore, we present our treatment approach for this case and the rationale behind it.

Reverse shoulder arthroplasty with a cementless short metaphyseal humeral prosthesis without a stem: survivorship, early to mid-term clinical and radiological outcomes in a prospective study from an independent centre.

INTRODUCTION: The use of reverse total shoulder arthroplasty has increased for the management of cuff-deficient glenohumeral joint arthritis and fractures. With bone preservation being a major target in reverse shoulder arthroplasty, metaphyseal humeral components without a stem were developed. The aim of this study is to present the survivorship, functional and radiological outcomes of a novel short metaphyseal prosthesis without a diaphyseal stem from an independent centre. METHODS: Clinical function and radiological features of patients undergoing stemless reverse shoulder arthroplasty were prospectively recorded. Patients' demographics, indications for surgery, complications, functional and radiological assessment at the final follow-up as well as survivorship with the end point of revision for any reason were recorded. RESULTS: Between 2009 and 2016, 36 patients received 37 reverse shoulder arthroplasties with the stemless Verso prosthesis. Mean age of the patients was 76.9 years. The most common indication for surgery was cuff tear arthropathy. Mean follow-up was 3 years (range 1-7 years). Oxford shoulder score improved from an average of 11 pre-operatively (range 2-19) to 44 post-operatively (range 29-48) (p < 0.0001). There was one case of a deep post-operative infection that needed washout, liner exchange with retention of the prosthesis. Radiographic analysis showed no lucencies, or stress shielding around the humeral or glenoid components. Constant score at the final follow-up was on average 63 (range 35-86). Activities of daily living with requirement for internal and external rotation score (ADLEIR) was on average 12 pre-operatively (range 0-27) and 31 post-operatively (range 18-36) (p < 0.0001). There was 100% survivorship of the prosthesis in this early to mid-term study. CONCLUSION: This early to mid-term prospective study demonstrates excellent survivorship and radiological results of the Verso reverse shoulder replacement. It needs a simple reproducible technique, and the results have been replicated at an independent centre. This study underlines its survivorship in the early to mid-term and confirms lower incidence of complications such as instability, notching, loosening and the need for revision surgery. Most importantly, it conserves the humeral bone stock for revision arthroplasties in the future. Our results are similar to those of the currently published literature.

Excessive venous bleeding in a patient with acetabular pelvic fracture secondary to inferior vena cava filter occlusion.

Inferior vena cava (IVC) filters can be used to prevent pulmonary embolism in cases where anticoagulation is contraindicated. Filter obstruction remains one of the major complications after its insertion. This is the rare case demonstrating excessive venous bleeding during attempted open reduction internal fixation of an acetabular fracture secondary to subcomplete IVC filter thrombosis day 1 postinsertion of the device.

Pneumopericardium: a rare complication of laparoscopic varicocoele ligation.

Although symptomatic pneumopericardium post-laparoscopic varicocoele ligation procedure is rare, numerous cases have been reported and identified pneumopericardium as a complication of laparoscopic surgery. Pneumopericardium after other urological procedures has been previously reported when diagnosed incidentally on chest X-ray but there are no reports of symptomatic presentation. We hereby present the first symptomatic pneumopericardium case after a routine procedure for the ligation of varicocoele.