In the management of idiopathic frozen shoulder, manipulation under anaesthesia is known to have serious potential complications including fractures and intra-articular injuries. Arthroscopy is a safer treatment modality but requires special instruments, experience, and involves added cost. The aim of this work was to study the use of miniopen Coracohumeral ligament release and manipulation of the shoulder as a safe and simple method of treating idiopathic frozen shoulder that could be performed as a quick procedure under short duration anaesthesia obtaining a significant improvement of shoulder function while avoiding complications that are feared to occur with the use of manipulation under anaesthesia. Miniopen Coracohumeral ligament release is performed through a 3-cm incision. The Coracohumeral ligament is divided, and then the shoulder is manipulated without undue force. A case series including fifteen patients (19 shoulders) with idiopathic frozen shoulder operated by this technique is described. Miniopen Coracohumeral ligament release and manipulation is a quick procedure that may be performed under short duration anaesthesia obtaining a significant improvement of shoulder function meanwhile avoiding complications that are feared to occur with the use of manipulation under anaesthesia.

Fracture displacement, a high Pauwels angle, and delayed presentation decrease the potential for healing of femoral neck fractures. In the young individual, head preservation is paramount. Valgus intertrochanteric osteotomy may increase the healing potential of femoral neck fractures in the presence of those detrimental factors. Ten patients younger than 60 years of age with delayed presentation of displaced Pauwels III femoral neck fractures were treated by osteosynthesis and valgus intertrochanteric osteotomy fixed by dynamic hip screws. All osteotomies and nine fractures united with one case developing avascular necrosis.

Background. Compartment syndrome is a serious complication that might occur following fractures. The treatment of choice is emergent fasciotomy of all the involved muscle compartments to lower the compartment pressure. The classic management of fasciotomy wounds was split thickness skin graft. Patients and Methods. Seventeen patients with fracture-related compartment syndrome were managed by fasciotomy in the Orthopaedic Casualty Unit of our university hospital. The fractures included four femoral fractures and 13 fractures of the tibia and fibula. Results. All fasciotomy wounds healed eventually. Wound closure occurred from the corners inward. The skin closure was obtained at an overall average of 4.2 tightening sessions (range 3–7). Fracture healing occurred at an average of 15.4 weeks (range 12 to 22 weeks). No major complications were encountered in this series. Conclusion. Closure of fasciotomy wounds by dermatotraction could be performed in a staged fashion, using inexpensive equipment readily available in any standard operating room, until skin was approximated enough to heal either through delayed primary closure or secondary healing.

Purpose:The aim of this study is to evaluate whether two 3.0 mm Schanz screws in two-part proximal humeral fractures (plus one additional Schanz screw or K wire in three-part fractures) can provide enough stability to allow early mobilization until healing occurs in elderly patients.Settings and Design:This prospective study was performed in the Orthopaedic Department of our University Hospital.Patients and Methods:We performed closed reduction and percutaneous pinning for thirty-three patients with proximal humerus fractures. Twenty-seven patients were available for the final follow-up. Of those 27 patients, 17 had two-part surgical neck fractures; while 10 had three-part fractures. For fixation, we used two 3.0 mm Schanz screws in patients with two-part fractures plus one additional Schanz screw or K wire in the 10 patients with three-part fractures.Results:The mean Constant score modified according to the age and sex was 89.8% (range: 77.3-97.2%). Fifteen patients had excellent results, 11 patients had good results, and one patient had a fair result.Conclusion:Closed reduction and percutaneous pinning with two Schanz screws for two-part surgical neck humeral fractures, plus an additional Schanz screw or K wire for three-part proximal humeral fractures is a useful and effective technique that provides enough stability to allow an early rehabilitation program till union occurs in elderly patients.Level of Evidence:IV; therapeutic study, case series.

Background: Neglected fractures in young adults can be amongst the most difficult to treat in the spectrum of fractures of the femoral neck. Because of its complex anatomy and blood supply, timely fixation is paramount. When this does not occur, non-union and avascular necrosis are common complications. Here, we present a meta-analysis of three common options available to the surgeon treating such complications. Methods: We identified 97 relevant papers by the keywords 'femoral neck fractures'; 'neglected'; 'joint preserving' and 'young adults'; 23 met the inclusion criteria and reported on an overall population of 725 patients. Results: Osteotomy with internal fixation had a union rate of 91.33% (95% CI 84.91-92.87). Fractures fixed by internal fixation with pedicled muscle graft proceeded to union in 86.25% (95% CI 78.92%-88.54%) of cases and those managed with free fibular graft in 88% (95% CI 78.35%-90.84%), respectively. Internal fixation alone, in this study, used as an illustrative control group, was successful in 76.5% (95% CI 65.58%-83.81%) of cases. Conclusion: These findings show superiority of osteotomy with internal fixation in the management of non-united femoral neck fractures, and more complex options with potentially higher morbidity confer no patient benefit.

Fracture Surgery Internal fixationLocked plate a b s t r a c t Background: The ideal surgical fixation for displaced distal clavicle fractures should not

Background. Acute degenerative Achilles tendons ruptures may be managed either operatively or nonoperatively with the superiority of the operative treatment in reducing the risk of rerupture. Acute rupture of Achilles tendon is commonly seen in diabetic patients. Open techniques for Achilles tendon repair have been associated with significant complications as deep infection and wound-related problems. Patients and Methods. Thirteen type II diabetic patients with acute degenerative rupture of the Achilles tendon were managed by miniopen repair augmented by peroneus brevis tendon. Results. All repairs healed successfully. The patients were able to return to preinjury level of activity after a mean of 5 months. The mean ATRS score improved from 15.1 preoperatively to 74.8 postoperatively. The mean Leppilahti ankle score was 59.6. Three patients suffered from superficial wound infection which was successfully managed. However, no patients suffered any major complications such as DVT, deep infection, or reruptures during the period of the study. Conclusion. Repair of acute degenerative tear of the Achilles tendon with peroneus brevis tendon augmentation could be successfully performed through a miniopen technique with minimization of wound complications in diabetic patients.

Background: Madelung deformity is a growth disorder affecting the distal radial epiphysis presenting usually near skeletal maturity with wrist pain, deformity, and limitation of wrist motion. Methods: Ten patients (13 wrists) with idiopathic Madelung deformity were treated with the Sauve-Kapandji procedure. The mean age at the time of operation was 21.8 yr old. The mean follow-up was 16.2 mo. Results: The ulnar head united successfully to the distal radius in all patients. The mean time of union was 10.3 wk. At the final follow up, all wrists were painless. The mean VAS of pain during stressful conditions improved from 6.2 to 2.3. The grip strength improved from 6.7 to 13.2. The mean DASH score improved from 41.9 to 13.2. Conclusions: The Sauve-Kapandji procedure is relatively simple procedure compared to radial osteotomy. It decreases pain and improves strength of wrists with Madelung deformity.