The deltoid abduction lag test for assessment of axillary nerve injury and functional deltoid recovery.

Background: Diagnosis and assessment of functional deltoid recovery following axillary nerve injury is challenging due to numerous other muscular contributions to shoulder movement - particularly supraspinatus, rhomboids and long head of triceps. We present the deltoid abduction lag test (DALT) which offers four clear benefits: 1) it successfully isolates deltoid in the presence of a functioning supraspinatus with intact tendon and attachment; 2) it is safe to perform early following anterior shoulder dislocation (the most common cause of axillary nerve injury); 3) it allows assessment of early functional reinnervation of posterior deltoid to aid decision-making with respect to surgical intervention; 4) it is an objective measure which does not rely on patient compliance with initiation of active movement.

Methods: A retrospective review of consecutive patients referred with axillary nerve injury to a national centre for Peripheral Nerve Injury between 2014 and 2024 was conducted.

Use of posteroanterior reference guides for bone block or coracoid process transfer in anterior glenohumeral instability: a cadaveric study of the relationship to the suprascapular nerve.

Background: Iatrogenic suprascapular nerve injury secondary to posterior drilling or screw penetration is a recognized complication of bone block or coracoid process transfers for anterior glenohumeral instability. We present the first cadaveric study that assesses the safety of posteroanterior reference guides and quantifies the relationship of the suprascapular nerve to posterior glenoid fixation with suture buttons.

Methods: Anterior glenoid bone block reconstruction with suture buttons utilizing a posteroanterior reference guide was performed in 10 fresh frozen cadavers via a posterior portal.

Pseudoachondroplasia associated with os odontoideum and retro-odontoid mass: case-based update.

Purpose: Pseudoachondroplasia is a rare skeletal dysplasia caused by a mutation in the COMP gene. Infants with pseudoachondroplasia present with rhizomelic dwarfism. Pseudoachondroplasia can resemble achondroplasia, which also presents with a phenotype of rhizomelic dwarfism.

Radiolucent cerclage for humerus fractures: beware of radial nerve injury-a case report.

A 73-year-old woman was referred to a National Centre for Peripheral Nerve Injury with a post-operative left radial nerve degenerative lesion following open reduction and internal fixation of a proximal third humerus fracture using radiolucent Arthrex FiberTape® Cerclage as an adjunct to plating to improve stability. Intra-operative photographs illustrate compression of the radial nerve under the cerclage construct. Use of radiolucent cerclage for humerus fractures is increasing with modern systems capable of withstanding an ultimate load of 4300 N.

Predictors of mortality in periprosthetic fractures of the hip: Results from the national PPF study.

Introduction: Periprosthetic fractures (PPFs) around the hip joint are increasing in prevalence. In this collaborative study, we aimed to investigate the impact of patient demographics, fracture characteristics, and modes of management on in-hospital mortality of PPFs involving the hip.

Methods: Using a multi-centre cohort study design, we retrospectively identified adults presenting with a PPF around the hip over a 10-year period.

Artificial intelligence in orthopaedics: can Chat Generative Pre-trained Transformer (ChatGPT) pass Section 1 of the Fellowship of the Royal College of Surgeons (Trauma & Orthopaedics) examination?

Purpose: Chat Generative Pre-trained Transformer (ChatGPT) is a large language artificial intelligence (AI) model which generates contextually relevant text in response to questioning. After ChatGPT successfully passed the United States Medical Licensing Examinations, proponents have argued it should play an increasing role in medical service provision and education. AI in healthcare remains in its infancy, and the reliability of AI systems must be scrutinized.

Causes and associations with mortality in patients with pelvic ring injuries with haemorrhagic shock.

Background: High energy pelvic ring injuries are associated with significant morbidity and mortality and can be accompanied by haemorrhagic shock following associated vascular injury. This study evaluated the causes and predictors of mortality in haemodynamically unstable pelvic fractures.

Methods: This retrospective observational study at a Major Trauma Centre reviewed 938 consecutive adult patients (≥ 18yrs) with pelvic ring injuries between December 2014 and November 2018.

Virtual fracture clinics: be vigilant for the ligamentous elbow injury.

The Covid-19 pandemic encouraged remote healthcare and led to dependency on virtual fracture clinics (VFC). VFC are orthopaedic consultant-led clinics where cases are reviewed virtually following referral by emergency department clinicians. Success is contingent on a comprehensive initial history and examination.

Range of Movement and Patient-Reported Outcomes in Shoulder Arthroplasty in the Elderly: A Comparison of Anatomical Versus Reverse Shoulder Replacements.

Introduction Shoulder arthroplasty is in increasing demand in the elderly given the rising prevalence of glenohumeral osteoarthritis (OA) across the population. There is a dearth of evidence in the current literature comparing anatomical total shoulder arthroplasty and reverse total shoulder arthroplasty (RTSA) in the elderly population. This study compares patient-reported outcome measures and range of movement (ROM) between anatomical and reverse total shoulder replacements in matched patient cohorts over the age of 70 years.

Evidence-based approach to providing informed consent for hip fracture surgery during the COVID-19 era.

Background: Hip fractures are the most common reason for inpatient orthopaedic trauma admission. Urgent surgical intervention for hip fractures has remained a clinical priority throughout the coronavirus disease 2019 (COVID-19) pandemic. Despite this, there is a paucity of clinical guidance addressing the informed consent process for hip fracture surgery in COVID-19 positive patients.

The effects of COVID-19 on perioperative morbidity and mortality in patients with hip fractures.

Aims: During the COVID-19 pandemic, many patients continue to require urgent surgery for hip fractures. However, the impact of COVID-19 on perioperative outcomes in these high-risk patients remains unknown. The objectives of this study were to establish the effects of COVID-19 on perioperative morbidity and mortality, and determine any risk factors for increased mortality in patients with COVID-19 undergoing hip fracture surgery.

The role of anterolateral augmentation in primary ACL reconstruction.

The anterolateral soft tissue envelope of the knee has long been recognised as a key stabilising structure. Once the mainstay of operative management of anterior cruciate ligament (ACL) rupture, interest in the area fell away with the advent of intraarticular arthroscopic reconstruction. Renewed interest in these structures together with cadaveric data evidencing the potential for restoration of near normal knee biomechanics following ACL and anterolateral soft tissue reconstruction has driven current concepts and development of operative techniques.

Dual mobility in primary total hip arthroplasty: current concepts.

Total hip arthroplasty (THA) is one of the most successful surgical procedures - reducing pain and providing functional improvement. However, THA instability is a disabling condition and remains the most common indication for revision THA. To combat the risk of instability, the concept of dual mobility (DM) was developed.

Patellofemoral arthroplasty: Current concepts.

Isolated patellofemoral arthritis (IPA) is a debilitating condition characterised by a loss of articular cartilage on the patella facets, the trochlear groove or both. By definition, patients with IPA must have normal cartilage in the tibiofemoral compartments of their knee. It is therefore logical to pursue arthroplasty which corrects the abnormality while sparing healthy bone and preserving the knee's native kinematics, which is the premise underpinning patellofemoral arthroplasty (PFA).

Unicompartmental knee replacement - Current perspectives.

Unicompartmental knee replacement (UKR) is an effective treatment for end-stage, symptomatic unicompartmental osteoarthritis of the knee. However, certain aspects of the procedure are still debated. These areas of discussion include patient selection criteria, implant design and the discrepancy in survival rates between national registries and independent case series.