Isolated greater tuberosity (GT) fracture of the humerus has comprised 14% of proximal humerus fractures. However, which factors may affect shoulder dislocation with GT fracture is rarely established. Hence, we investigate fracture morphology to confirm the correlation between shoulder dislocation and GT fracture. We performed a retrospective study and evaluated 3D-CT in 132 cases of GT fractures, which developed from May 2011 to August 2015. Fracture morphology was evaluated 3D-CT. GT fracture was divided into anterior (supraspinatus insertion), middle (infraspinatus insertion), posterior (teres minor insertion), and fracture morphology was classified as avulsion (A), split (S), and depression (D). Two or more fracture fragments were defined as comminuted (C). Confirmed shoulder dislocation cases by x-ray were 40 cases (Group A) (27.3%). Anterior A, middle and posterior S (type 1) were 19 cases, and anterior CS and middle and posterior S (type 2) were 10 cases, and anterior and middle A (Type 3) were 10 cases. One case was the posterior S type. Shoulder dislocation was not confirmed in 92 cases (Group B), and types 1 and 2 were only 2 and 1 cases, respectively. There were statistically significant in types 1 and 2 between the two groups (p<0.001). Type 3 in group B was 32 cases, and statistical significance was not found between the two groups (p=0.132). This study showed that types 1 and 2 were highly associated with anterior shoulder dislocation. Therefore, these fracture patterns should be evaluated carefully with an MRI scan to find other shoulder pathology.

Objective: Reverse hill-sacks injury is more common in posterior dislocation of shoulder joint. It is difficult to treat the joint by traditional incision method. In this paper, we discuss how to obtain better clinical effect by arthroscopic shoulder bone grafting from the iliac bone.Methods: Arthroscopic operation under general anesthesia was performed in lateral position, posterior, anterior and anterior superior approaches were taken, bone bed was cleaned, glenoid and humerus skull defects were evaluated, iliac bone was taken, and the corresponding correction was made for use. Rivet was inserted into the glenoid bed and humerus skull defect, and the bone graft was inserted over the tail line, and then the bone block was sent into the defect and fastened. Postoperative follow-up.Results: The preoperative UCLA score was 11.50±1.8, and the follow-up score was 28.80±2.7. Active shoulder joint abduction was 33.20°±15.80 before surgery and 141.35°±9.25 during follow-up. The differences were statistically significant.Conclusion: Traditional incision surgery for patients with reverse hill-sacks bone defect requires two anterior and posterior approaches, which is difficult to reveal and traumatic. In this study, the patient underwent arthroscopic surgery. The iliac bone from the body was transplanted into the bone defect area and fixed with rivets and stitches. We found that this fixation method was reliable and easy to operate. In addition, arthroscopy can comprehensively examine the intraarticular lesions, and at the same time, comprehensive treatment can be performed under arthroscopy to achieve better results.Key words: reverse hill-sacks injury, bone defect, bidirectional bone grafting, arthroscopy

Introduction: Proximal Humerus Fractures (PHF) is the 3rd most common fracture in patients >65 years old, occurring mainly in women. Most can be treated conservatively, however displaced multi-fragmented fractures are associated with a poor prognosis. The use of Reverse Total Shoulder Arthroplasty (RTSA) is increasing and has revealed satisfactory and reproducible results. Methods: Single-center retrospective study of patients treated between 2020-2022. Inclusion criteria: diagnosis of PHF, RTSA surgery, >65 years old. Demographic and clinical parameters were analyzed. Results: 46 patients were included. Mean age was 77.4 years. All patients were women. Dominant arm was affected in 63.6%. Mean follow-up time was 22 months. Mortality rate was 10.2%. 22 shoulders were clinical evaluated. Mean Constant-Murley score was 51 points and QuickDASH score was 29 points. Mean range of motion was 110,2º flexion, 36.8º extension, 87.9º abduction, 25.6º external rotation and 3,8º internal rotation. Discussion: Population evaluated and clinical results were similar to those reported in the literature. Mean subjective evaluation of Constant-Murley score was 28.1, presenting an important degree of satisfaction. Regarding mobility, the loss of external rotation and internal rotation compared to the contralateral is evident, however 68.1% of cases report being able to maintain their daily activities without major limitations. Conclusion: The study concludes that RTSA is a satisfactory treatment option for PHF in the elderly. Our hospital center has results comparable to those described in the literature.

Objectives: To evaluate the effect of the treatment of proximal humeral fractures with anatomic locking compression plate(LCP) and injectable calcium phosphate cement(CPC) in eldery patients.
Methods: From March 2021 to July 2023,Twenty-eight eldery cases of proximal humeral fractures were treated
with open reduction and interna1 fixation with anatomic locking compression plate,and meanwhile
filled bone defect with calcium phosphate cement by injection.
Results: All patients were followed up for 5 to 14 months (average,12.3months).All patients obtained bone union after 12 to 18 weeks(average,16.6 weeks).The Constant-Murley scores was59~100(average,87.3). According to Hardegger shoulder score, 20 patients were excellent,3 good,4 fair,and 1 poor.The excellent to good rate was 82.1%.
Conclusion: LCP and injectable CPC in the treatment of proximal fractures in eldery patients promotes bone healing, allows early function exercise and has satisfactory clinical effect.
Keywords: Locking compression plate(LCP);Calcium phosphate cement(CPC);Bone substitutions; Proximal
humeral fractures

Optimal treatment strategies for radial head fractures remain a subject of debate and continue to challenge orthopaedic surgeons. We compared the results of radial head arthroplasty and osteosynthesis.


Between 2018-2022 identified patients with radial head fractures treated with osteosynthesis and arthroplasty. Studied mechanism of injury, classification of fracture, complications, type of osteosynthesis and configuration and revision surgery needed. Patients were evaluated regarding the Mayo Elbow Score, VAS for pain, Satisfaction score and ROM at a medium follow up of 12 months.

35 patients were enrolled in the study, 10 with simple fracture pattern and 25 with complex ones. 22 patients submitted to osteosynthesis (33% needed a revision surgery) and 13 to arthroplasty (28% revision surgery), no significant differences encountered. 33% complication rate reported in both subgroups. Regarding the Mason classification for fractures submitted to osteosynthesis there was 2 type I, 11 type II, 6 type III and 3 type IV and 7 type III and 6 type IV were submitted to arthroplasty. In the osteosynthesis group the medium Mayo Elbow Score was 84.82 and in the arthroplasty was 71.67, the VAS score for pain was 2 and 3.5 respectively, no statistically significant differences. Regarding the ROM it was complete in 36.4% in the osteosynthesis subgroup and in 16.7% in the arthroplasty.

Rates of arthroplasty were significantly higher in the context of associated injury and consequently the final ROM obtained was significantly lower in the subgroup submitted to arthroplasty. Regarding the need for revision surgery no statistically significant differences were encountered.

Background: Study aims to observe the possible association of capsular and/or labral injuries and their correlation with radiological features in 3 and 4 part anterior fracture dislocation of the shoulder.
Methods: The Clinic-radiological data of patients underwent ORIF for 3 and 4 parts anterior fracture dislocation were collected: Neer's type, fracture morphology, type of anterior dislocation and intra-operative finding about glenoid
labrum and/or capsule.
Results: Based on Neer's classification, 12 patients had 3-part
anterior fracture dislocation (3-part Group) with a mean age of 34±9 years, while 12 patients had 4-part anterior fracture dislocation (4-part Group) with a mean age of 46±7 years (p=0.001). 10 patients had subcoracoid type of dislocation in the 3-part Group, whereas preglenoid dislocation observed in 9 patients from 4-part Group (p=0.003). The head position was at a mean distance of 1.85 cm from the anterior glenoid rim in the 4-part Group, whereas the head was engaged at the anterior rim of the glenoid in the 3-part Group. The medial metaphyseal beak was present only in the 3-part Group (p=0.001). 92% of the included patients in our study had capsulo-labral injury. 11 patients in the 3-part Group had labral injury, whereas 10 patients in the 4-part Group had capsular stripping (p=0.001). 
Conclusion: The 3-part fracture dislocation, long medial metaphyseal beak and subcoracoid type of dislocation had a strong association with labral injury, whereas the 4-part fracture dislocation, preglenoid type of dislocation and absent metaphyseal beak had a strong association with a
capsular.

Background: The purpose of classifying distal humeral fractures is to assist the surgeon in selecting the most appropriate treatment. Currently, there is a controversy regarding the reliability of classification systems for distal humeral fractures. The purpose of this study was to introduce a simple and clinically applicable classification–The Copenhagen Classification of Distal Humeral Fractures (CCDHF) and to compare the inter- and intra-observer agreement for this classification with the AO/OTA, and Sheffield classification systems. The primary objective of the new classification system is to distinguish fractures that may not be suitable for open reduction and internal fixation (ORIF), necessitating treatment options such as elbow hemiarthroplasty(EHA) or total elbow arthroplasty(TEA).
Materials and Methods: This is a single-center observer study. Five consultant elbow surgeons assessed a consecutive series of 105 sets X-rays of distal humeral fractures on two occasions with ten weeks interval. All X-rays were classified according to AO/OTA, Sheffield, and the CCDHF systems. The CCDHF system has been developed collaboratively by a panel of five experienced elbow surgeons. Based on consensus, the surgeons identified specific fracture characteristics where EHA or TEA might be needed.
Results: The mean inter-observer agreement was fair for AO/OTA classification and moderate for Sheffield and CCDHF. The mean intra-observer agreement was moderate for AO/OTA classification and substantial for Sheffield and CCDHF. Conclusion: The CCDHF demonstrated validity and clinical applicability, showing a moderate level of agreement among observers. The CCDHF can be used to assist surgeons in identifying fractures that may require treatment with EHA or TEA.

Introduction: Postoperative instability following reverse shoulder arthroplasty (RSA) is a common complication and continues to pose a clinical challenge. Currently, there are no specific methods available to address patients with this condition. In this study, we presented two cases of recalcitrant dislocation following RSA. Methods and results: Between 2014 and 2023, we conducted a retrospective search for reverse total shoulder arthroplasties (RTSAs) performed at our institution by a single surgeon employing a consistent technique. We identified instances of postoperative dislocations or symptoms of instability. Out of 182 patients who underwent RTSAs, two patients experienced recalcitrant dislocation. In these two patients, the preoperative diagnoses were an acute proximal humerus fracture in one case, while the other had a fracture malunion. One dislocation occurred after 3 weeks, while the other occurred after 2 weeks, with no apparent traumatic event preceding either incident. All dislocations required operating room intervention initially; none were successfully managed with simple closed reduction in the Emergency Room. Despite liner augmentation in both cases, dislocation persisted. Ultimately, open reduction followed by immobilization with a brace for 4 weeks was performed in there two patients. Following the last surgical intervention, none of the patients experienced subsequent dislocations. Conclusion: Recalcitrant dislocation following RSA remains a complication with limited salvage options. Open reduction followed by immobilization with a brace for 4 weeks may be a viable solution for recalcitrant dislocation.

Introduction: The suprascapular nerve provides up to 70% of the sensory innervation of the shoulder joint; branches extend from it to the acromaclavicular joint, the capsule of the shoulder joint, the supraspinatus and infraspinatus muscles, providing pain and proprioceptive sensitivity. The high efficiency of the radiofrequency denervation technique in terms of relieving pain in the shoulder joint, and, at the same time, the small number of scientific works devoted to the use of the technique in patients who have undergone reverse shoulder arthroplasty, determines the relevance of this study. Methods: At the FSBI «NMRC TO named after N.N. Priorova» of the Ministry of Health of the Russian Federation, radiofrequency denervation was performed on patients who had undergone reverse shoulder arthroplasty and had chronic pain syndrome. The follow-up period was 12 months. The criteria for inclusion of patients in the study were an anamnesis of reverse shoulder arthroplasty, the presence of incurable chronic pain syndrome, and the absence of absolute indications for revision surgery on the shoulder joint. The absolute criteria for excluding patients from the study was the presence of postoperative complications in the operated patients (infectious complications, instability and conflict of components). Results: Patients who underwent radiofrequency denervation of the suprascapular nerve were observed. All patients had a persistent positive effect throughout the entire observation period. Motor denervation of the shoulder joint was not observed in any of the patients. Conclusion. During the study, the developed RFD technique proved its effectiveness in relieving pain after shoulder arthroplasty.

Introduction: Prediabetes is a metabolic disorder with elevated glucose levels but not high enough to be classified as diabetes. There is a varying prevalence of prediabetes in adhesive capsulitis (AC) patients (8%-48%). Aim: To evaluate the prevalence of prediabetes in patients presented with shoulder AC. Methods: This is a prospective study with patients diagnosed of shoulder AC. According to medical history patients included as normoglycemics and diabetics. Fasting plasma glucose (FPG) levels and glycosylated hemoglobin (HbA1c) have been determined, knowing that ADA (American Diabetes Association) defines prediabetes as: FPG ≥100 o <125 mg/dL or HbA1c level of ≥5.7 to <6.5%. Patients were evaluated as range of motion(ROM), Visual Analogue Scale(VAS) for pain, and Shoulder Pain and Disability Index (SPADI). Results: Between 2021-2022, 82 consecutive patients diagnosed with primary AC. Mean age 58 years (28-75), 57% women and 52 % left-shoulder. Initially, 59 patients were normoglycemic and 23 were diabetics. Considering FPG: only 11,9% patients were prediabetics, but considering HbA1c: 50% of the participants were normoglycemic, 21,9% were prediabetics, and 28,1% were diabetics. The difference in mean HbA1c between the 3 groups was statistically significant (P < 0.01). No significant differences in age, gender, FPG, ROM, VAS, SPADI between the groups. Prediabetic patients have been referred to the Department of Endocrinology. Conclusion: There is a high prevalence of prediabetes (21,9%) in patients diagnosed with AC, initially considered as normoglycemics. HbA1c is an effective tool to detect prediabetes, meanwhile FPG estimation is not. Screening for prediabetes in AC patients should be performed.

Introduction: Management of bone loss in both primary and revision total elbow arthroplasty (TEA) is surgically challenging. Techniques used include mega prosthesis, large segment allograft struts +/- allograft prosthetic composites. These techniques have high complication rates. We present a novel solution of salvage TEA using a custom Intramedullary humeral prosthesis with a locking flange.
Methods: We prospectively reviewed data on 11 complex cases performed between 2017 and 2023. Electronic patient records, clinic letters, surgical logbook and the patient recorded outcome measures (PROMS) database were reviewed.
Results: All eleven cases were revisions of previously failed prostheses. Mean age was 64 (range 40-75). The mean number of previous arthroplasty procedures per patient was 6 (range 3-10). At a mean follow up of 29 months (range 2-81) ten of eleven prostheses remain fully in situ; however all humeral components remained well fixed. Clinical satisfaction was high with an improvement in visual analogue scale pain (VAS) from 8 to 1 postoperatively. Average function (SANE score) improved from 21% to 75% post-operatively. Oxford Elbow Scores improved from an average of 11 to 32. EQ-5D index improved from an average of 0.5 to 0.6. At most recent follow up there was no evidence of progressive radiographic lucency in any implant. One patient had the ulna component removed post-operatively for continued infection and remains on antibiotic suppression. The humeral component remains well fixed.
Conclusion: When faced with extensive humeral bone loss, customised distal humeral replacements with a locking flange offer an alternative solution with acceptable medium-term outcomes.

Purpose of the study:In reverse shoulder arthroplasty, positioning the components in the correct position is important. Our study assessed the results of treatment of patients requiring glenoid correction. Materials and methods: Retrospective study. Since October 2019, one surgeon has performed 97 implantations of shoulder joint endoprostheses, 39 of which involved correction of the scapular plane. Eccentric rimming – 10 cases, BIO-RSA plastic surgery – 14 cases, correction with titanium augment – 15 cases. Shoulder function was assessed by DASH, UCLA, and Constant-Murley preoperatively and at 6, 12, and 24 months postoperatively. Results and discussion: At follow-up 1 year after surgery, 26 cases were tracked. Of these, after 6 months, an improvement in function is determined by an average of 36.98 DASH points, 32 Constant-Murley points, and 11.6 UCLA points. 1 year after surgery, there was an improvement in function by an average of 41.73 DASH points, by 34 Constant-Murley points, by 11.9 UCLA points, which better results in patients without axis correction. During the entire observation period, there were no cases of instability of the endoprosthesis, infectious or other complications. Depending on the correction method, the degree of influence of “notching” was lower in the groups using augments and BIO-RSA than with rimming. Conclusions: To implant a reverse endoprosthesis in the correct position, it is necessary to take into account the position of the glenoid plane. We attribute the positive clinical results of treatment to the implantation of the scapular component in the correct position.

Introduction: Surgical treatment of acromioclavicular dislocation is indicated mainly in high demand patients with horizontal and vertical instability. There are a lot of techniques to stabilize the joint but there is now evidence that an horizontal stabilization is important to decrease complications and revisions. The goal of this study was to compare only vertical stabilization (VS) with horizontal and vertical stabilization (VHS) in the treatment of this patients. Methods: Retrospective study including all patients that underwent to surgery for acromioclavicular dislocation in our hospital between 2020-2023. Inclusion criteria: Acute dislocation (<6 weeks), horizontal instability (Rockwood IIIB/V) and arthroscopic surgery. Exclusion criteria: Associated fracture. Statistics was made with IBM SPSSv29 (statistically significant difference p<0,05). Results: 27 patients, 89% men, mean age 43yo. 22% grade IIIB and 78% grade V. In 66% was made VS with double button and in 33% was added horizontal stabilization with non-absorbable suture in transosseous tunnels (acromion and clavicle). Mean time to surgery 10 days. From those with VS, 28% went to revision and in the VHS group none went to revision (p<0,01). Discussion: A mild loss of reduction occurs in a lot of patients with no difference between VS and VHS and there is no clinical issues. As with current literature, we verified that the system fails more with VS only, with no revision surgery in the group with VHS. Conclusion: In the treatment of acromioclavicular dislocations, horizontal stabilization is a determinant issue in preventing loss of reduction due to system failure and a revision surgery.

Objective
Conventional techniques for the fixation of displaced proximal humeral fractures include the use of locking plates, intramedullary nailing, hemiarthroplasty, and reverse shoulder replacement. Valgus impacted fractures are a common subtype of proximal humeral fracture, but there is limited published work on outcomes of treatment. This study aims to review outcomes following an ‘all-suture’ technique for this fracture subtype without the use of trans-osseous sutures.

Design and Methods
All patients over the age of 18 who presented with 3- or 4-part valgus impacted proximal humeral fractures and who underwent ‘all-suture’ repair at our centre were included. We reviewed their post-operative imaging and collected data on post operative complications and patient reported outcome measures.

Results
We identified 15 patients who had undergone all suture fixation. The cohort’s mean age was 56 and 11 patients were female. Eight patients had 3 part fractures and seven patients had 4 part fractures. There were no major post-operative complications. All fractures united successfully. The mean Oxford Shoulder Score was 43.7 and the mean Single Assessment Numerical Evaluation score was 85.9 at final follow up.

Conclusion
Our results suggest that all suture fixation of proximal humeral fractures presents an attractive alternative to conventional techniques, whilst avoiding complications relating to metalwork implantation.