Objectives: The primary objective of this systematic review was to evaluate pain relief and shoulder functional outcome following reverse shoulder arthroplasty for three-and four-part proximal humerus fractures in patients over the age of 60 years. The secondary objective was to assess the clinical end radiological complications following this procedure for this indication.Methods: Studies were identified using a MEDLINE search for relevant articles on 20th May 2019. The key terms 'reverse shoulder arthroplasty' and 'proximal humerus fracture' were used.Results: Five retrospective case-series fully met the eligibility criteria. No randomized controlled trials or meta-analyses were found. All of the studies agreed that reverse shoulder arthroplasty was able to offer good pain relief, function end range of forward flexion (FF), and abduction (Abd.). Restrictions in shoulder rotation have to be fully addressed. The rate of major complications, reduction in functional outcome, and development of scapular notching with time was a concern.Conclusions: Reverse shoulder arthroplasty for comminuted proximal humerus fractures has increased over the past several years, yet the published data evaluating the surgical outcome is limited. Large well-designed prospective randomized controlled trials are needed for comparing the various treatment options, in order to ensure that these patients receive the best treatment available.

The trauma and orthopaedic speciality continues to advance as surgery becomes more accessible and safe. However, the bygone days of treatment with traction still has its merits and should remain a part of practitioner's repertoire. This will allow the practitioners to be resourceful in times of unexpected scenarios. We aim to write this article to describe indications, applications of various forms of traction, and their relevant complications.

Introduction The cementless acetabular implants are commonly used in primary and revision hip arthroplasty. Reconstruction of acetabulum in case of bone defects can be challenging. The aims of this single center study are to review the mid-term outcomes of porous tantalum cups (TM) and evaluate complications. Methods The midterm outcome of a trabecular metal tantalum modular uncemented cup was evaluated in 59 hips in 58 patients. In our group, we had 23 males and 35 females. The mean age was 70.11 years (range, 30 to 87 years). Four patients were lost to follow-up and 13 died during the period without having further surgeries attributed to the hip arthroplasty. The remaining 41 patients (42 revision hip arthroplasties) had complete data available. Results The mean follow-up was 87 months, ranging from 24 to 144 months. Standard pelvic anteroposterior (AP) radiographs were used to assess and preoperatively classify acetabular defects as per Paprosky classification. The serial radiographs showed excellent stability, bone opposition and graft incorporation. Four patients had further surgeries. Two of these were due to infection (one superficial and one deep infection). One of the patients had washout and then removal of metal work, the other patient only had a washout and symptoms settled. One patient had vascular compromise and went for surgery to stem the bleeding. One patient had re-revision due to stem loosening and hence required surgery but the revision cup remained stable. We noted a 96% survival at an average of 7.2 years follow-up. Conclusion The mid-term results with the trabecular metal cementless cup appeared to be promising in both primary and revision hip arthroplasty, even in the presence of considerable bone loss which requires bone grafting and augments. Level of evidence IV.

Background There are 75,000 neck of femur (NOF) fractures that occur each year in England and Wales. Prompt, adequate analgesia is a major priority in hip fracture management to reduce the risk of delirium and facilitate earlier return to mobility and independence. NICE guidelines recommend the use of fascia iliaca block (FIB) for NOF fracture patients. Current literature suggests that FIB significantly improves pre-operative pain scores; however despite this, the uptake of FIB still varies between centers. Objective The study aimed to review pre-operative analgesia management of NOF patients in our center. The primary endpoint was to improve uptake of regional fascia iliaca block (FIB) in NOF patients by means of an educational e-learning tool. Study Design and Methods We performed a prospective review of all patients with NOF fractures admitted via the emergency department from September to October 2018 in a single district general hospital in the UK. We recorded patient demographics, time of admission, grade of physician performing block and pain scores and total FIB uptake. A multidisciplinary-led, short interventional training program of FIB administration was then developed and delivered to all relevant staff. Pain management and pain scores were recorded in a second prospective cycle along with uptake of FIB. Results There was a 53.2% reduction in pain score in the group that received FIB compared to 26.7% in patients who received oral analgesia only, consistent with current literature (p value = 0.0046). There was a significant increase (2.66x) in FIB administration by orthopedic doctors (27.3% in cycle 1 to 100% in cycle 2) after the educational session intervention. Conclusion This study shows that with the use of an educational training tool, all members of the multidisciplinary team can successfully administer FIB without any complications. Our educational tool has enabled a significant increase in delivery of FIB.

Introduction: Medial knee osteoarthritis is a source of debilitating pain. Varus malalignment is associated with a 4-fold increase in unicompartmental osteoarthritis. Current non-surgical treatments include patient education, weight loss, analgesics. Two contemporary surgical treatment options for medial knee osteoarthritis are available and each procedure has its merits. These are based on different principles: high tibial osteotomy (OW-HTO) where correction of knee angular deformity with slight valgus overcorrection is the goal and unicondylar knee replacement (UKA) surgery's aim in replacing damaged articular surface.Aim: To review clinical outcomes of two matched populations between open wedge high tibial osteotomy (OW-HTO) and unicondylar knee (UKA). Material and Methods:This was a prospective study of two matched populations at two different centres, employing different techniques for managing medial knee compartment osteoarthritis. The OW-HTO centre had recruited 19 patients over February 2012 to December 2013. The TomoFix® knee osteotomy. The unicondylar knee replacement (UKA) centre had 22 patients over June 2012 to August 2013 and used the Oxford™ partial knee system in these operations. Conclusion:In conclusion, this study shows that open wedge high tibial osteotomy and unicondylar knee replacements have no significant differences in oxford scores at 6 weeks and 6 months.