Introduction :Venous thromboembolism is a rare surgical complication after shoulder replacement surgery. Most common seen for those who underwent for lower limb reconstruction such as: total hip or knee arthroplasty as well as orthopaedic trauma surgery in general. Case Presentation : we report one case of 56-year-old male known to have diabetes mellitus and hypertension who had an isolated proximal humerus fracture. He underwent for reverse shoulder arthroplasty and the patient had an uneventful day of surgery. On postoperative day 2, patient started to have lightheadedness with decreased oxygen saturation. He denied any history of chest pain or shortness of breath. Patient was put on 2L oxygen face mask. Patient was evaluated by the medical team. CT spiral was done and it revealed bilateral small filling defects involving the right lower pulmonary artery and the left upper lobar pulmonary artery. Patient was started on anticoagulant therapy with improvement in his condition.Conclusion : Prophylactic anticoagulants therapy should be given after shoulder arthroplasty to an elderly patient or those who have multiple comorbidities. Surgeons should have a high degree of clinical suspicion for pulmonary embolism when a patient has development of respiratory difficulty, hypoxia, and tachycardia following shoulder arthroplasty.

Introduction: The count of instabilities has benefited greatly from anatomical and biomechanical knowledge of shoulder stabilisation factors.
Materials and methods: Between 2015 and 2020, 40 patients with treated by the Latarjet technique, the average follow-up is 3 years. Clinical evaluation assessed subjective stability, pain, examination of joint mobility as well as looking for signs of instability. As for the radiological evaluation, it mainly consisted of an evaluation of the position of the stop relative to the anterior glenoid rim (perfect position: 0-5 mm, too medial:> 5 mm and too lateral: overhanging), of its appearance. (lysis, consolidation) and the appearance of glenohumeral arthritis. Patients were treated with the Latarjet technique, which consisted of attachment of the distal end of the coracoid process to the anterior aspect of the neck of the sharpened scapula.
Results: the male sex is largely in the majority, 82% between 20 and 30 years old, the dominant side represents 72% of cases, 40% were professional athletes
Discussion:The technique of Latarjet gives little complication; such as infection, glenoid fracture, shoulder stiffness. During the first approach, the section of the tendon of the subscapularis muscle promotes fatty degeneration of this muscle more than initially by dissection of its fibers. The position of the stopper must be checked intraoperatively after its fixation, if the position is too lateral, part of the graft must be removed to avoid an arthrogenic conflict with the humeral head.
Conclusion: Latarjet technique is effective on physiopathological factors and should lead to excellent results, especially

Introduction:Shoulder joint infections occur after proximal humerus fracture or a joint arthroplasty procedure as a complication. Eradicating the infection is difficult in presence of an implant in situ and infection leads to implant loosening and causes pain , swelling, redness, discharging sinus, reduced range of motion. When the infection is confirmed, surgery is needed including antibiotics , implant removal & maintaining joint stability. PROSTOLAC has been established as a definitive intermediate step for control of infection & giving a reasonable range of motion in such patients.Materials & Methods:Case1:40year Male, Right hand dominant,1 year old outside operated Right proximal humerus fracture with PHILOS plate in situ with discharging sinus since 8 months ,other complains of pain, swelling, restricted ROM, no dnvc. Patient was admitted, investigated & operated with Implant removal & Prostalac Implantation.Case 2: 32year Female , Right hand dominant, H/o injection in Left shoulder , developed progressive loss of ROM , pain at night, developed progressive loss of function, Patient was admitted, investigated, X ray revealed complete resorption of left proximal humerus, MRI revealed partially intact Rotator cuff. Operated with complete debridement & Prostalac Implantation.Result:After 2 years follow up, both patients had significant improvement in ROM of affected shoulder & complete eradication of the infection with use of PROSTALAC. Both patients did not want further surgery.Conclusion:In carefully selected cases of infected shoulder, Prostalac can work as a definitive treatment modality.Keywords:Prostalac,Proximal humerus,Infection

Background: The aim of this study was to evaluate the changing experiences of shoulder surgeons with the introduction of newer prostheses and the growing popularity of reverse shoulder prostheses. Methods: Two retrospective audits looked at the outcome and complication rates while undertaking 312 shoulder replacement’s over 15 years performed by two shoulder surgeons in a district general hospital with an average follow up of 4.5 years. Results: Overall there was an 88% satisfaction rate with the outcome in our 289 patients in our study with an 18% complication rate of which 4% required revision. The average Constant’s shoulder score achieved was 68 including trauma and elective cases. In the first 10 years 141 shoulder replacements for all reasons were included with a 23% complication rate, Constant score of 69 and satisfaction rate 92% compared to the last 5 years with a change in the hemiarthroplasty, total shoulder and expansion in the number of cases treated with a reverse prosthesis were there was a 20% complication rate, Constant score of 68 and satisfaction rate of 85%. Conclusion: Introducing new implants does not appear to lead to a reduction in patient outcomes and appears to have the desired improvement predicted in the literature. Shoulder surgeons operate on an average of 11 cases a year this appears adequate to maintain high quality care and develop and maintain a service.

Objective: To evaluate the outcome of RSA in terms of improvement in pain and range of motion, prosthetic survival and any complications at 2-years follow up.

Methods: This descriptive case series was prospectively conducted at the Department of Orthopedic Surgery, National Institute of Rehabilitation Medicine (NIRM), Islamabad over a period of 7-years. It included all patients of all genders who underwent RSA for various indications during the period spanning from Jan 2014 to Dec 2020. A minimum follow-up of 2-years was ensured.

Results: There were 21 patients with 16 males and 5 females. The age ranged between 17-35 years with a mean age of 21±4.41 years. The various indications were rotator cuff arthropathy (n=10; 47.61%), post traumatic three part fracture (n=5; 23.80%), post traumatic four part fracture (n=3; 14.28%), primary osteoarthritis of glenohumeral joint (n=2; 9.52%) and rheumatoid arthritis (n=1; 4.76%). We encountered complications among seven patients (33.33%). These included nerve palsies (n=3), scapular notching (n=2) and wound infection (n=2)

Conclusions: We observed remarkable improvement in pain and range of motion following reverse shoulder arthroplasty among our patients. Our share of complications conform to what is reported in the published literature.

Background No biomechanical study to discover the role of lateral triceps tendon and anconeus as an active stabilizer against gravity varus.

Methods Seven cadaveric elbows were tested under gravity varus stress using a custom-made machine. Contact pressure data were collected and processed using TekScan sensors and software. The specimens were tested in a sequential muscle loading of lateral triceps in 3 stages. (Stage 1: 40N in central triceps tendon, 10N in lateral triceps tendon, Stage 2: 25N in CT, 25N in LT, Stage 3: 10N in CT, 40N in LT). After data collection was completed without muscle loading of lateral triceps (Stage 0, 50N in CT, 0N in LT), sequential muscle loading of triceps was performed and tested in each stage with two different condition of anconeus (active/inactive). The mean contact pressure and mean M/L ratio (contact pressure of medial coronoid / contact pressure of lateral coronoid) was used for the comparison among the three groups (Stage 1-3) with the LCL deficient elbow.

Results The mean contact pressure and M/L ratio decreased progressively with sequential loading of LT in both anconeus mode. (Inactive; p < .0001, Active P<.0001) The mean contact pressure and M/L ratio of active anconeus was higher than that of inactive anconeus in each Stage. (P<.0001) The combination of Stages (Stage 0-3) and Anconeus (active or inactive) is not associated with mean contact pressure (p=0.474) and M/L ratio (p=0.204) .

Conclusions Lateral triceps tendon and anconeus act independently as an active stabilizer against varus laxity.

Chronic radial head dislocation is a rare but potentially devastating injury resulting in long term impaired function and movement. Early recognition and management are essential to restore elbow flexion and, as much as possible, pronation supination.
The annular ligament plays a fundamental role in maintaining the position of the radial head and the stability of the elbow joint and several treatment strategies have been proposed.
The treatment of chronic radial head dislocations in children can be challenging and currently there is no consensus on the optimal treatment.
Case Report of a 6-year-old boy who suffered a fall onto his outstretched left arm, with 6 weeks of evolution, and sustained a left radial head fracture with anterior dislocation, without ulnar deformity. A Boyd and Speed approach was made, and a modified Bell Tawse procedure was performed using a lateral slip of the triceps tendon, passed around the radial neck and fixed with a suture anchor in the ulna.
Pediatric cases of isolated radial head dislocation can be successfully managed with minimal complications by using Bell Tawse modified technique for the reconstruction of the annular ligament.
This versatile approach allowed access to all the structures, minimizing the risk of surgical scarring, with excellent functional and imagiologic results, without long-term complications.
To our knowledge, there are no reported cases regarding a modified Bell Tawse procedure using suture anchor to fix the ligament at ulna.

Background: Injuries of the acromioclavicular joint (ACJ) are quite common in young and active people and account for about 9% of all shoulder girdle injuries. The best management of grade III injuries has been a source of controversy and extensive debate. When surgery is indicated, there is still no gold standard surgical technique for treating Type III dislocations.
Methods and Materials: A comprehensive search of PubMed, Medline, Cochrane and EMBASE using various combinations of the keywords "Rockwood", "Type III", "treatment", "surgery", "acromioclavicular joint", "dislocation” since the inception of the databases to December 2020. Surgical techniques were divided into two groups, Group 1: AC joint fixation using hardware, and Group 2: CC ligament fixation/reconstruction.
15 studies were selected for the final review following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines.
Results/Conclusions: This review showed better outcome scores in Group 2. Overall, complication rates were higher in Group 1 compared to Group 2. The results of this review show that CC fixation using suspensory, or loop devices of Rockwood Grade III injuries have better outcomes and fewer complications than fixation of the AC joint with hardware

Background: Deep vein thrombosis (DVT) of the upper limb is a rare complication following shoulder replacement surgery (SRS), with an incidence not well described in the literature.
Case Presentation: The authors report a case of 81 years old female patient that underwent reversed total shoulder arthroplasty for symptomatic humeral head osteonecrosis. The immediate post-operative care had no intercurrences. Two weeks after the procedure, the patient was referred to the ER with upper limb pain and significant swelling. Eco-doppler showed parcial thrombosis of the ipsilateral subclavian vein, despite the patient being under therapeutic anticoagulation (apixaban 5mg bid) due to an auricular fibrillation. During peri-operative care, apixaban was interrupted and replaced with a low molecular weight heparin (LMWH) enoxaparin 60 mg bid. No personal or family history of DVT was described. The patient was discharged with a LMWH tinzaparin 0.7 mL/day and suspended apixaban.
Clinical Outcomes: Two weeks later, the patient was evaluated by an imunohemotherapist that suspended the LMWH, restarted apixaban 5mg bid and initiated a study to identify the possible cause of this DVT. At that time the patient already referred an improvement of the swelling.
Discussion: Despite there are not well-established guidelines regarding thromboprophylaxis during and after SRS, several factors have been hypothesized to predispose to thrombotic events; from medical history, to intra-op and post-op procedures. However, the 2010 guidelines of the AAOS define prior DVT as the only pre-op risk factor recognized for post-op DVT.

The uncommon Monteggia injury is defined as a fracture of the proximal ulna associated with a dislocation of the radial head.
Depending on the trauma mechanism, associated lesions may occur, namely, fracture to the radial head, olecranon or distal forearm
The authors describe a case of a Bado I Monteggia Fracture associated with an ipsilateral olecranon fracture, treated with open reduction and internal fixation of both fractures.
A 54 year-old female entered our emergency room after a motorvehicle accident, she complained of elbow and forearm pain, with local swelling and range of motion limitations. Radiographs showed a type I Monteggia fracture associated with a fracture of the olecranon.
The patient was taken to the operating room and submited to open reduction of the olecranon and proximal ulnar fracture, which allowed the reduction of the radial head. The olecranon was fixated with Kirshner wires and a tension band system, while the proximal ulna received a reconstruction plate.
The patient was left with a posterior splint for 2 weeks and then progressive range of motion was initiated.
At 1 month follow up the radiographs showed sign of consolidation, clinical examination with no pronossupination limitation and elbow stability.
The patient had radiographic and clinical follow-up for 6 months, with normal range of motion after physicaltherapy.
Controversy exists in the literature regarding the Monteggia Equivalent Injuries. In the authors’ opinion, we present a case of a Bado I Monteggia fracture associated with an olecranon fracture, an association very scarse in the literature.

Introduction: Shoulder arthroscopy is frequently performed in rotator cuff repair (RCR). As of yet, no study has investigated specific age groups to characterize the types and risks of postoperative complications. Methods: The National Surgical Quality Improvement Program was queried to identify arthroscopic RCR patients between 2008 and 2016. Patients were stratified into age groups of 5 years starting from age 50. Univariate analysis assessed patient age ranges and postoperative complications within 30 days. Binary logistic regression predicted relative odds of postoperative adverse events. Results: From all arthroscopic RCR patients, 243 (0.86%) had 30-day complications. Overall readmission and reoperation rates were 0.9% (255) and 0.2% (62), respectively. Prevalence of any complication significantly increased with age group (50-54: 0.73%; 55-59: 0.83%; 60-64: 0.49%; 65-69: 1.06%, 70-74: 1.20%; 75-79: 2.40%; 80+: 2.40%; p<0.001). Ages 75-79 (2.3%) and 80+ (2.3%) had significantly increased readmission rates (p=0.002). Relative to patients aged 50-54, age groups 75-79 (OR=2.8 95% CI [1.7–4.6], p<0.001), and 80+ (OR=2.6 95% CI [1.3–5.2], p=0.001) were significantly more likely to develop any complication. Ages 75-79 were more likely to be readmitted (OR=2.1 95% CI [1.2–3.5], p=0.001). Conclusion: Increasing age is associated with increased complication rates in arthroscopic RCR patients. Patients aged 75+ are at significantly increased risks for any complication and readmission.

Distal biceps tendon rupture is a relatively uncommon injury, representing 3% of all tendon lesions. Usually occurs an eccentric contraction against a heavy load in semi-flexed position. Surgical repair can decrease pain and improve strength compared with nonoperative management, which is associated with significant loss of supination and flexion strength.
We reviewed patients with acute or sub-acute (less than 2 weeks) distal biceps tendon rupture, between January 2015 and December 2018, repaired with cortical button and interference screw, with a follow-up of at least 9 months. Surgical technique involved single anterior transverse incision and tendon fixation with cortical button plus interference screw. Patients were immobilized with posterior splint at 90º for 2 weeks.
7 male patients with mean age of 36 years were surgically treated for acute distal tendon rupture. The dominant arm was involved in 6 cases and all were right-handed patients. Average time from injury to surgery was 5 days. Average follow-up period was 15 months. The ROM recovery rate was 95% for flexion (min 112º - max 138º, mean 126º) and 88% for supination (min 30º - max 90º, mean 75º). There were two cases of antebrachial cutaneous nerve neuropraxia and one case of long term intermittent pain.
Conclusions: There are several surgical techniques described in the literature with good results, without evidence of benefit of any of them over the others. In our cases, we achieved good functional results with few complications with the technique described.

Despite 2.2 million bone allografts conducted annually, their complication rate remains high, with recipients incurring infection, fracture, instability, and failure to incorporate. Nonunion rates in massive bone allografts-a bone segment greater or equal to 5 cm in length that contains the total circumference of replaced bone- have been documented as high as 50%. However, if early complication can be avoided, a 75% success rate at 20 years postoperatively has been reported. Non-massive allografts may yield decreased nonunion rates, as massive bone allografts must overcome a greater metaphyseal to diaphyseal incorporation rate and osteoconduction may not ensue beyond the bone periphery. The patient in this case is a 23-year-old male demonstrating absent bone in the right olecranon process of the ulna without attachment of the triceps brachii following a motorbike accident. The patient underwent olecranon allograft reconstruction with triceps brachii tendon reattachment. Four and a half years following allograft reconstruction of the right olecranon, the patient presents with minimal symptoms. However, he reports occasional aching at the site of injury. His current active arc of sagittal motion was 20°-130°, and pronation-supination was 70°-80°. His triceps strength was 4/5 MRC grade. Radiographic evaluation revealed a well incorporated graft with a re-contoured olecranon tip. Overall, this report demonstrates that operations involving a non-massive allograft about the olecranon process may display minimal side effects in comparison to massive allografts, specifically regarding nonunion. Furthermore, this operation allows for improved range of motion following bone loss, allowing the patient to partake in activities of daily living.

Anterior shoulder instability is a common problem in the young active population with an incidence of 23.1/100,000 person-years in Canada. One of the most important factors in surgical decision-making for this pathology is the amount of glenoid bone loss (GBL). Currently, there is no consensus on the best technique for assessing glenoid width and bone loss. The purpose of this study is to investigate the relationship between glenoid width and other morphologic parameters using 3D-CT images of native shoulders to create a measuring tool for GBL. 102 glenoid images were obtained for patients who underwent contralateral shoulder arthroscopy for anterior shoulder instability between 2012 and 2020. Subjects were excluded if they had a history of ipsilateral shoulder instability or fractures. The following glenoid parameters were measured: width (W), height (H), anteroposterior depth, superior-inferior depth and version. Data were analyzed based on gender and age. Simple logistic regression, Kruskal-Wallis Rank and Fisher Exact tests were performed. There were 35 male and 8 females with a mean age of 39.74±17.88 years. Glenoid width was correlated with the height (R2=0.78; p=0.002) and a regression model equation was obtained: W=3.4+0.68*H. There was also a strong correlation with gender (P<0.0001), age (P=0.0384), and BMI (P<0.0001). Male gender was associated with higher values for all parameters and older age was correlated with larger glenoid width (P=0.0015 and P=0.0104, respectively). Glenoid width and bone loss can be estimated using glenoid height. This is particularly important for surgical decision-making when facing glenoid defects in patients with shoulder instability.