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Anterior glenohumeral instability is a widespread pathological condition, not only in athletes but also in the general population. The variations in the lesions (soft tissue and bone defects) that occur after traumatic dislocation or recurrence, combined with the degree of ligamentous laxity and activity, have led to numerous surgical techniques. Following the introduction of arthroscopy in the treatment of shoulder pathology, several new procedures and modifications of old methods were introduced to treat anterior instability. Despite this, there is still controversy regarding the proper management of instability cases combined with bone loss or insufficient anterior soft tissue wall or laxity. Additional soft tissue procedures, along with the simple Bankart repair, strengthen the stability of the repair and can fill the gap in the transition from the classic Bankart repair to the potential overtreatment of bony procedures. This literature review attempts to summarize all the critical studies referring to soft tissue techniques and highlight the most crucial points of their conclusions.

Pyomyositis is a rare bacterial infection that used to prevail in tropical areas for the past century. Nowadays though, more and more cases are reported in high-temperature climate areas. Diagnosis is often delayed due to the variance in clinical presentation, the challenging nature of physical examination of a child, and lack of specific laboratory investigating tools. When the diagnosis is delayed, the outcome may be unpredictable. Multifocal localization through hematogenous or direct spread that may affect the skeletal bone tissue is common. Timely diagnosis and response is a race against septic shock. We present a case series of seven children diagnosed with pyomyositis due to Staphylococcus aureus. High or less clinical suspicion has obviously affected the final outcome since two patients who were not treated in time were subjected to a life-threatening hazard. Five patients who were diagnosed and treated within the first three days after initiation of their symptoms had a predictable and good outcome without complications.

Congenital constriction ring syndrome (CCRS) is a well-described pathological entity that is caused by fibrous bands that entrap parts of the fetus. The manifestations of this syndrome may vary a lot. We present a case of an almost intrauterine amputation of a fetus’s upper limb. Our case is infrequent because the constriction band caused a fracture of the fetus's forearm during pregnancy. Both the band and the fracture resulted in ischemia to the hand and a salvage procedure was applied after birth. Not many authors have reported fractures due to constriction ring bands and even less have reported fractures of the upper limb. A literature review of this rare entity was conducted.

The treatment of painful and chronic dislocated hip in children with severe cerebral palsy (CP) is particularly demanding and controversial. Numerous surgical techniques have been described, and their outcomes vary a lot. The purpose of the present study is to evaluate a new method, which combines varus derotational subtrochanteric osteotomy (VDSO) and external osteosynthesis: (VDSOEO). Methods Six non-ambulatory children with spastic quadriplegia and chronic dislocated painful hips were treated. The technique involved a small incision on the subtrochanteric site of the osteotomy, followed by retention with a single-sided external osteosynthesis with rotational correction capability [swiveling clamp (SC)] for the reduction of the femur head in the acetabulum, and finally by the osteotomy. Hardware was removed without a second intervention four-six months postoperatively and after the osteotomy was healed. Evaluation of the method was based on clinical, functional, and radiological criteria. Results Four patients achieved improved radiological scores. Two patients demonstrated resubluxation during the period of the osteotomy's healing process. However, no patients experienced pain, and all were able to sit post-surgery, while caregivers reported improved capacity for nursing care.

Purpose This study aims to investigate the clinical and functional outcomes of the all-arthroscopic McLaughlin procedure in a clinical series of patients suffering by neglected locked posterior shoulder dislocation. Methods A retrospective clinical study based on prospectively collected data was conducted in a single center regarding 10 patients with neglected locked posterior shoulder dislocation and concomitant reverse Hill–Sachs lesion, who were treated with the all-arthroscopic Mclaughlin procedure. The average humeral bone defect was 39 ± 7% according to the preoperative computed tomography evaluation. The mean time of follow-up was 77 ± 16 months (range, 63–104 months). Results No patient had suffered a new dislocation, whereas all of them were satisfied with the surgical outcome and returned to their previous activities of daily living. External rotation was restored to every patient studied from 0 degrees at the baseline. At the last follow-up, the median external rotation beside the body was 90 degrees (range, 50–90 degrees; p < 0.01) and the respective measurement at 90 degrees of abduction was 90 degrees (range, 80–90 degrees; p < 0.01). The active forward flexion was increased (p < 0.01), from 60 degrees (range, 30–180 degrees) at the baseline to 180 degrees (range, 160–180 degrees) at the last follow-up and the internal rotation was gained (p < 0.01) from the level of buttock (range, lateral thigh–T12) at the baseline to the T11 level (range, T7–L3) at the last follow-up. The median UCLA score was increased from 8 (range, 4–22) to 35 (range, 33–35; p < 0.01) and the Oxford instability score from 5 (range, 3–16) to 46 (range, 43–48; p < 0.01), respectively. Conclusion The arthroscopic McLaughlin procedure in substantial reverse Hills–Sachs lesion caused by locked posterior dislocation leads to excellent clinical and functional results in the long-term follow-up. Level of Evidence This is a therapeutic study, case series with no comparison group, Level IV.

Background A number of papers have been published reporting on the clinical performance of modern trabecular metal-backed glenoid components in total shoulder arthroplasty. However, no systematic review of the literature has been published to date. Methods The US National Library of Medicine (PubMed/MEDLINE), and the Cochrane Database of Systematic Reviews and EMBASE were queried for publications from January 1980 to October 2019 utilizing keywords pertinent to total shoulder arthroplasty, trabecular metal, and clinical outcomes. Results Overall, seven articles were included for analysis (322 operated shoulders, mean follow-up range: 2–4 years). The survival rate of modern trabecular metal-backed glenoid components was 96% (309 out of 322 cases) at 43 months mean follow-up, while the rate of aseptic loosening was 0.3% (1 out of 322 cases). There were 35 cases (10.9%) with glenoid component radiolucency (one of them required revision), and 37 cases (11.5%) of metal debris formation, with four of them undergoing revision. Conclusions There was low quality evidence to show that the use of modern trabecular metal-backed glenoid components in total shoulder arthroplasty may be safe and effective at short-term follow-up. However, this analysis showed alarmingly high rates of both radiolucency of the glenoid component and metal debris formation which raise concern for potential failure of this glenoid component in the long term. Therefore, we feel that modern trabecular metal-backed glenoid components should be still used with caution as part of a structured surveillance or research program until we know if there is a detriment to the prosthesis in the medium to long term. Level: Systematic review, IV.