We report our retrospective multicentre experience of managing periprosthetic knee fractures using locking plates, cemented nails and distal femoral prosthesis. The Aim of this study is to analyze the practicality of management of these injuries using modern methods of fixation or salvation. 62 patients presented to 3 centres between 2003 and 2010. After implementation of inclusion criteria, clinical, radiological and functional outcomes were evaluated in 54 patients, with a minimum follow-up of 6 months. 34 patients were treated with locking plates (10 males, 24 female; mean age 76), 16 with cemented/locking nails (4 males, 12 females; mean age 84.5), and 4 with distal femoral replacement prosthesis (2 males, 2 females; mean age 79).

Locking plates which were used with a minimally invasive pattern produced the best outcomes in our study. A statistical significance of p value of less than 0.01 was found in union time between patients operated on with an open technique (6.69±2.69 months) and those operated on with a minimally invasive technique (3.6±0.91 months). Nailing with augmented cement is a useful technique in patients who are not suitable for challenging surgery & rehabilitation programmes. There was a significant difference in mean time to functional weight bearing (p< 0.01) between the plate group (4.79±2.6 months) and the nail group (2.63±0.5 months). Post-operative range of motion was also better for nails (106.36±14.33^O flexion) compared to plates (93.24±26.8^O), a result that approached significance (p=0.065). We recommend minimal invasive plating in uncompromised physiological conditions, as an ideal method of fracture fixation in view of statistically significant union rates. Cemented nailing is recommended in patients where early rehabilitation is essential. Distal Femoral prosthesis replacement is a useful salvage method.

We present a biomechanical cadaveric study investigating the effect of type II Superior Labrum Anterior Posterior (SLAP) lesions on the load-deformation properties of the Long Head of Biceps (LHB) and labral complex. We also report our assessment of whether repair of the type II SLAP lesion restored normal biomechanical properties to the superior labral complex.

Using a servo-controlled hydraulic material testing system (Bionix MTS 858, Minneapolis, MA), we compared the load-deformation properties of the LHB tendon with:

the LHB anchor intact;

Seven fresh-frozen, cadaveric, human scapulae were tested. We found that the introduction of a type II SLAP lesion significantly increased the toe region of the load deformation curve compared to the labral complex with an intact LHB anchor. The repair techniques restored the stiffness of the intact LHB but failed to reproduce the normal load versus displacement profile of the labral complex with an intact LHB anchor.

Of the two suture techniques, the mattress suture best restored the normal biomechanics of the labral complex.

We conclude that a type II SLAP lesion significantly alters the biomechanical properties of the LHB tendon. Repair of the SLAP lesion only partially restores the biomechanical properties. We hypothesise that repairs of type II SLAP lesions may fail at loads as low as 150N, hence the LHB should be protected following surgery.

Introduction: Uncemented humeral components rely heavily on initial stability and fixation as a function of the design of the implant. Concerns over initial torsional stability of humeral components have motivated the development of a variety of design concepts.

Aim: To investigate the torsional stability of two types of cementless humeral shoulder prostheses.

Methods: Twelve fresh-frozen cadaveric humeri were cleaned of all soft tissues and prepared for reconstruction with the two types of cementless humeral shoulder prostheses. The humeri were embedded in a low melting point alloy and tested in a servohydraulic-testing machine. The loading applied to the humeri was a controlled angle loading regime at ± 1.5 degrees for 150 cycles. Torque versus time was measured, and the exponential time constant was calculated.

Results: The Z implant displayed overall a tightening effect, and a positive time constant. Whereas the G implant displayed a negative time constant, i.e. a loosening of the implant.

Discussion: These differences reflect the initial stability achieved immediately following surgery and may have important implications for bone in-growth and long-term stability.