The conservative management if isolated humeral shaft fractures is a long, drawn out, painful process for the patient. For the clinician, it involves multiple clinic attendances and repeated radiographic assessment and brace alteration.

The primary reason for conservative management is the excellent results, but a very definite secondary consideration is the high incidence of shoulder pathology after I.M. nailing. This is thought to be due to rotator cuff pathology at the time of surgery. We question the validity of this second argument.

Ten consecutive humeral shaft fractures attending our unit had an MRI of both shoulders carried out during the initial stages of their injury. Two of the ten had retrograde nailing and the remainder was managed conservatively. While there was no patient with an occult coracoid fracture in association with the shaft fracture. We found eight out of ten to have significant signal changes in the subacromial space on the side of the fracture only.

We conclude that there is a significant occult injury to the shoulder at the time of humeral shaft fracture and this may in fact represent a cause for the high incidence of shoulder pain post fracture.

Introduction. Virtual fracture clinics (VFC's) aim to reduce the number of outpatient appointments while improving the clinical effectiveness and patients experience through standardisation of treatment pathways. With 4.6% of ED admissions due to trauma the VFC prevents unnecessary face to face appointments providing a cost savings benefit to the NHS. Methods. This project demonstrates the importance of efficient VFC process in reducing the burden on the fracture clinics. We completed preformed a retrospective cross-sectional study, analysing two cycles in May (n=305) and September (n=332) 2021. We reviewed all VFC referrals during this time assessing the quality of the referral, if they went on to require a face to face follow up and who the referring health care professional was. Following the cycle in May we provided ongoing education to A&E staff before re-auditing in September. Results. Between the two cycles there was an average 19% improvement in quality of the referrals, significant reduction in number of inappropriate referrals for soft tissue knee and shoulder injuries from 15.1% (n=50) to 4.5% (n=15) following our intervention. There was an 8% increase in number of fracture clinic appointments to 74.4% (n=247), primarily due to an increase number of referrals from nurse practitioners. Radial head fractures were targeted as one group that were able to be successfully managed in VFC, despite this 64% (n=27) of patients were still seen in the outpatient department following VFC referral. Conclusion. Despite the decrease in the number of inappropriate referrals, and the increase in quality of referrals following our intervention. The percentage of VFC referrals in CAVUHB is still higher than other centres in with established VFCs in England. This possibly highlights the need for further education to emergency staff around describing what injuries are appropriate for referral, specifically soft tissue injuries and radial head fractures. In order to optimise the VFC process and provide further cost savings benefits while reducing the strain on fracture clinics

The aim of the study was to prospectively review the incidence of shoulder injuries in a group of professional rugby union players and to identify any relationship between the injury and the causes, position of play, treatment and time to return to playing. An electronic database system was developed specifically to identify the objectives listed above with a view of reducing injury incidence and recurrence through identification of trends. The system was implemented in both Cardiff(2000–2003) and Llanelli(2005–2007) Rugby Football clubs. Extensive prospective data was collected by the team physiotherapists including: Type of injury(Orchard Coding), playing position, session, mechanism of injury and days lost per injury. Shoulder injuries represented 14% of all injuries sustained. Soft tissue injuries account for about 50% of the injuries and result in an average loss of five playing days. AC joint injuries ( 26%) with a recovery period of 5 days were all treated conservatively. Glenohumeral dislocations caused an average loss of 150 days and all required surgery. Fractures around the shoulder were rare with an incidence of 4%. The most common mechanism for shoulder injury was the tackle (43%). Collisions accounted for 15% of injuries whereas weight training was responsible for 31%. Contact situation training was as risky as real game situations. Back row players were more likely to sustain AC joint injuries. Surgical intervention was needed in only 11% of all shoulder injuries. Our data has shown that most shoulder injuries were from contact related areas. Physiotherapy played a key role in the rehabilitation of these players with surgery only indicated in glenohumeral dislocations and fractures. Careful planning of training sessions with emphasis on tackling and weight lifting techniques may reduce the incidence of such injuries

Although the epidemiology and pathomechanics of shoulder injuries in throwing athletes has been wellstudied, less is known about shoulder injuries in other sports where significant loads are carried by the upper limb. We evaluated 90 professional gymnasts who participated in a regular performance schedule during the millennium celebrations in the calendar year 2000. The gymnasts were divided into Group I (n=60) who were selected and trained for 18 months, and Group II (n=30) who were ‘fast-tracked’ through recruitment and training in the final six months before performance. At the conclusion of the performance year, athletes were assessed using a subjective questionnaire, the SF-12 general health instrument, the Oxford instability questionnaire and the Constant score. They also underwent clinical examination, hypermobility scoring and fatigue testing. Of those surveyed, 46% complained of pain in one or both shoulders, and the majority of these received nonoperative physical therapy during the year and were able to continue performing. Five patients (6%) had refractory pain, demonstrated signs of hypermobility, abnormal joint translation and positive relocation tests, often in the absence of symptomatic instability. All were in Group II, presented in the final six months of performance and required arthroscopic treatment for complex tears involving the anterior and superior labrum, including the biceps anchor. These results indicate that the incidence of shoulder injury is very high among professional aerial gymnasts. The underlying cause is likely to be multifactorial in these hypermobile athletes, but the findings are consistent with the concept of cumulative microtrauma to the capsulolabral complex. Acute-on-chronic injury appears to be associated with complex labral pathology which presents with pain rather than with overt instability. Our observations suggest that training and performance schedules should be carefully monitored, incorporating extended preparation and recovery, in order to reduce the risk of shoulder injury. Further work on kinematics of the shoulder during dynamic loading of the weightbearing upper limb is required

The expansion of arthroscopic treatment to serious and catastrophic injuries to the weightlifters of the Hellenic National Weightlifting Team. The evaluation of the results of this specific arthroscopic treatment. 45 athletes (36 male, 9 female) with shoulder injuries 2000–2009. 15 yrs – 35 yrs, average: 27 yrs. One 3-times Golden Olympic. One Bronze medalist, Two Silver Olympic, Three Olympic winners, Five World championsetc. Clinical examination and musculoskeletal ultrasound. Plain X-rays. E.M.G, M.R.I.-arthrography, 3DC/T when that was required. Strength measurement with Nottingham McMecin Myometer for ipsi-contro lateral shoulder. Full ROM was necessary for the operated shoulder before starting exercise for a competition. All 48 underwent arthroscopic treatment (3 mini-open). Arthroscopic stabilization using absorbable or non anchors. 45 athletes, 48 shoulders operated,(3 bilat-erally).36 RC tears, 6 bony-bankart, 2 posterior and 28 anterior labrum detachment, 3 avulsion osteochondral fractures, 2 AMBRII, 4 deranged LH of biceps, 4 underwent SSN release. All patient returned at same sport level except one with AMBRII and cervical spine pathology. Rehabilitation time for basic weightlifting exercise was 3.5 months and for competition level was 4,5 -6 months. The shoulder demands during the snatch, clean and jerk of the weightlifters provoke often shoulder injuries. The arthroscopic surgery gives thorough and broad knowledge of their shoulder injuries. The minimal detachment, less postoperative joint stiffness and decreased shoulder pain are encouraging factors for the arthroscopic treatment. Additionally, the returning time for training and competition combining with a proper rehabilitation seems to be less than open surgery

This study was carried out to determine the incidence of shoulder injuries in the ipsilateral shoulder of patients who attended our unit with fractures of the humeral diaphysis. This was a prospective study. 22 patients with fractures of the humeral diaphysis had an early (within 10 days of injury) MRI scan of the shoulder. The contralateral shoulder was also scanned as an internal control. There were 10 male and 12 female patients. The average age was 45 years. 20 were treated non-operatively, and 2 had retrograde intra-medullary nailing of the humerus. 6 patients in our study had a symmetrical MRI scan. The remaining 16 patients had some acute abnormality evident in the ipsilateral shoulder. 11 patients had a significant subacromial bursitis. 2 of these patients had a tear of the supraspinatus tendon. 1 patient had an undisplaced fracture of the coracoid process. The remaining 4 patients had significant AC joint inflammation, 3 being acute, the 4th being acute-on-chronic. This study shows a high incidence of asymmetrical MRI scans, indicating a definite shoulder injury sustained at the time of the fracture of the humeral diaphysis. We therefore surmise that shoulder pain and dysfunction post antegrade intra-medullary nailing of the humerus may not be due to iatrogenic causes, but may in fact result from concomitant ipsilateral shoulder injury. To our knowledge, this is the first study demonstrating such an association

Purpose of the study:. To describe the incidence, nature, and risk factors associated with upper limb injuries in athletes participating in the London 2012 Paralympic Games. Materials and methods:. This study formed a component of the large prospective cohort study conducted over the 14-day period of the London 2012 Paralympic Games, coordinated through the IPC Medical Committee. Daily injury data were collected by team physicians in 3 329 athletes (46 606 athlete days) participating in the study, and 258 upper limb injuries were recorded. The incidence proportion (IP=number of injuries per 100 athletes), and incidence (number of injuries per 1000 athlete days) of upper limb injuries was calculated. Results:. The overall IP (with 95% CI) of upper limb injuries was 7,2 (6,4–8,1), with an incidence of 5,2 (4,6–5,8). Shoulder injuries were encountered most frequently with an overall incidence of 2,2 (1,85–2,7) and caused the greatest amount of time lost from sport. The incidence of shoulder injuries by sport was 8,8 (5,4–13,5) in powerlifting, 5,0 (2,1–9,8) in Judo, 2,8 (1,2–5,6) in wheelchair basketball, and 2,7 (1,6–4,2) in swimming. The incidence of injuries of the wrist and hand was 3,9 (1,4–8,5) in goal ball, 3,2 (1,5–6,0) in wheelchair basketball, and 2,8 (1,3–5,4) in table tennis. The majority of upper limb injuries occurred in athletes with spinal cord injuries (38,3%) and athletes with amputation or limb deficiency (28,4%). Rotator cuff impingement syndrome and chronic rotator cuff injury were the most frequent specific diagnoses in the upper limb injuries. Conclusion:. To date, this is the largest study evaluating upper limb injuries at the Paralympic Games. The shoulder is the anatomical region most frequently injured and caused the greatest time lost from sport. Type of sport, older age group, and athlete disability category were identified as risk factors for upper limb injuries

The early diagnosis of the suprascapular nerve (SSN) entrapment in overhead athletes with simultaneous shoulder injuries and its arthroscopic release plays an important role for their appropriate treatment and recovery. SSN release at suprascapular and spinoglenoid notches, seems very helpful for increasing their performance. 21 Elite overhead athletes were treated from Jan 2005–May 2009. From 16 to 34 years old, mean 26 years, 4 Javelin throwers (Olympic and National level thrower), 4 Weightlifters (International level), 8 Volleyball Players, 3 Kick Boxer, 2 Water Polo Players. Extreme ROM of arm creates large torques about the shoulder cycle of repetitive microtrauma to the SSN, Direct trauma: fracture, dislocation, blunt trauma traction injury, Sling effect with hyper-abduction injury at the SS Notch, Correlation ROM with SSN entrapment in volley ball players, Eccentric contraction of the ISP (spinoglenoid notch), Internal impingement, Rotator cuff tears, Biceps lesions, Instability, SLAP lesion, Bankart lesion, Mainly infraspinatus muscle atrophy. X-rays, Nerve conduction studies, EMG studies, MRI. All of them had complete pain relief, especially at the posterior shoulder, regained full ROM of the operated shoulder, 19 fully recovered at the pre-injury level, 2 at the postoperative phase, Muscle atrophy improved. Advanced SSN entrapment provoke significant muscle wasting, often irreversible. This underscores the importance of a quick and accurate diagnosis to appropriate intervention. The overhead athletes with increased ROM of their shoulder predispose in SSN entrapment and shoulder injuries and vice-versa. An arthroscopic shoulder procedure for repairing the glenohumeral pathology with a simultaneous arthroscopic SSN release seems to be the appropriate treatment regarding to our resu

Background. The purpose of this retrospective study was to examine the functional outcomes of patients treated for isolated fracture of the greater tuberosity (GT) and to determine how their outcomes were affected by fracture pattern, treatment choices, associated shoulder injuries, the post fixation displacement of GT fragment and the time delay between injury and fixation. Methods. Forty-eight (28 male and 20 female) patients (mean age 45 years) treated at our institution between 1999–2009 matched our inclusion criteria. Thirty-five patients were treated surgically and 13 conservatively. Functional outcome was assessed using Oxford scores (OS), University of California and Los Angeles (UCLA) rating scale and the shoulder index of the American Shoulder and Elbow surgeons (ASES). The outpatient follow up time required and the presence of other shoulder injuries, time delay to surgery and the time off work were also recorded. Results. Outcome scores for patients who sustained simple vs comminuted fractures were not significantly different (OS = 41.8 vs 41, ASES 23.8 vs 23.4, UCLA 26.6 vs 26.3). Time taken off work was less in those who had a comminuted vs a simple fracture (21 vs 30 weeks). Shoulder dislocation was present in 77% and patients had a significantly worse outcome than those with no dislocation (OS = 40.6 vs 44, ASES 22.9 vs 26). Rotator cuff repair was required in 21% of patients and was also associated with a worse outcome (OS 42.8 vs 36.8, ASES 24.5 vs 20.5). Post fixation displacement of the GT fracture of < 5 mm led to a significantly better outcome than displacement >5mm (OS = 43 vs 37, ASES = 25.6 vs 17.7, UCLA 28.2 vs 21.3). Conclusion. Isolated fractures of the greater tuberosity have a worse outcome if they are associated with shoulder dislocation, rotator cuff tear and post fixation displacement of >5mm

Aims

This study aims to describe a new method that may be used as a supplement to evaluate humeral rotational alignment during intramedullary nail (IMN) insertion using the profile of the perpendicular peak of the greater tuberosity and its relation to the transepicondylar axis. We called this angle the greater tuberosity version angle (GTVA).

Aims

Orthopaedic surgery requires grafts with sufficient mechanical strength. For this purpose, decellularized tissue is an available option that lacks the complications of autologous tissue. However, it is not widely used in orthopaedic surgeries. This study investigated clinical trials of the use of decellularized tissue grafts in orthopaedic surgery.

Our purpose was to study the functional outcome and electrophysiologically to assess the axially nerve function in patients who have undergone surgery using a deltoid-splitting approach to treat complex proximal humeral fractures. This was a prospective observational study and was carried out in the Shoulder injury clinic at a university teaching hospital. Over a one-year period we treated fourteen locally-resident patients (median age 59 years) who presented with a three- or four-part proximal humeral fracture. All patients were treated using the extended deltoid-splitting approach, with open reduction, bone grafting and plate osteosynthesis. All patients were prospectively reviewed and underwent functional testing using the DASH, Constant and SF-36 scores as well as spring balance testing of deltoid power, and dynamic muscle function testing. At one year after surgery, all patients underwent EMG and nerve latency studies to assess axillary nerve function. Thirteen of the fourteen patients united their fractures without complications, and had DASH and Constant score that were good, with comparatively minor residual deficits on assessment of muscle power. Of these thirteen patients, only one had evidence of slight neurogenic change in the anterior deltoid. This patient had no evidence of anterior deltoid paralysis and her functional scores, spring balance and dynamic muscle function test results were indistinguishable from the patients with normal electrophysiological findings. One of the fourteen patients developed osteonecrosis of the humeral head nine months after surgery and had poor functional scores, without evidence of nerve injury on electrophysiological testing. Reconstruction through an extended deltoid-splitting approach provides a useful alternative in the treatment of complex proximal humeral fractures. The approach provides good access for reduction and implant placement and does not appear to be associated with clinically-significant adverse effects

Background: Complex anterior fracture-dislocations of shoulder are rare injuries and little is known about the functional outcomes following operative treatment. The aim of our study was to evaluate the functional outcomes following open reduction and internal fixation for these injuries. Methods: Over a ten and a half year period, we studied thirty-two consecutive patients who presented to shoulder injury clinic at the Royal Infirmary of Edinburgh with an acute Type-I complex anterior fracture-dislocation of the shoulder. The average age of the 19 men and 13 women was 58 years (range 21–81 years). All patients were treated with open reduction and internal fixation and were followed up for at least two years. The functional outcomes were assessed by three scoring systems (Disabilities of the Arm, Shoulder and Hand questionnaire, the Constant questionnaire, and the Short Form-36 general health questionnaire). Results: At two years post injury, the median DASH score was 26 points and the median Constant score was 83.5 points. The range of motion of the shoulder joint showed significant improvement throughout the two year period and degree of forward flexion and abduction continued to show significant improvement at five years. At two years, the mean forward flexion was 162°, mean extension was 152°, mean internal rotation was 109° and mean external rotation was 73°. All but one patient returned to their job at two years. Conclusions: Type I complex anterior fracture-dislocations of the shoulder are rare and occur in the middle age and elderly group of population. Following open reduction and internal fixation, the functional outcomes have been shown to be satisfactory. We recommend that open reduction and internal fixation should be the first choice of treatment in Type-I complex anterior fracture-dislocation of shoulder

Aims: Aim of this study was to asses the glenohumeral joint internal and external range of motion using ultra-sonographic based kinematic measurement. Methods: 27 male professional tennis players were bilaterally measured for internal and external rotation at 90 degrees of shoulder abduction while negating scapulothoracic motion. The normal control group consisted of 20 asymptomatic volunteers. Results: Both arms had signiþcantly greater degrees of external rotation than internal rotation (p< 0,05). The dominant arm (playing arm) had signiþcantly greater range of external rotation than the nondominant arm (p< 0,01). Analysis of internal rotational deþciency showed highly decreased internal rotation on the dominant arm (p< 0,01). The total rotational range of motion of the dominant arm was also found signiþcantly less (p< 0,01) in the elite tennis players. No signiþcant difference was found for the dominant and nondominant extremity in the control group. Conclusions: The objective measurement of glenohumeral rotational abilities has clinical application for the development of a speciþc treatment protocol that may reduce the risk of shoulder injury

Introduction: Clavicle fractures represent 5% of fractures in adults and almost 44% of shoulder injuries and are usually treated none operatively with good results. However significantly displaced fractures can be associated with high non-union rate and there is a lack of consensus on when surgical treatment is indicated for such fractures. The aim of this study was to identify guidelines for surgical intervention, safer surgical approach and outcome of surgical intervention. Method: A retrospective audit of all clavicle fractures managed surgically over past 5 years (March 2004 to 2009) in a district general hospital. Case notes were reviewed to study the surgical indication, surgical approach, patient satisfaction and oxford should score and need for metal work removal. In all 35 patients (29 male) underwent surgery for significant fracture displacement with shortening, manual workers and keen sportsmen at the time of injury. The infraclavicular approach was used in 21 patients and 14 patients had direct incision approach. Radiological union was achieved in all patients after an average of 13.26(8–24) weeks. Six patients required plate removal at 6 months following surgery, infraclavicular (2 patients) & direct approach (4 patients). All patients returned to their original occupation at average 2.55 months. The Oxford Shoulder Score at 3 months after surgery was average 15 (range12–20) and all patients, except one, scored excellent on subjective scoring. Conclusion: Our study showed excellent surgical outcome for displaced clavicle fractures in young and active patients and is supported by the high union rate, good oxford shoulder score, early return to work and high patient satisfaction scores. The infraclaviculr approach is a betterthan direct approach based on the low complication rate and less need for metal work removal

Purpose: There is controversial information on recovery of patients with compensable injuries. The purpose of this matched case-control study was to examine the impact of an active compensation claim following a work-related shoulder injury on reporting disability as measured by subjective and objective outcomes at 1 year post-operatively. Method: Data of 506 consecutive patients who had undergone a decompression or rotator cuff repair were reviewed. One hundred and fourteen patients were on compensation related to their shoulder problems. Patients were matched with a historical control group (patients without a compensation claim) based on age (4 age groups: < 40, 40–49, 50–59, 60–70), sex, and pathology (full-thickness tear vs. no tear). Outcome measures used were a disease-specific outcome, the Western Ontario Rotator Cuff Index (WORC) and two shoulder specific instruments, the American Shoulder and Elbow Score (ASES) and the Constant Murley (CM) score. Paired and independent t-tests and an analysis of covariance were performed. Results: Data of the 214 patients (72 males and 35 females in each group) was used for analysis (mean age 48, SD: 10, range 20–69). Out of 107 patients in each group, 42 patients (58%) had undergone a full-thickness repair and 65 (61%) had surgeries related to impingement syndrome. Paired and independent t-tests showed that both groups improved significantly regardless of their claim status. However, the compensation group had a significantly lower level of improvement than the non-compensation group. An analysis of covariance which adjusted for pre-operative differences in disability scores showed that an active claim was indeed a strong predictor of follow up scores. Conclusion: This is the first study that has used a matched case-control design to control for potential confounding factors in injured worker population. Our results indicate that although patients with work-related injuries demonstrate a lower level of recovery, they still benefit from surgery

Aim: The aim of this study is to evaluate the efficacy of the multidetector CT scan in shoulder fractures and to correlate these findings with those of plain x-rays. Material and Method: A 105 patients with shoulder fracture were examined with a multidetector CT scanner after the acute injury. There were 64 male and 41 female with an average age of 52 yrs (range 16–95 yrs). The examination was performed with a CT PHILIPS BRILLIANCE, and six groups of detectors were used, with thin slices (1.6–2 mm). MPR and three dimensional reconstructions were performed. Results: The mechanism of injury was fall during walk in 66 patients, fall from a height in 11 patients, and road traffic accident in 28 patients. They were detected 210 fractures at the shoulder region. A 135 fractures were located at the proxd imal end of the humerus, 75 at the scapula, in 95 out of 105 patients. In 10 patients with a comminuted fracture of the upper end of the humerus, the exact number of fragments as well as the precise location of them was not accurately assessed with plain xrays. MDCT control with multilevel anasynthesis and three dimensional reconstruction improved the understanding of the anatomic orientation in complex fractures and fractures–dislocations and in detection of subluxation of the fragments of the shoulder headin four part fractures in two patients. Conclusion: Our results would orient us for using the MDCT scan in patients with acute shoulder injury, especially in cases with comminuted fractures, because it is better assessed the place, the orientation and the displacement of fragments, which are not easily identified in plain xrays. Furthermore, these reconstructions improve the preoperative planning in those patients

The axillary nerve injuries most commonly are observed after trauma such as contusion-stretch, gunshot wound, laceration and iatrogenic injuries. Two of the most commons causes seem to be the glenohumeral dislocation and the proximal humerus fractures. The axillary nerve may sustain a simple contusion, or its terminal elements may be avulsed from the deltoid muscle. Compressive neuropathy in the quadrilateral space also has been reported (quadrilateral space syndrome, Calhill and Palmer, 1983). The axillary nerve injuries incidence represents less than 1% of all nerve injuries. Aim: The purpose of this study was to analyze outcome in patients, who presented with injuries to the axillary nerve. Material and methods: We report a series of 15 cases of axillary nerve lesions, which were operated between 1995 and 2002. These injuries resulted from shoulder injury either with or without fracture and or dislocation. Patients were operated between 3 to 6 months after trauma and an anterior deltopectoral approach was usually followed during surgery. The follow up period ranged from 1 to 8 years. Results: The results were considered as satisfactory in 11 out of 15 axillary nerve lesions. According to clinical examination, of the function of the shoulder and the muscle strength the results were classified as excellent in 5 cases, good in 6 cases and poor in 4 cases. Conclusions: If indicated, nerve repair can lead to useful function in carefully selected patients

Shoulder arthroscopy has become a valuable method for the diagnosis and treatment of this region’s injuries. The aim of this study is to present our experience on this procedure in young adults who are subjected in special training. During last year, in our clinic underwent arthroscopy 15 men with history of shoulder injury. Eleven of them suffered from anterior recurrent shoulder dislocation and the rest four had only one incident of injury. All patients were military personnel and were operated for the first time after a period of conservative treatment. Imaging control included magnetic resonance in 8 recruits. In all patients with chronic anterior instability a typical Bankart lesion was found. Two of them had also bone deficit of the glenoid, seven had Hill Sachs lesion and three had type II slap lesion. Bankart lesion was treated with Mitek anchors in 4 patients arthroscopically. The rest underwent open procedure. In those patients with one episode of injury were found: small detachment of anterior labrum in one, which was treated arthroscopically with debridement of the chondral surface, traumatic synovitis in another and partial tear of the rotator cuff in two, which was sutured by open procedure. Our experience in this small series shows that shoulder arthroscopy is not only a useful diagnostic method but also an effective, whenever indications are present, surgical method of rehabilitation

Background: The Bankart repair remains a safe and effective method for repairing instability in shoulder injuries. We report the results of a large series of patients treated using this technique. Materials and Methods: We retrospectively reviewed 136 consecutively treated patients with either anterior, antero-inferior or multidirectional shoulder instability over a 7-year period from 1999–2006 with a minimum of 2-year follow-up. All patients underwent open bankart repair through a deltopectoral approach, performed by a single surgeon. A thorough chart review was performed and patients were evaluated according to the Oxford Instability Score (OIS), the level of sport returned to, the influence of pre-operative physiotherapy and the incidence of redislocation. Results: Of the 136 identified patients, 108 (79%) responded to the questionnaire. Of the responders, there were 95 males and 13 women. The average age was 24 years (range 14–72). Ninety-one patients had confirmed dislocations whereas 17 suffered from subluxations. The majority of patients had either anterior or antero-inferior instability, whereas four (3.7%) had multidirectional deficits. The average time to surgery from the index instability incident ranged from 3 months to 10 years. The average OIS was 23 which corresponded to a good result. There was no significance found in the OIS in relation to the age of the patient or pre-operative physiotherapy. Significant associations with a better outcome included: delay to surgery greater than 12 months; and the absence of multidirectional instability. Of those who actively participated in sport, 75% returned to the same level of non-contact sport where only 47% returned to a similar level in collision sports. Eight patients (7.4%) experienced re-dislocation post open repair and 3 (2.8%) reported feelings of subluxation. Conclusions: Open bankart repair +/− capsulorrhaphy remains the gold standard for treatment of patients with shoulder instability. While our rate of success, in terms of re-dislocation, is equivalent to international norms, we found that a delay to surgery may be associated with a better outcome. Furthermore, the use of the Oxford Instability Score enables accurate and easy determination of the success of the operation