This review article presents a comprehensive literature review regarding extended trochanteric osteotomy (ETO). The history, rationale, biomechanical considerations as well as indications are discussed. The outcomes and complications as reported in the literature are presented, discussed and compared with our own practice. Based on the available evidence, we present our preferred technique for performing ETO, its fixation, as well as post-operative rehabilitation. The ETO aids implant removal and enhanced access. Reported union rate of ETO is high. The complications related to ETO are much less frequent than in cases when accidental intra-operative femoral fracture occurred that required fixation. Based on the literature and our own experience we recommend ETO as a useful adjunct in the arsenal of the revision hip specialist. Cite this article: EFORT Open Rev 2020;5:104-112. DOI: 10.1302/2058-5241.5.190005

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We propose pragmatic approach to the initial treatment of fracture dislocations of shoulder. In type I injury, where there is an anterior dislocation with greater tuberosity fracture, one should attempt a reduction under sedation; 94% of attempted reductions under sedation were successful and no fracture propagation occurred. In case of a type II injury, when the fracture is involving a surgical neck of the humerus with or without greater tuberosities fracture, our experience suggests that no attempt of reduction is undertaken under sedation and patient has general anaesthetic. Posterior dislocation with any fracture remains an unsolved problem, but in our series no attempt of reduction under sedation was made.

Purpose This clinical study was performed to establish the incidence of symptomatic deep vein thrombosis and pulmonary embolism after shoulder surgery as the incidence of venous thrombo-embolism complicating shoulder surgery is poorly described in literature. Methods We reviewed retrospectively clinical records of 920 consecutive patients who had any surgical procedure performed on their shoulder in Glan Clwyd Hospital, North Wales and a further 1,421 consecutive patients who had surgery in Morriston and Singleton Hospitals, South Wales. Patients' records were assessed for any admissions due to proven VTE; we investigated for any radiological results suggestive of venous thrombo-embolism and for deaths in the post-operative period. Results We analyzed data of 2,341 patients. There was one fatal PE in this group, whereby the patient died within 48 hours following reverse shoulder replacement, and post mortem revealed massive pulmonary embolism. There were a further three cases of symptomatic, non-fatal PE. There were six cases of symptomatic DVT of lower limb. All these cases were treated successfully with anticoagulation. No upper limb DVT was identified. Conclusion Recent studies suggest that DVT prevalence following shoulder arthroplasty is as high as 13 %. In our study we examined occurrence of symptomatic VTE only. According to our results the prevalence of symptomatic DVT following shoulder surgery is 0.26 %, symptomatic PE 0.17 % and combined prevalence of VTE is 0.43 %. We would advise careful thought about the risk of thrombosis and use mechanical prophylaxis in shoulder surgery, especially for longer procedures. We would not recommend routine pharmacological prophylaxis unless there are additional risk factors.

Fractured neck of femurs is a very common presentation to hospital, especially in an elderly population and in almost all cases requires an operation, usually a cemented or uncemented hemiarthroplasty. Current evidence and multiple guidance issued in UK suggest the use of cemented hemiarthroplasty above uncemented prostheses. This retrospective case series performed in District General Hospital in Wales, UK. Notes and radiographs of 80 consecutive patients who had hemiarthroplasty for the fracture of neck of femur were examined by independent observer. All patients received modern prosthesis-collarless, polished tapered cemented stem or fully HA-coated uncemented stem-based on the choice of treating consultant. There were 47 uncemented prostheses and 33 cemented hemiarthroplasties used. We identified 12 significant complications in the uncemented group (26 %) as compared to three in the cemented group (6 %). The most significant difference was periprosthetic fracture rate, with five in the uncemented group (10.7 %) as compared to none in the cemented group. There were a total of six reoperations in four patients all of whom had initially undergone uncemented operations. In both groups, 24-h mortality rate was similar. Our study supports the use of modern cemented prosthesis as opposed to modern uncemented hemiarthroplasty. Post-operative complication rate after uncemented prosthesis is unacceptably high, especially periprosthetic fracture rate.

This study reports a case of a 57-year-old woman diabetic patient who presented to the authors' institution with signs and symptoms typical of plantar fasciitis. Her condition did not resolve with nonsteroidal anti-inflammatory drug therapy, podiatry, and physiotherapy input and she was given a steroid injection for treatment of plantar fasciitis. She was admitted to the hospital 17 days following injection with signs of acute infection. Diagnostic workup revealed an acute calcaneal osteomyelitis. Infection did not respond to conservative treatment and the patient required a partial calcanectomy. This case highlights the significant risk of steroid injection in plantar fasciitis, especially in diabetic patient. The authors urge surgeons to consider this when obtaining consent for injection and they advise very close follow-up of such patients.

There is no significant difference in subsidence or survivorship between Revitan and MP stems.

Periprosthetic Joint Infection (PJI) is a devastating complication of the Total Joint Arthroplasty (TJA). It presents a great challenge for the clinician to diagnose and manage it appropriately, with significant morbidity for the patients and cost for health care providers. The purpose of this study is to review and examine the role of multi-disciplinary team (MDT) approach in diagnosis and management of prosthetic joint infection (PJI) and how this approach can influence outcomes. All published literature examining the role of multidisciplinary care in the management of PJI and the influence of this approach to the management and outcomes of patients with this diagnosis were included. Studies published in languages other than English were excluded. There is a paucity of data on the influence of multidisciplinary care on outcomes of the management of PJI. Evidence suggests that the MDT has important role in ensuring all factors in the management of this complex group are considered and best possible care is delivered. Multicentre randomised clinical trials are required to assess the influence of MDT’S on outcome as well as important questions around the structuring of these teams.