Helen Ingoe

Background: Complete long head of the triceps release (LHTR) during reverse shoulder arthroplasty (RSA) aims to eliminate inferior impingement and ensures tether-free range of motion (ROM). However, it remains infrequently performed due to concerns such as triceps strength deficits and instability. This study aimed to present the clinical and radiological outcomes following RSA with LHTR, focusing on the impact on triceps strength. Methods: This was a retrospective review of patients who underwent primary RSA with LHTR. The primary outcome was 2-year triceps strength compared with the preoperative strength. Secondary outcomes were the improvement of shoulder ROM, Constant Score, American Shoulder and Elbow (ASES) Score, and Visual Analog Score (VAS) at 2-year postoperative time point, and radiological outcomes including notching and heterotopic ossification (HO). Results: Eighty patients were included with mean age of 71.1 years. Two-year triceps strength was comparable to the preoperative strength (6.3 kg vs. 6.2 kg, p = .703). Active ROM, VAS, ASES, and Constant scores significantly improved at 2 years postoperatively (p < .001). Notching was present in 15% of patients while HO was present in 18.75%. There were no dislocations or neurovascular injuries. Discussion: Complete LHTR during RSA appears safe with no adverse effect on triceps strength, patient-reported outcomes, or stability.

Objectives: To compare outcomes between planned and delayed ex-fix and identify predictors for requiring external fixation for closed ankle fractures. Methods: Design: Retrospective case–control study. Setting: Single trauma centre. Patient selection criteria: Skeletally mature patients with closed ankle fractures, with or without dislocation, temporised in cast or external fixation (ex-fix) (< 24 versus > 24 h), treated with open reduction/internal fixation. Outcome Measures and Comparisons: Planned (≤ 24 h from admission) or delayed (> 24 h) patients were compared in terms of time to definitive fixation, length of stay (LOS), and complications. A control cohort of cast-only patients with identical AO/OTA fracture patterns was identified to evaluate predictors of requiring ex-fix. Initial radiographs were analysed for talar displacement, posterior malleolar fragment (PMF) size, and number of reduction attempts. Results: Seventy-one patients underwent external fixation (25 planned, 46 delayed). Planned ex-fix was associated with significantly shorter time from admission to definitive fixation (7.8 vs 11.7 days, p < 0.0001) and reduced LOS (11.2 vs 16.6 days, p = 0.0037) compared with delayed ex-fix. Complication rates did not differ significantly between groups. Compared with controls, patients requiring delayed ex-fix demonstrated greater talar displacement on AP and lateral radiographs ( p = 0.02 and p = 0.001, respectively). A PMF size ≥ 23% (OR 5.74, p = 0.0002) and two or more reduction attempts (OR 4.68, p = 0.0022) were independently associated with the need for external fixation. Conclusions: Planned external fixation in closed ankle fractures is associated with shorter hospital stay and earlier definitive fixation compared with delayed application. Significant talar displacement, larger posterior malleolar fragments, and multiple failed reduction attempts may help identify fractures that would benefit from planned external fixation. Level of evidence: Therapeutic and Diagnostic Level III

Background/Objectives: Dislocation of the acromioclavicular joint (ACJ) is a common injury for which numerous operative fixation and reconstructive techniques have been described. This technique combines a coracoclavicular ligament (CC) repair with an acromioclavicular ligament (AC) and CC reconstruction with an additional ACJ internal brace to address both horizontal and vertical instability. Methods: The surgery is performed through a superior approach in the following sequence: (1) CC ligaments are repaired using a TightRope construct, (2) CC reconstruction is performed using a peroneus longus tendon allograft, (3) AC ligaments are repaired using an internal brace, and (4) AC reconstruction is performed with a second peroneus longus tendon allograft. The results of consecutive patients with grade IIIB, IV, and V AC joint dislocations were included. Results: Six patients with acute and six patients with chronic injuries were eligible for inclusion. The Constant–Murley Score improved significantly from 27.6 (8.0–56.5) to 61.5 (42.0–92.0) (p = 0.006 paired t-test) at 12 months of follow-up. There was one complication (frozen shoulder) from which the patient recovered spontaneously; no other complications were observed with this technique. The coracoclavicular distance (CCD) was reduced from 18.7 mm (13.0–24.0) to 10.0 mm (6.0–16.0, p < 0.001) and 10.5 mm (8.0–14.0, p = 0.002) at 12 weeks and 12 months, respectively. Conclusions: This study describes a new technique to treat acute and chronic Rockwood stage IIIB–V ACJ dislocations with promising short-term clinical and radiological results. The results suggest that the combined repair and reconstruction of the AC and CC ligaments is a safe procedure with low complication risk in experienced hands. Addressing the vertical and horizontal stability in ACJ dislocation is key to achieving optimal long-term results. Further, follow-up is required to investigate the long-term outcomes.

Background: Proximal humeral bone deficiency in revision shoulder arthroplasty is an emerging and challenging problem as the use of reverse shoulder arthroplasty (RSA) increases. This paper presents a technical note discussing our detailed preoperative planning steps, surgical techniques, and their rationale in carrying out the use of an allograft prosthetic composite (APC) to address proximal humeral bone deficiency in revision RSA. The outcomes of this technique are also presented. This paper also presents a systematic review to further discuss the existing literature on RSA with APCs. Methods: The preoperative surgical planning and the surgical technique employed to execute proximal humeral reconstruction using APC during revision arthroplasty are discussed in the technical note. The preliminary clinical and radiological results of five patients who underwent revision shoulder arthroplasty with proximal humeral reconstruction using APCs are presented. The PRISMA guidelines were followed to perform the systematic review. A systematic search using PubMed, Embase, and Cochrane databases was conducted. All studies involving RSA and APCs were pooled, and the data were extracted and analyzed. Results: A total of 14 studies were eligible for inclusion in the systematic review, with a total of 255 patients and a mean follow-up of 57 months. All studies in the systematic review and the patients included in the author’s case series showed improvements in the level of pain, range of motion, function, and satisfaction. Graft incorporation in the systematic review was 84%. Conclusions: Based on the available literature and the results of our case series, the use of an APC construct is a viable option for proximal humeral bone deficiency in revision shoulder arthroplasty.