Purpose: We aimed to investigate the incidence rate of suicide-related death over time, and analyze the association between RCR and suicide using a representative nationwide large cohort database.
Methods: We used the National Health Insurance Service Senior cohort version 2.2 (NHIS-Sample) of South Korea, which includes all records of healthcare and long-term care services. RCR patients were identified from the National Health Information Database and matched with control subjects using propensity score matching (1:1). Time-dependent Cox proportional hazard models were used to estimate the hazard ratios (HR) of suicide for RCR patients compared to matched controls.
Results: We included 3,992 incident RCR patients and 3,992 matched controls. The incidence rate of suicide among RCR patients was 62.61 per 100,000 person-years for a period of more than 1 year and 56.15 per 100,000 person-years (95% confidence interval [CI]: 32.61–96.68) during the entire follow-up period. During the entire follow-up and a period of more than 1 year after RCR, RCR patients were 3.19 and 5.86 time more likely to die by suicide than their matched controls (95% CI: 1.04–9.76, p = 0.043 and 95% CI: 1.31–26.15, p = 0.021, respectively).
Conclusions: Patients who underwent RCR demonstrated no association with suicide within the first postoperative year, but a noticeable trend of increased suicide incidence emerged after this period. This finding suggests the potential impact of challenges, such as intense pain, rehabilitation difficulties, persistent functional limitations, and RC retear, on the psychological well-being of patients following RCR.

Fractures of the proximal humerus have long been neglected in operative treatment. This review aims to present, through a historical overview of treatment methods in our region, from the earliest non-operative methods, through operative treatment by synthesis with various materials, from wire loops, screws, nails, Kirschner wires, various plates, to anatomically contoured plates with locking screws, to partial, total, and reverse shoulder prostheses. Immediate results, complications, as well as long-term functional outcomes after several years of follow-up are presented. Today, with increasing demands for functional recovery after such injuries, a multidisciplinary approach is necessary, which involves proper indication for operative treatment, choice of treatment method, postoperative course, as well as continuation of rehabilitation with prompt and properly directed physical therapy, along with analysis of postoperative status and prevention of possible complications. Despite everything, functional outcomes are not always satisfactory, leading to dissatisfaction both for patients and surgeons and the entire team. Patient expectations are almost always higher than the achieved results, which supports further development of treatment methods.

Purpose: We aimed to find the distinctions between intra-venous (IV) and intra-articular (IA) tranexamic acid (TXA) concerning intraoperative visual clarity, postoperative pain management, and the incidence of complications during arthroscopic rotator cuff repair (ARCR).
Methods: In our retrospective cohort study, we included patients who had a history of rotator cuff tears. The primary outcome, visual clarity during surgery, was evaluated using a five-grade arthroscopic visual scale (AVS) by the operating surgeon. This scale ranged from grade 1, indicating optimal clarity, to grade 5, the least clarity necessitating a switch to open surgery. These assessments were made at 10-minute intervals during the review of the operation’s video footage. We also measured the duration of the surgery and postoperative pain levels as secondary outcomes.
Results: IA group included 30 patients and the IV group had 31 patients. IA group had lower grade of AVS grade 1-2 compared to IV group (90.0% vs 64.5%, p=0.011). PVAS suggested a trend towards less pain in the IA group at various postoperative times, and less pain at postoperative 48 hours (IA 2.7 vs IV 4.2, p=008). Notably, 4 patients in the IA group required anticoagulants, a contraindication for intravenous TXA administration.
Conclusions: Both IA and IV routes are effective and safe for the administration of TXA in ARCR. However, given the increased distribution of low grade of AVS in IA group, the slight trend towards reduced postoperative pain, and context of patients with cardiac conditions requiring anticoagulants, IA administration presents a more viable alternative.

Prelomi nadlakatne kosti, odnosno humerusa,variraju po svojoj lokaciji (proksimlani deo, dijafiza, distalni deo), tipu preloma i uzrastu pacijenta. Najčešće su u pitanju povrede nastale traumom većeg intenziteta (sobraćajni udes, pad sa visine) kod mladih ljudi, odnosno povrede dominantno proksimalnog dela, nastale minimalnom traumom, padom na istom nivou kod starijih ljudi.
U poslednje tri godine na odeljenju koje se ranije bavilo dominatno hirurgijom šake i ručnog zgloba, lečili smo 50 pacijenata od različitih tipova preloma humerusa, metodom otvorene repozicije i unutrašnje fiksacije LCP pločama. Pacijenti su operisani od tročlanih hirurških ekipa. kombinovanih od članova istog odeljenja.
Kod svih operisanih pacijenata su postignuti dobri rezultati, sa minimalnim komplikacijama.
Uspeh u lečenju je posledica kontinuiranog napretka hirurške tehnike, kao i uigranog timskog rada i multidisciplinarnog pristupa
kako u operacionoj sali, ali i kasnije u toku hospitalizacije na odeljenju i daljeg ambulantnog praćenja i reahabilitacije pacijenta.
Key words: humerus, rame, lakat, osteosinteza, tim, multidisciplinarni

Fractures of the proximal humerus in individuals older than 70 years are common and are caused by low-intensity force, most commonly a fall on the same level.
Treatment is mostly non-operative and does not yield good functional results. In individuals with higher physical demands, surgical intervention is necessary. Material from 45 operatively treated patients was analyzed. Fractures were classified radiologically according to the NEER classification, after which operative treatment was undertaken with an anatomically contoured plate. Rehabilitation followed thereafter. Results were followed up at 6 and 12 months, clinically and radiographically, as well as with functional tests. Shoulder mobility and muscle strength were analyzed, as well as patient satisfaction with achieved results in daily activities.
Results depend on several factors such as age, bone tissue condition, comorbidities, fracture type, surgical technique, and the length and quality of rehabilitation treatment.

Despite the recent trend of operative treatment for comminuted proximal humeral fractures in the form of total reverse shoulder arthroplasty (RSA), hemiarthroplasty remains an option that should be considered for certain, especially younger patients. Historically, when open reposition and osteosynthesis were not possible due to comminution of the humeral head, general osteoporosis or massive injury of the rotator cuff, hemiarthroplasty was used as first choice. However, the results of this surgery were largely unpredictable since they depend on the anatomical restoration of the lesser and above all the great tubercle. Total reverse arthroplasty has recently taken its place as a good option for surgical treatment in such cases, since postoperative results do not depend to a large extent on the healing of tubercles and their anatomical restitution. The stability and range of motion can be improved with proper repositioning and healing of the tubercle, which contributes to the constant evolution of adequate surgical technique and implant design to optimize healing. Complications of reverse shoulder arthroplasty in the field of trauma include general surgical complications, consists some special ones in the form of scapular notching and neurological injuries. In this review, we summarize the indications, choice of surgical technique, outcomes, and complications of treatment for non-reconstructive proximal humeral fractures with treatment modalities ranging from hemiarthroplasty to total reverse shoulder arthroplasty.

Fracture of the proximal humerus most commonly occurs in the elderly population, often due to a fall on an outstretched arm and 10-20% of these fractures require surgical treatment. However, in young, healthy individuals, this fracture is often the result of high-energy trauma, with such fractures being frequently multifragmentary and accompanied by more extensive soft tissue damage. When an appropriate indication for surgical treatment of these fractures is established, the most common method of fixation is the use of a PHILOS plate. The surgical approach can be either deltoid-pectoral or transdeltoid. Fracture of the proximal humerus often presents a challenge for the surgeon, considering the complex anatomy, often osteoporotic bone, or when a multifragmentary fracture is present. The PHILOS plate provides technical solutions for such problems. On the other hand, complications related to the method of open reduction and internal fixation itself or related to the limitations of plate fixation are not uncommon. The aim of this study is to review the general epidemiology, indications for surgery, surgical approaches, technical specifics of the PHILOS plate, as well as the most common complications.