The proximal humerus internal locking system is an internal fixation device consisting of a low-profile plate and locking screws, which is used for the fixation of three- and four-part fractures of the proximal humerus. We describe a case in which the screws cut out of the humeral head causing injury to the axillary artery necessitating urgent removal of the implant.

We present the outcome of 47 Souter-Strathclyde replacements of the elbow with a mean follow-up of 82 months (12 to 129). The clinical results were assessed using a condition-specific outcome measure. The mean total score (maximum 100) before the operation was 47.21 and improved to 79.92 (p < 0.001). The mean pain score (maximum 50) improved from 21.41 to 46.70 (p < 0.001) and the mean functional component of the score (maximum 30) from 11.19 to 18.65 (p < 0.001). There was negligible change in the score for the range of movement although a significant improvement in mean flexion from 124° to 136° was noted (p < 0.001).

Revision surgery was required in four patients, for dislocation, wound dehiscence and early infection in one, late infection in two and aseptic loosening in one. The cumulative survival was 75% at nine years for all causes of failure and 97% at ten years for aseptic loosening alone. Our study demonstrates the value of the Souter-Strathclyde total elbow arthroplasty in providing relief from pain and functional improvement in rheumatoid patients.

Purpose of the study: To assess the survivability of the metal backed glenoid component, to examine its mode of failure and to measure the range of movement, specifically rotation following Total Shoulder Arthroplasty.

Patients and methods: 46 patients (55 shoulders) were prospectively followed up after Biomet biomodular Total Shoulder Arthroplasty using a metal backed glenoid component fixed with screws. 36 patients (43 shoulders) had Rheumatoid arthritis, 9 patients (11 shoulders) had Osteoarthritis and 1 patient had Psoriatic arthritis. Mean age at surgery was 58 years (range 37 to 79 years). Patients were followed up for a minimum of 5 years. Data was collected prospectively for a mean follow up of 84 months. 28 of the 46 patients had more than 10 years follow up. Range of movement including forward flexion and rotation was measured. Data was analysed by 3 independent observers. Intention to treat or revision of component was taken as failure. Paired t test comparison was carried out for statistical analysis.

Results: One failure was noted in the Osteoarthritis group at 8 years follow up. Superior head migration and eccentric wear of polyethylene liner was noted in an otherwise well fixed glenoid component. Range of external rotation improved from a mean of 18.2 to 38.2 degrees. This improvement was statistically significant (p=0.01, 95% CI= 6.3 to 35.2). The range of forward flexion improved significantly from a mean of 80.5 to 110 degrees (p= .01, 95% CI= −42.6 to −5.9)

3 failures were noted in the Rheumatoid group. 2 patients needed revision to hemiarthroplasty within 4 years of surgery for rotator cuff insufficiency with superior head migration but without loosening of glenoid. One other shoulder was revised at 11 years for glenoid component loosening with a worn out polyethylene liner. All 3 failures occurred in patients more than 60 years of age. Rheumatoid patients under 60 had a significant improvement in the range of external rotation from a mean of 24.2 to 30.6 degrees (p= 0.03, 95% CI = −21.4 to −1.1). The range of forward flexion improved from a mean of 71.2 to 73.3 degrees which was not statistically significant (p=.767). Rheumatoid patients over 60 years of age did not have a statistically significant improvement in the range of external rotation( p= 0.712) or in their range of forward flexion (p=.757).

Conclusion: Contrary to recent literature, in this study the metal backed glenoid component performed well in the medium to long term following Total Shoulder Arthroplasty particularly in patients with Osteoarthritis and in younger patients suffering with Rheumatoid arthritis.

A prospective study to assess the long-term outcome of ASAD (arthroscopic subacromial decompression) in the presence of un-reconstructable large and massive cuff tears using a modified Constant score.

All patients under the care of the senior author admitted for ASAD had a modified Constant score recorded pre-operatively, excluding the power component. Review of patient notes between May 1994 and August 2000 identified 40 patients (45 shoulders) with un-reconstructable rotator cuff tears found at the time of surgery. Nine patients failed to attend. Thirty-one patients (35 shoulders) were scored by a single independent observer. Five shoulders were excluded having undergone subsequent surgery. Five pre-operative scores could not be retrieved. The preoperative and review scores were compared in the remaining 25 patients (25 shoulders).

The average age at review was 75 years (range 39–85) with mean review of 51 months from surgery (range 20–94). In the studied population the mean score increased as follows (95% confidence limits in parentheses). Mean pain score improved from 4.8 (+/−2) to 8.5 (+/−1.6), the mean activities of daily living score increased from 8.9 (+/−1.5) to 12.6 (+/−2.4) and the range of motion improved from 22.9 (+/−2.9) to 31.3 (+/−3.3) points.

The total score improved from 36.6 (+/−4.6) to 52.4 (+/−6.5). The average gain for each patient was 15.8 (+/−6.5)

The 95% confidence limits indicate significant improvement for pain, range of motion and total score.

In our study population of patients undergoing ASAD in the presence of un-reconstructable cuff tears, the 95% confidence limits of the preoperative and follow up scores do not overlap. ASAD confers significant benefit in patients with large cuff defects.

Thirty-four patients with an average age of 64 years had forty consecutive total elbow replacements done using Souter-Strathclyde prostheses between 1991 & 1994. Six patients had died, however useful data was available in three that were included in the series, two patients failed to attend review clinic due to other medical problems and were excluded from this study. The results of thirty-five elbows were analysed and are presented in this paper. Mean follow up at the final evaluation was 79 months.

All patients were evaluated before and after the operation using Modified Mayo’s Performance index with maximum score of 100. An independent observer performed the latest clinical evaluation.

The average score before the operation was 51. 4, this improved to 82. 4 (p< 0. 001), pain score (maximum 50) improved from 23. 4 before the operation to 47. 1 (p< 0. 001) and the functional component of the score (maximum 30) also improved from 12. 5 to 18. 57 at the time of follow up. The range of motion score (maximum 20) showed least improvement with slight improvement in flexion from 127. 57 before the operation to 134. 34 (p=0. 387) at the time of last follow up.

Four elbows were removed, one due to early and three due to late onset deep infection; there has been no incidence of aseptic loosening requiring revision. Other complications were ulnar nerve dysthesia (two), minor intra-operative fracture (two), dislocation (one).

The Souter-Strathclyde elbow provides sustained pain relief, and functional improvement in the upper extremity. Motion remains unaffected, with some improvement in flexion. We believe that the Souter-Strathclyde elbow replacement can help patients with rheumatoid elbow disease, and we continue to evaluate prospectively a larger series of patients.