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The use of a polyvinyl alcohol hydrogel synthetic cartilage implant hemiarthroplasty for osteoarthritis of the first metatarsophalangeal joint has increased since publication of the results of a pivotal, prospective, randomized, multicenter, noninferiority, clinical trial performed in the United Kingdom and Canada. The synthetic cartilage implant was awarded FDA approval in July 2016, permitting its commercial distribution in the United States, which has led to a notable escalation in its use. Concomitant failures in a small proportion of these patients will require conversion to arthrodesis. This study describes the surgical technique used to convert synthetic cartilage implant hemiarthroplasty of the first metatarsophalangeal joint to arthrodesis and the 3 cases that underwent revision at a single center in the United Kingdom. Level of Evidence: Diagnostic Level IV, case series. See Instructions for Authors for a complete description of levels of evidence.

Controversy surrounds the management of displaced three- and four-part fractures of the proximal humerus. The percutaneous Resch technique of stabilisation involves minimal soft-tissue dissection and a reduced risk of stiffness and avascular necrosis. However, it requires a second operation to remove Kirschner wires and the humeral block. We describe a modification of this technique that dispenses with the need for this second operation and relies on a sequential pattern of screw placement. We report the outcome of 32 three- or four-part fractures of the proximal humerus treated in this way at a mean follow-up of 3.8 years (2 to 8)). There were 14 men and 18 women with a mean age of 56 years (28 to 83). At final follow-up the mean Oxford shoulder scores were 38 (31 to 44) and 39 (31 to 42), and the mean Constant scores were 79 (65 to 92) and 72 (70 to 80) for three- and four-part fractures, respectively. We further analysed the results in patients aged < 60 years with high-energy fractures and those aged ≥ 60 years with osteoporotic fractures. There were no cases of nonunion or avascular necrosis. The results were good and comparable to those previously reported for the Resch technique and other means of fixation for proximal humeral fractures. We would recommend this modification of the technique for the treatment of displaced three-part and four-part fractures in patients both younger and older than 60 years of age.

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