Frozen shoulder is a common disease which causes significant morbidity. Despite over a hundred years of treating this condition the definition, diagnosis, pathology and most efficacious treatments are still largely unclear. This systematic review of current treatments for frozen shoulder reviews the evidence base behind physiotherapy, both oral and intra articular steroid, hydrodilatation, manipulation under anaesthesia and arthroscopic capsular release. Key areas in which future research could be directed are identified, in particular with regard to the increasing role of arthroscopic capsular release as a treatment.

Nasal septal perforations present a distinct challenge to the otolaryngologist and a significant cause of symptoms to affected patients. Many surgical techniques for the repair of septal perforations have been described. Connective tissue autografts are commonly used as interpositional grafts between the septal flaps. Recently acellular human dermal allograft has been used with success. In total, 17 patients with symptomatic anterior nasal septal perforations that had failed conservative treatment underwent a closed endoscopic repair of their perforations with acellular human dermal allograft (alloderm) and an anteriorly based inferior turbinate flap; 13 patients had a successful closure of the perforation, two patients, despite initial success, re-perforated as a result of persistent crust picking and, in two patients, the graft failed. With appropriate patient selection and stringent postoperative care the authors consider this technique offers a good surgical outcome for the closure of septal perforations.

Surgical intervention for the acute Jones fracture should be reserved for the athletic individual because there is a clear advantage in terms of time to return to sporting activity. Nonoperative treatment remains a viable alternative to surgery in all acute and delayed cases, providing there is no established nonunion and the patient is aware of the implications.

The aim of this study was to determine which anaesthetic and vasoconstrictor preparations UK Otorhinolaryngologists use for rhinological surgery, with particular reference to cocaine and adrenaline. The incidence and types of adverse reactions to cocaine were also recorded. A postal survey of all BAO-HNS consultant members was performed. Of the 360 consultant surgeons included in the survey, the majority still use peri-operative cocaine on a regular basis, 66 per cent use cocaine and adrenaline together and more than 40 per cent use cocaine in paediatric patients. Sixteen per cent of respondents did not use cocaine. Only 11 per cent of surgeons had experienced cocaine toxicity in their patients, with only one recorded case of mortality. Most surgeons in the UK use cocaine because of the superior operative field it provides and because they consider it to be safe even with adrenaline. The actual incidence of adverse reactions to cocaine is low, with serious complications being less common than the risks from general anaesthesia. Cocaine remains a valuable agent in the armamentarium of the rhinologist.

Background: Although dislocation of the shoulder is a relatively common event, the overwhelming majority of injuries are anterior. Posterior shoulder dislocation is more uncommon, comprising between 3% and 5% of all shoulder dislocations. One percent of shoulder dislocations involve a fracture, whereas only 0.9% of the 1500 cases reported by Neer (J Bone Joint Surg Am 1970; 52:1077-89; J Bone Joint Surg Am 1970; 52:1090-103) concerned posterior fracture dislocations. Bilateral posterior fracture dislocation is an even rarer event, comprising just 5% of all posterior fracture dislocations. Given the rarity and relative poor outcome often observed after these severe injuries, it is important that upper limb function is optimized. Methods: Bilateral posterior fracture dislocations of the shoulder pose a difficult clinical challenge that requires careful management planning. To date, there have been three isolated case reports of using contralateral osteochondral humeral autograft and hemiarthroplasty. We report our experiences and clinical outcomes in managing four such cases using a variety and combination of treatments, including the first reported use of reverse shoulder arthroplasty with contralateral osteochondral humeral autografting. Results: Shoulders reconstructed with humeral autograft demonstrated superior Oxford Shoulder Scores and an improved range of motion, as measured by a markerless machine vision system, compared to hemiarthroplasty. Conclusions: Our results support the use of a contralateral humeral autograft in bilateral posterior shoulder fracture dislocation.

The relationship of these vessels to the landmark of the tendon of the insertion of pectoralis major into the proximal humerus is described. Damage to these previously undocumented branches can cause persistent bleeding leading to prolonged surgery and post-operative haematoma and infection, as well as poor visualisation during the procedure. Cite this article: Bone Joint J 2016;98-B:1395-8.

Compartment syndrome of the leg and forearm are well described in the literature. However, compartment syndrome of the hand is rare and in children it is even rarer. Atraumatic hand compartment syndrome has not to our knowledge been previously reported. We describe a case of an atraumatic compartment syndrome of the hand in a child who underwent an urgent fasciotomy. The child was diagnosed with hereditary angiooedema. We highlight a rare but serious complication of a hereditary disease not commonly seen by the surgical community. We hope that this report raises the awareness of this condition, thereby reducing delays in reaching a prompt diagnosis.Paediatric compartment syndrome is a rare condition. Compartment syndrome of the leg and the forearm are much more common and are well described in literature. The average annual incidence is given as 7.3/100,000 for men and 0.7/100,000 in women.1 The incidence of compartment syndrome of the hand is not documented although there are a limited number of anecdotal reports. Trauma, for example in the form of crush injuries, venomous animal bites, 2 vascular injuries and burns, 3-5 is the most common underlying aetiology behind these case reports. There is one report of Henoch-Schönlein purpura 6 causing an acute compartment syndrome of the hand. We describe the first reported case of an acute hand compartment syndrome caused by hereditary angiooedema. case historyA 13-year-old Asian, right hand dominant girl presented with progressive left hand swelling (Fig 1) and a 5-day history of fever and malaise. There was no significant history of trauma, fall or any animal or insect bites. She had suffered from previous episodes of idiopathic swelling over the last two years on a monthly basis affecting both hands and legs as well as her head and face. She was otherwise fit and healthy.The patient was referred to the orthopaedic service five days into her illness. She was haemodynamically stable and apyrexial with gross, painful, oedematous swelling of the left hand. Digital perfusion was not impaired and she had paraesthesia in a median nerve distribution. Radiographs were normal and blood tests including a full blood count and inflammatory markers were also normal.A clinical diagnosis of compartment syndrome was made and the patient was taken to emergency theatre for a fasciotomy (Fig 2). Intraoperatively, a tight carpal tunnel was released. Necrotic fascia and muscle was found in the mid palmar space. The thenar eminence was normal and the recurrent palmar branch of the median nerve was preserved. Intermetacarpal spaces were also released, which again showed evidence of a necrotic brown exudate. A sample of this fluid was sent for microscopy and culture and went on to show no evidence of any organisms. In addition, the patient's blood and urine cultures were also negative. Postoperatively, the left limb was kept elevated and intravenous antibiotics were administered prophylactically after surgery until the result of the microbiology sample was known.At the 12-week foll...

Anterior dislocation of the shoulder is a common injury which is often reduced in the emergency department, without specialist orthopedic input. We report a case of an irreducible locked anterior glenohumeral dislocation with impaction of the humeral head onto the antero-inferior glenoid rim and subsequent generation of a Hill–Sachs lesion. To our knowledge, we describe the first reported case of using computer-assisted tomography to generate a sequence of movements to safely disimpact the locked dislocation without causing further iatrogenic injury or a fracture through the humeral articular surface. This novel image-assisted closed reduction technique spared the patient from the morbidity associated with performing open reduction surgery. At 6-month follow-up, the patient reported no re-dislocations, returned to work and had excellent range of motion.