Intra-operative complications vary from extremely benign such as glenoid vault penetration to life and limb threatening for example brachial artery injury. Most intra-operative complications can be avoided with careful pre-operative planning, anticipation, and execution. However, even the best planning and execution including fluoroscopic guided reaming cannot prevent all complications. The following intra-operative complications will be discussed in detail in regards to both prevention and management: Glenoid vault penetration, Glenoid component malposition - reverse and primary, Glenoid fracture - reverse and primary, Humeral component malposition - reverse and primary, and Humeral fracture - reverse and primary

Thirty-four acute traumatic dislocations in children aged 5 to 13 years, treated between 1994 and 2002, were reviewed retrospectively. All injuries were caused by a fall. Two injuries were compound. Two children had ulnar nerve injuries, one a radial nerve injury, and one median nerve and brachial artery injury. Posterolateral dislocations were seen in 22 children, posteromedial in eight, posterior in one, anteromedial in two and anterolateral in one. Pure dislocations occurred in eight children and 26 had associated elbow injuries, including 11 medial epicondyle, five lateral mass, one olecranon, one radial head and eight combined injuries. In the combined group, six children had associated fractures and two had divergent dislocation of the proximal radio-ulnar joint. Twenty required open reduction. The injury was initially missed in eight. The child with vascular and median nerve injury had not recovered by four months. Among the others, at follow-up of 4 to 48 months 22 results were excellent to good, 10 fair and one poor. Complications included pseudarthrosis of the medial epicondyle in one child and loss of flexion and rotation of 10° to 30° in 15. Radial and ulnar nerve injuries recovered. A high index of suspicion, good clinical examination and compared radiographs are recommended to avoid missed injuries

We analysed the functional outcome of 27 humeral shaft fractures treated non-operatively in our unit between 1999 and 2000. The mean age of the 20 men and seven women was 37.9 years (20 to 65). Ten fractures occurred in motor vehicle accidents, eight in falls and three in assaults. The remaining six were gunshot injuries. There were 18 closed fractures and nine grade-I compound fractures. Nine fractures were oblique, eight transverse, eight comminuted and two spiral. There was radial nerve palsy in 12 patients, and one poly-trauma patient had a concomitant brachial artery injury. All patients were treated initially by closed reduction and U-slab immobilisation. Radiological union was achieved in 12 patients (44.4%) at a mean of 11 weeks. Fixation by compression plating was necessary in 51.9%, treating delayed union in eight patients, radial nerve palsy in three, nonunion in one, a brachial plexus injury in one and polytrauma in one. One patient (3,7%) developed a pseudarthrosis and refused surgery. We assessed pain, range of movement of adjacent joints, ability to perform activities of daily living and work. In patients treated by U-slab immobilisation, the mean time to full functional recovery was 18 weeks. Those who underwent surgery achieved full functional recovery a mean of eight weeks later. Transverse and short oblique fractures are prone to delayed union and we recommend they be treated by primary internal fixation