Recent advances and future innovations in shoulder arthroplasty: a review of the current literature

There have been incredible innovations in knowledge, techniques, and implants for total shoulder arthroplasty over the last few decades. On the humeral side, modularity has improved the ability to recreate native anatomy, while shorter humeral stems have improved our ability to preserve bone stock. On the glenoid side, the anatomic restoration and baseplate fixation have improved and augments have allowed surgeons to overcome bone loss. Future innovations in implant design, surgical technique and planning will continue to improve this operation. These will likely include robotic assisted surgery, augmented reality, patient specific guides, and others. In this review, the recent literature highlighting important recent innovations in the field of shoulder arthroplasty are critically reviewed and compiled. Recent innovations and projected future trends are discussed.     

Does overcorrection cause any negative effect on pediatric missed Monteggia lesion?

European Journal of Orthopaedic Surgery & Traumatology - To evaluate the outcome of different types of ulna osteotomy in missed Monteggia fracture with a particular interest in anatomical...     

Standard versus customised locking plates for fixation of schatzker ii tibial plateau fractures

Aim3D-printed implants could improve the capture of fracture fragments for improved stability of tibial plateau fracture fixation. The aim of this study was to compare the biomechanical strength of fixation constructs using standard and customised 3D-printed proximal tibial locking plates for fixation of tibial plateau fractures.MethodsThis is a biomechanical study utilising six pairs of cadaveric tibiae. Fractures were created in an identical fashion using an osteotome and mallet, and fixed using either a standard, commercially-available proximal tibia locking plate or a customised 3D-printed plate. Design and production of the customised plates followed a “3D printing at point-of-care” model. Customised stainless steel 316 L plates were produced within a local additive manufacturing laboratory based upon pre-operative CT scans. Determination of implant choice within each cadaver pair was performed via simple randomisation. Following fracture fixation, the tibiae were skeletalised and biomechanically tested using a customised loading jig and a size-matched femoral knee prosthesis. The constructs were loaded cyclically from 100 N to approximately three times the cadaveric body-weight at 5 Hz for 10 000 cycles. Every 1000 cycles, the test was paused and the tibia was physically checked for failure. If failure had not occurred by the end of the testing cycle, the construct was loaded to failure and the load at which the construct failed was noted.ResultsFixation constructs using the 3D-printed plates performed comparably to those using the standard plates. There was no significant difference in the degree of fracture fragment displacement in both constructs. Overall longitudinal construct stiffness and load to failure was higher in the 3D-plates group but this did not reach statistical significance.ConclusionProduction of customised plates for proximal tibia fractures at point-of-care is feasible, however fixation constructs with these plates did not provide any biomechanical advantage over standard plates in terms of axial loading stiffness.