Arthroscopic synovectomy is recommended for patients with rheumatoid arthritis who fail conservative treatment.

Posterior fracture dislocation of the shoulder is rare injury. Treatment is challenging especially for a complex type fracture dislocation with delayed presentation or a reverse Hill-Sachs lesion. We reviewed the surgical approaches, the reduction and fixation techniques, management of reverse Hill-Sachs lesion, pitfalls, and outcomes. We also shared our experience in treating a short case series of posterior fracture dislocation of the shoulder. There were no major complications such as wound infection, nerve palsy, non-union or avascular necrosis of the humeral head in our patients. All could cope with the original activities and had satisfactory recoveries of shoulder functions. The anterior deltopectoral approach alone had some limitation especially in the delayed cases and with complex fracture dislocation. The Utility approach was noted to be a versatile approach for the chronic or delayed cases.

Background: Many patients who suffer from hip fractures have multiple medical comorbidities and there are risks when undergoing spinal or general anaesthesia. In fact, screw fixation can be performed under local anaesthesia infiltration for undisplaced femoral neck fracture, thus enabling patients for early mobilisation and rehabilitation. Methods: Ten patients had screw fixation performed under local anaesthesia. Parameters including pain tolerability, operation time, time to mobilisation after operation, hospital stay, and surgical outcomes were measured. Results: All 10 patients were able to complete the operation under local anaesthesia with minimal pain during the intraoperative period. No extra sedation, any form of intraoperative analgesia, or conversion to other form of anaesthesia was needed. No local wound or implant-related complication was detected in the early postoperative period. An average of 23.1 months (range: 17e28 months) follow-up showed all fractures had healed without any implant-related complications or avascular necrosis of the femoral head. Conclusion: Screw fixation can be performed safely under local anaesthesia in selected patients who have high-risk of spinal or general anaesthesia in order to accelerate their rehabilitation.

a b s t r a c tPurpose: To evaluate the prognostic factors that affect the surgical outcome of laminoplasty in patients with cervical compressive myelopathy. Methods: This is a retrospective review of 43 cases of multi-level cervical compressive myelopathy treated operatively with expansive laminoplasty (Itoh surgical technique), from June 1989 to August 2008. The mean follow-up duration was 7 years. The Japanese Orthopaedic Association score, Hirabayashi recovery rate and improvement of Pavlov's ratio were used to assess the clinical results after laminoplasty. Results: The mean Japanese Orthopaedic Association score improved from 9.7 to 13.7 points after laminoplasty (p < 0.001), with 65.1% excellent or good results. The Pavlov ratio improved from 0.71 to 0.9 after operation (p < 0.001). Excellent or good surgical outcome is demonstrated in patients aged <70 years. Conclusion: Laminoplasty is a viable surgical option for patients with three or more levelsofcervical cord compression. Patients youngerthan 70 years predict a favourable surgical outcome.