Omid Jamei-Martel

Background: Traumatic posterior shoulder dislocation is rare, and the role of posterior acromial morphology in acute traumatic posterior dislocation is unknown. We compared posterior acromial morphology in first-time traumatic posterior versus first-time traumatic anterior dislocations. Methods: In this retrospective comparative cohort study, 34 consecutive patients with a first-time acute traumatic posterior shoulder dislocation were compared with 34 consecutive patients with a first-time acute traumatic anterior shoulder dislocation. The posterior dislocation cohort included 26 males and 8 females, with a mean age of 43.4 ± 16.5 years, and the anterior dislocation cohort included 29 males and 5 females, with a mean age of 41.3 ± 15.4 years. Posterior acromial tilt (PAT), posterior acromial coverage (PAC), posterior acromial height (PAH), and the critical shoulder angle (CSA) were measured on standardized radiographs. Comparisons between the groups were performed, and logistic regression analyses were used to assess associations between acromial morphology parameters and posterior dislocation. Interobserver and intraobserver reliability were assessed using intraclass correlation coefficients. Results: Compared with the anterior dislocation group, patients with posterior dislocation demonstrated a significantly higher PAT (65.8° ± 6.7° versus 58.9° ± 8.4°, p < 0.001), lower PAC (55.6° ± 6.6° versus 59.5° ± 8.4°, p = 0.038), greater PAH (27.0 ± 4.2 versus 22.0 ± 6.7 mm, p < 0.001), and smaller CSA (32.9° ± 4.0° versus 35.5° ± 4.1°, p = 0.009). Logistic regression showed that higher PAH and PAT were most strongly associated with posterior dislocation. Measurement reliability was good to excellent for all parameters. Conclusions: Acute traumatic posterior shoulder dislocation is associated with distinct posterior acromial morphology similar to that described in recurrent posterior instability. Level of Evidence: Diagnostic Level IV . See Instructions for Authors for a complete description of levels of evidence.

Background: Over the past few decades, shoulder arthroplasty has evolved rapidly, driven by a growing demand for surgical solutions to degenerative, traumatic, and irreparable rotator cuff-related pathologies, particularly in an aging but increasingly active population. Objective: This narrative review aims to examine the main clinical indications and the most commonly used implant designs, highlighting differences in functional outcomes, complication rates, and revision rates between anatomic total shoulder arthroplasty (ATSA) and reverse total shoulder arthroplasty (RTSA). Methods: Articles published between 2011 and 2025 were selected through PubMed and the Australian Joint Replacement Registry reports from 2023 and 2024. The included studies comprised randomized controlled trials, systematic reviews, and meta-analyses involving adult patients treated for primary osteoarthritis, proximal humerus fractures, and massive irreparable rotator cuff tears. Results: ATSA remains the preferred option in younger patients with an intact rotator cuff, due to superior outcomes in mobility and prosthesis longevity. However, glenoid component loosening remains a significant limitation. Initially reserved for irreparable cuff tears and complex fractures, RTSA has seen a progressive expansion of its indications, offering lower revision rates and satisfactory functional results, particularly in elderly patients. Recent prosthetic innovations include stemless implants, augmented glenoid components, and convertible platforms. Conclusions: The choice between ATSA and RTSA should be individualized, based on patient-specific factors such as age, rotator cuff integrity, functional demands, and bone quality. Advances in implant materials and design, together with improved patient selection, have significantly enhanced clinical outcomes.

Background: 1^st and 2^nd generation cephalosporins used for perioperative prophylaxis in orthopaedic surgery do not cover non-fermenting Gram-negative rods (NFR).