Convertible implants: Simplifying the revision from anatomic total shoulder arthroplasty to reverse total shoulder arthroplasty

Modern shoulder arthroplasty techniques include hemiarthroplasty, total shoulder arthroplasty (TSA), and reverse shoulder arthroplasty (RSA). Out of all arthroplasty procedures, total shoulder arthroplasty produces more satisfactory outcomes for osteoarthritis and inflammatory arthropathy (Sanchez-Sotelo, 2011 [1]). As shoulder arthroplasty procedures continue to increase in popularity, so do revision surgeries (revision TSAs and revision RSAs). Implants used in shoulder arthroplasty procedures have been transformed substantially from generation to generation, going from 1st to 4th generation implants. We propose 5th generation convertible implants that enable a more patient-specific, anatomic reconstruction with the potential to solve major issues that exist with implants from previous years.     

温通膏外敷联合中频电疗治疗冻结肩的疗效观察

目的:观察温通膏外敷联合中频电疗对冻结肩的临床疗效。方法:选取90例冻结肩病例,随机分为温通膏组、中频组,联合组。温通膏组使用温通膏外敷患者患处,中频组使用中频电疗,联合组则同时给予温通膏外敷及中频电疗治疗,三组均连续治疗10天。观察患者治疗前后的Constant-Murley肩关节评分中的疼痛评分、活动度评分,并于3个月后随访患者,记录复发情况。结果:治疗后,三组患者的肩关节Constant-Murley疼痛评分、活动度评分均高于治疗前(P<0.05);联合组患者的肩关节Constant-Murley疼痛评分、活动度评分明显优于温通膏组及中频组(P<0.05);治疗3个月后联合组的复发率(6.67%)明显低于其它两组。结论:温通膏联合中频电疗可以有效缓解冻结肩患者的疼痛,改善活动度,临床效果较单独使用温通膏外敷或中频电疗更优。     

Superior shoulder suspensory complex fracture dislocation case report

BackgroundAcromioclavicular joint dislocation can be more complex than it first appears. The presented case had an unusual combination of injuries to the superior shoulder suspensory complex, which yielded some interesting learning points.Case summaryThe injuries were sustained after a fall from a push bike and included acromioclavicular dislocation with coracoid process, clavicle and acromion process fractures. These were identified on the initial X-ray examination, which was followed by computed tomography for surgical planning. The injuries were successfully treated by internal fixation.ConclusionThe unexpected complexity of the injuries could have led to subtle but important findings being overlooked. This case highlights the importance of a thorough search strategy, consideration of injury biomechanics and knowledge of associated injuries.     

Anaesthesia for joint replacement surgery

Joint replacement surgery, especially hip and knee, demand is increasing globally. Many patients are elderly, frail and have significant comorbidity requiring careful perioperative management. Patient prehabilitation and enhanced recovery protocols have been successfully introduced. Multimodal analgesia including regional nerve blocks, deep venous thromboembolism prophylaxis, blood management and bone cement implantation syndrome are some important perioperative aspects to be considered.