Background Phyllodes tumours represent less than 1% of all UK breast neoplasms. Histological features allow classification into benign, borderline or malignant, which has a significant impact on prognosis and recurrence. Currently, there is no consensus for the optimal surgical excision margin. This systematic review aims to provide a comparative summary of outcomes (local recurrence, metastasis and survival) for borderline and malignant phyllodes tumours resected with either ≥1cm or <1cm margins. Methods MEDLINE and Embase were systematically searched (1990 to July 2019), in line with PRISMA guidelines. Study quality was assessed using the Newcastle–Ottawa scale. Results Ten retrospective studies were included (Newcastle–Ottawa scale mean score: 5.6, range: 8–4). Nine reported local recurrence rates, four reported distant metastasis and four reported survival. Meta-analysis pooling demonstrated no statistically significant difference between <1cm and ≥1cm margins in terms of local recurrence rates (relative risk [RR] 1.43, 95% confidence interval [95% CI] 0.70 – 2.93; p=0.33, n=456), distant metastasis (RR 1.93, 95% CI 0.35 – 10.63; p=0.45, n=72) or mortality (RR 1.93, 95% CI 0.42 – 8.77; p=0.40, n=58) for borderline and malignant tumours. Additionally, two studies demonstrated no significant difference in local recurrence for borderline tumours excised with <0.1cm margins compared to ≥1cm. Conclusion Current evidence suggests that margins <1cm may provide adequate tumour excision. This could enable breast conservation in patients with smaller breast-to-tumour volume ratios, with improved cosmetic outcomes and patient satisfaction. A prospective, multi-institutional trial would be appropriate to further elucidate the safety of smaller margins.

Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Objectives: The primary objective of this systematic review was to evaluate pain relief and shoulder functional outcome following reverse shoulder arthroplasty for three-and four-part proximal humerus fractures in patients over the age of 60 years. The secondary objective was to assess the clinical end radiological complications following this procedure for this indication.Methods: Studies were identified using a MEDLINE search for relevant articles on 20th May 2019. The key terms 'reverse shoulder arthroplasty' and 'proximal humerus fracture' were used.Results: Five retrospective case-series fully met the eligibility criteria. No randomized controlled trials or meta-analyses were found. All of the studies agreed that reverse shoulder arthroplasty was able to offer good pain relief, function end range of forward flexion (FF), and abduction (Abd.). Restrictions in shoulder rotation have to be fully addressed. The rate of major complications, reduction in functional outcome, and development of scapular notching with time was a concern.Conclusions: Reverse shoulder arthroplasty for comminuted proximal humerus fractures has increased over the past several years, yet the published data evaluating the surgical outcome is limited. Large well-designed prospective randomized controlled trials are needed for comparing the various treatment options, in order to ensure that these patients receive the best treatment available.

The trauma and orthopaedic speciality continues to advance as surgery becomes more accessible and safe. However, the bygone days of treatment with traction still has its merits and should remain a part of practitioner's repertoire. This will allow the practitioners to be resourceful in times of unexpected scenarios. We aim to write this article to describe indications, applications of various forms of traction, and their relevant complications.