Background: The common surgical procedure in the treatment of bilateral shoulder osteoarthritis is surgical correction in two steps. There is little experience regarding the safety and the effectiveness of the simultaneous bilateral shoulder arthroplasty, as for other joints like knee and hip. In this study the results of the surgical procedure of both shoulders, in a single surgical stage, are presented and compared with an equal number of patients who underwent total shoulder arthroplasty in both their shoulders in two different stages.

Materials and Method: We studied a series of 7 patients treated with bilateral shoulder arthroplasty in a single stage procedure for severe degenerative glenohumeral joint disease. The average age at the time of surgery was 72 years. These were 4 patients with primary osteoarthritis (8 total anatomical prostheses) and 3 patients with rotator cuff arthropathy (6 reverse prostheses). The second series include 7 consecutive patients who underwent the same shoulder arthroplasties in two different stages for the same diseases. The average age was 69 years and the time between the two operations was 6 to 12 months.

The effectiveness of each one of the two procedures was evaluated on the basis of multiple objective characteristics like safety, total surgical duration, total blood loss, Constant Score, range of motion of the joints, post-surgical discomfort (pain, stiffness, motion, disability), post-surgical complications and ability of resumption of daily living activities.

Results: The average follow up was 18 months. Patients that underwent bilateral shoulder arthroplasty in one stage had significantly shorter total time of in-hospital stay (mean stay 5 days in the first and 9.3 days in the second group), recovery (9 weeks vs. 20 weeks) and proportionately lower rate of post-operative blood loss in comparison with the patients that were treated with two different surgical procedures. The average need for blood transfusion was 2 blood units in the first group and 3.5 blood units in the second. The overall rate of complication was the same in two groups. The Constant Score improvement and the joint function, range of motion and pain improved more, but not in a statistically significant degree in the single-stage group.

Conclusions: Bilateral shoulder arthroplasty in a single stage, in carefully chosen patients regarding their general condition, is a safe procedure, not associated with increase in complications, yielded better clinical results, reduced in-hospital stay and recovery period and decreased patient discomfort in comparison to the standard surgical procedure in two surgical stages and must be considered for selected cases.

AIM: The diagnosis of the posterior dislocation can be missed. Chronic missed locked posterior fracture dislocations of the shoulder raise a difficult problem for treatment especially in young patients. The options for the treatment depend on the size of the humeral defect, the age of the patients and the time from injury to diagnosis.

METHOD: Eleven patients with missed locked posterior fracture dislocation of the glenohumeral joint, 25 to 52 years of age were treated with open reduction and transfer of the subscapularis tendon to the defect (modified Mc Laughlin technique). The interval from the injury to diagnosis ranged from 6 weeks to 6 months. Significant pain, prominence of the acromion, posterior bulging and complete loss of external rotation of the shoulder led to the diagnosis that was confirmed by an axillary radiograph and C.T. scan. The humeral head defect was from 20 to 40 per cent of the articular surface. Four patients also had a minimally displaced fracture of the upper humerus.

RESULTS: The average length of follow up was 3,5 years. Stability was restored and maintained in all cases. Six patients reported little or no pain. They had almost full range of motion and no functional restriction in the ADL. The remaining five patients had mild pain and slight restriction of movements mainly in external rotation in abduction (elevation 150°, external rotation 25°, internal rotation to L5). These patients had mild functional dysfunction in the ADL. All patients had normal muscle strength and constant score from 60–82.

CONCLUSION: Once the diagnosis is established, open reduction and subscapularis tendon transfer reliably decreased patients pain level and significally improved the range of motion and the level of function, restoring stability of the joint. The alternative for older patients or patients with humeral head defect greater than 40% is the use of shoulder prosthesis.

The external fixation device has successfully been applied in comminuted and unstable fractures of the distal end of the radius. We used the fixator in Smith type fractures, since they are unstable and the literature is quite poor.

Within 2 years, mean follow up time 13 months, we operated 21 patients (8 male, 13 female) aged 17–74 years (average 43 years) with Smith type fracture using Penning type external fixation device. The device remained for 6– 10 weeks (mean time of immobilization 8 weeks). early mobilization – dynamization was not applied to any of the cases.

The final estimation was based on the Gartland and Werley score system and the results were characterized as very good (83%), good (13%) and poor (4%). In those with very good result extension-flexion, supination –pronation of the wrist as well as the power grip were completelly rehabilitated (compared to the healthy limb) within 6 months. In those with good results the outcome was approximately the same to the previous group, involving though complications such as superficial infection, loosening of the pins, 1 case of mild algodystrophy, sensitivity disorders of the radial nerve. All complications were faded after the removal of the device.

Finally there was a case with lose of the reduction and malunion post the removal of the device, poor results due to the early (on the 3 week) mobilazation –dynamization of the wrist.

Despite the good clinical and radiological results, treatment of Smith type fracture with the use of external fixation does not provide earlier and complication free rehabilitation of the wrist, so that should be used in certain cases only.