Introduction. Cosmetic lengthening is currently growing, raising Ethical concerns. In cosmetic lengthening, the psychological benefit vs process and risks is not quantified in publications. We designed a prospective longitudinal study for evaluating quantitatively the psychological PROMs of patients with cosmetic lengthening and value its interest. Materials and Methods. Forty five cosmetic patients were operated on with the G-Nail with full weight-bearing, and sports: M/F 34/11, age 29.3±11.5 year-old, Gain 79 mm (range 86–187). All undertook preoperative preparation, psychological tests, post-operating training (lengthening period, twice daily) and a specific psychological program. No patient presented sequels. Questionnaires were provided before and 40.0 month after surgery (scale 0–10) with: Psychological suffering, Happiness in Life (HiL), Quality of Live (QoL), Self-Esteem, Self-Image, Self-Confidence, Professional, Family, Friends and Sexual Relations, Sexual Attraction. Average, SD of changes and T-Test (unequal variances) were computed. Results. Improvements were greater for self-Image (+54%, p 1.21×10. −12. ) raising from an initial value of 5.44 (+/− 1.62) to 8.40 +/− 1.20), Self-esteem, Self-confidence and HiL or over (p between 1.7×10. —7. and 1.8×10. −10. ), QoL (+22%, p 8.1×10. −5. ), Professional relationships (+20%, p 4.2×10. −5. ), Family relationships (+12%, p 0.003), Friendship (+11%, p 0.002), Sexual Attraction (+24%, p 1.0×10. −5. ), Sexual relationships (+19%, p 0.001) and psychological suffering due to the statue decreased by 53% (p 0.0002). Conclusions. Within the protocols used, patients improved strongly their Psychological Health, with +44% of their self-image, self-esteem and self-confidence. With a reliable technique and strong programs for supporting recovery both physically and psychologically, cosmetic surgery can benefit strongly to patients

Introduction. The practice of limb lengthening using intramedullary nails has surged in popularity in recent years. Our study explores the relationship between femur lengthening and overall height gain in adults undergoing cosmetic limb lengthening with telescoping magnetic intramedullary lengthening nails (MILNs). Materials & Methods. Demographic information, pre- and postoperative radiographic data, and secondary outcomes, such as mechanical angles and sagittal alignment, were analyzed for 42 adult femurs MILNs (PRECICE 2, NuVasive, Inc.). Height was assessed with a digital stadiometer. Limb lengthening was defined as the amount of nail distraction seen on a calibrated weight bearing X-ray at consolidation. mLDFA, mMPTA, MAD, AMA, and femoral sagittal bow were evaluated as secondary outcomes. Results. Mean starting height was 163.5 cm (SD 10.4, range 137–179) Post -lengthening mean height increased to 171.1 cm (SD 10.1, range 146.7–185.3). Average height gain was 7.5 cm (SD 1.3 cm, range 5.1–9.5). Average femoral lengthening was 7.3 cm (SD 1.14, range 4.1–10.1). There were no statistically significant difference between height gain and femur lengthening. Secondary outcomes showed reductions in femoral sagittal bow and AMA. Conclusions. We conclude that measuring femur lengthening is a reliable and accurate method of measuring gained height in deformity-free patients undergoing limb lengthening. We further reason that straightening of both femoral and spinal sagittal bow counteracts potential lengthening loss over the anatomical axis, versus mechanical axis lengthening

Introduction. Fully implantable distraction nails are frequently used for lengthening of the lower leg. What are the indications for humerus lengthening and which results can be expected?. Materials and Methods. The humerus as the best healing bone in the human body is suitable for lengthening with a nail as well but the indications are rare in comparison with the lower legs. Especially when driving a car or when working on a tablet length discrepancy of the arms of more than 4–5cm may cause severe hardening of the cervical muscles and induce chronical pain in the upper spine. Results. A distraction nail (FITBONE) was used in 5 cases for humerus lengthening. The nail was inserted in all cases from proximal. The mean age of the patients was 34 years. The mean lengthening amount was 58mm (55–100). In one case the system was exchanged to reach the desired length. There was no infection, no radial nerve irritation and no chronical shoulder pain. The system was removed in 4 cases in an average of 15 months the other nail will be removed soon as well. Conclusions. The preliminary results of our 5 cases demonstrate, that the FITBONE device is advantageous for lengthening the humerus, if the initial length is sufficient for implantation. In comparison with the use of external fixators the functional outcome, the comfort of treatment and the cosmetic result is amazing

Introduction. Fully implantable systems are used commonly only after maturity. What are indications to use fully implantable systems at the femur even in children?. Materials and Methods. Implantable lengthening nails (FITBONE) were used retrograde at the femur in minimal invasive technique to correct a limb length discrepancy of >6 cm. In 5 cases a relevant deformity was corrected in the same surgery. In all cases a final step of lengthening was planned at the femur and at the tibia with fully implantable devices at maturity. Results. 18 patients with the medium age of 10,3 years (8–14) were treated. In 17 cases the goal of lengthening was achieved without any complication. In one case of proximal femoral deficiency lengthening had to be stopped because of increasing tendency of knee joint luxation. Bone formation occurred circular around the nail in all cases. Full load bearing was possible in the average after 2,2 days/mm. No technical problems occur. In one case induced deformity in the lateral plane was observed which was corrected at the final step. At the end of treatment functional and cosmetical result was perfect in all cases. Conclusions. Fully implantable motorized distraction nails are a favorable option for lengthening and deformity correction of the femur even for children older than 10 years to correct limb length discrepancy of more than 6 cm. The treatment has a low pain level, is comfortable and nearly no scars are visible

Introduction. Deformations of forearm with different degree of expression and functional restrictions of upper limb in children with hereditary multiple exostosis are formed in almost 80% of the cases. The question of indications for the selection and conduct of surgical procedure remains controversial, existing treatment methods and post-operative recovery methods for children need to be improved. Materials and Methods. The long-term outcomes of surgical treatment of 112 patients diagnosed with “Hereditary Multiple Exostosis” (HME) aged from 2 till 17 years old were researched. Evaluation of surgical treatment results was carried out in accordance with complaints, functional condition of the forearm, radiographs (taking into account reference lines and angles). Depending on the variant of deformation, the following surgical operations were performed: resection of bone-cartilage exostoses (in 20.5%); correction of forearm deformation with external fixator (in 79.5). In 14 cases, for a more accurate correction of deformity a hexapod frame was used. Results. Differentiated approach provided “good” anatomical and functional results in 55.6%; “satisfactory” results in 40.2%; “unsatisfactory” results in 4.2%. Postoperative complications in the form of non-union, pseudoarthrosis, delayed consolidation or neurological disorders were in 6.2%. Conclusions. The choice of surgical treatment is determined by the variant and severity of deformation. This approach allows to improve cosmetic and functional condition of forearm and adjacent joints. The use of hexapod allows to increase accuracy of correction of physiological axis of forearm bones

Introduction. The Patient's Dream is not to stay in hospital even overnight, including in limb lengthening. We developed the ‘Hyper Fast Track Protocol’ (HFTP) in 2015 to fasten recovery and shorten hospital stay. Materials and Methods. The protocol included surgical stab incisions, use of weight bearing lengthening nails (G-Nail), intramedullary saw, a specific anaesthesia care (blood hypo-pressure, tranexamic acid, low hydration), absence of early anticoagulants, systematic vascular US controls, but early motion (hip and knee Ext/Fle, leg raise, horizontal ‘scissors’), walking, stairs, bike, clicking (maneuvers to lengthen), early discharge, along with other patient's parameters. Timing and exercises reps were registered. Protocols improved over time. Means ± SD are computed. Results. Forms were analysed in 112 patients (unilateral 7, dwarfism 2, cosmetic 103). Besides patients operated in the afternoon (18), physio sessions initiated (h:mm) in average 0:46 ± 0:19 after awakening in operative room, for a duration of 2:15 ± 0:46. No DVT was noted on US nor clinically. In 2016, hospitalisation averaged 2.88 nights, decreasing to 2.07 in 2017, then to 1.07 from 2020. In late 2020 and in 2021, we had several patients in Daycare only, even in bilateral lengthening. In late 2021, we could discharge a patient after walking, full motion and exercises 3.5 hours after awakening from bilateral surgery. Conclusions. With continuous result monitoring and constant improvement of Care, walking, stairs, clicks and biking are fully feasible within 3h of surgery awakening, with discharge on the same day, using specific protocols

Abstract. Aim. The aim of this study was to present the results of treatment of displaced lateral clavicle fractures by an arthroscopically inserted tightrope device (‘Dogbone’, Arthrex). Methods. We performed a retrospective series of our patients treated with this technique between 2015 and 2019. Patients were identified using the ‘CRS Millennium’ software package and operation notes/clinic letters were analysed. We performed an Oxford Shoulder Score (OSS) on all the patients at final follow-up. Our electronic ‘PACS’ system was used to evaluate union in the post-operative radiographs. Results. We treated 26 patients with displaced lateral clavicle fractures between 2015 and 2019. There were 4 patients who were treated with a ‘dogbone’ and supplementary plate fixation and the remaining 22 were treated with a ‘dogbone’ alone. Radiological union was seen in 22 (84%) patients. The mean Oxford Shoulder Score (OSS) was 46. Apart from one patient who required removal of the superior endobutton and knot under local anaesthetic there was no other secondary surgery. There were no cases of infection, nerve injury or frozen shoulder. Conclusions. Arthroscopic ‘dogbone’ treatment of lateral clavicle fractures is a safe, cosmetically friendly technique with promising high rates of fracture union and return to normal function. We recommend its use over the more conventional treatment of a hook plate

Introduction. Torsional malalignment syndrome (TMS) is a unique combination of rotational deformities in the lower limb, often leading to severe patellofemoral joint pain and disability. Surgical management of this condition usually consists of two osteotomies in each affected limb, with simultaneous correction of both femoral anteversion and external tibial torsion. However, we believe that a single supratubercular osteotomy followed by tibial derotation with the Taylor Spatial Frame (TSF) can be used to provide a significant improvement in both appearance and function. Materials and Methods. This is a retrospective case analysis in which we will be reviewing 16 osteotomies performed by one surgeon between 2006 and 2017. The study includes 11 patients with a mean age of 16.7 ± 0.8 years. Pre and post-operatively, patients were fully evaluated through history and physical examination, and CT rotational profiling. Statistical analyses were performed in order to determine whether or not any observed clinical or cosmetic improvements were statistically significant. Results. The results show significant improvements in scores reported on post-operative functional assessment, with mean Oxford Knee Score (OKS) increasing by 18.3 and mean Kujala Anterior Knee Pain Scale (AKPS) also increasing by 31.4. In addition to this, post-operative clinical assessment showed a reduced thigh-foot angle (TFA) in all cases, by a mean value of 31.9o. The angle of the transmalleolar axis (TMA) was successfully reduced in 14/16 cases, by a mean value of 8.6o. Statistical analysis showed all of these results to be statistically significant where p<0.05. Conclusions. The results show that supratubercular osteotomy, followed by gradual correction with TSF, can be used to provide a significant improvement in both appearance and function for patients suffering from TMS

The functional importance of the long head of biceps tendon remains controversial, but it is well accepted as an important source of anterior shoulder pain. Both biceps tenotomy and tenodesis have well-documented results in the native shoulder. Management of the long head of biceps tendon during shoulder arthroplasty remains controversial. The existing literature supports surgical treatment of the biceps during shoulder arthroplasty. Walch et al. reported the largest series in multicenter study of over eight hundred shoulder arthroplasty patients with or without biceps tenodesis. The authors found more reproducible pain relief with biceps tenodesis and no difference in range of motion. Similarly, Soliman et al. reported on a prospective review of 37 patients undergoing hemiarthroplasty for fracture randomly assigned to biceps tenodesis vs. no treatment. The authors found a statistically significant improvement in Constant score and shoulder pain with biceps tenodesis. If left untreated during shoulder arthroplasty, the intact biceps tendon may be a source of anterior shoulder pain requiring revision surgery. Tuckman et al. reported excellent pain relief after biceps tenotomy or tenodesis for biceps-related pain after previous shoulder arthroplasty. The decision to perform a biceps tenotomy versus a tenodesis during shoulder arthroplasty also remains controversial. Tenotomy may increase the risk of cosmetic pop-eye deformity and muscle cramping or fatigue over tenodesis. Therefore, routine long head of biceps soft tissue tenodesis is recommended during shoulder arthroplasty as it safe, reproducible, cost-effective, associated with improved outcome scores, and minimises the risk of cosmetic deformity and pain associated with biceps tenotomy

Surgical site infections constitute the cause of 13% to 18% of readmissions within 90 days of a total hip arthroplasty and are a leading cause of failure of revision total knee arthroplasty. The goals of wound closure are to enhance healing potential, prevent infection, and provide a cosmetic appearance. Traditionally, this has been achieved with the use of interrupted sutures. However, recently “barbed” sutures have been introduced which consist of a solid core with peripheral etched barbs in a helical array. These sutures have been used for both the deep and superficial layers of wound closure in a running fashion with the barbs intended to be self-retaining in the event that the suture is cut or pulls out of the tissue. Proposed advantages include the avoidance of knots, less needles required, improved efficiency, and creation of a “watertight” seal. Numerous studies have shown decreased times for wound closure with the use of barbed vs. interrupted sutures with no difference in infection or complication rates. With less needles and improved efficiency, there is the potential for cost savings with the use of barbed sutures. However, there have been two studies raising concerns of arthrotomy failure with their use in total knee arthroplasty. In addition, several reports have noted the potential for increased superficial wound complications when barbed sutures are used for a subcutaneous closure. Therefore, what remains clear is that there is no proven, optimal method of wound closure in total joint arthroplasty and that every closure method remains technique dependent

Purpose. Tenodesis of the long head of biceps is an established technique for management of biceps pathology including tears, instability, and chronic tendinosis intractable to non-operative management. Very few studies have reported on clinical outcomes of all-arthroscopic, non-interference, biceps tenodesis techniques. The purpose of this study is to evaluate the functional and quality of life outcomes of patients treated with an all-arthroscopic biceps tenodesis with a suture anchor. Method. Case Series Level 4 Evidence. Fifty-eight (58) patients with a mean age of 58.5 years were treated with an arthroscopic biceps tenodesis in a single surgeons practice. A single suture anchor was used with a non-interference technique, either in isolation or in association with an arthroscopic rotator cuff repair. A retrospective analysis was performed on prospectively collected outcome measures on patients with a minimum one-year follow-up. Patients were evaluated with an ASES, Constant, and WORC scores pre-operatively and at 6 and 12 months post-operatively. In addition, patients were questioned post-operatively as to whether they experienced any biceps cramping, fatigue, or cosmetic deformity (popeye sign). Results. Following an all-arthroscopic biceps tenodesis, the ASES, Constant, and WORC scores improved significantly from 45, 54, 32 to 58, 75, 73 respectively (P<0.001). When analyzed separately, patients who underwent an arthroscopic biceps tenodesis in isolation (no cuff repair) and in association with an arthroscopic cuff repair demonstrated similar gains in functional and quality of life outcomes. (P<0.001). Few patients reported post-operative bicipital cramping, fatigue, or cosmetic deformity. Conclusion. The all-arthroscopic biceps tenodesis is a reliable procedure that results in significant improvement in functional outcome and quality of life measures

Aims

Tissue adhesives (TAs) are a commonly used adjunct to traditional surgical wound closures. However, TAs must be allowed to dry before application of a surgical dressing, increasing operating time and reducing intraoperative efficiency. The goal of this study is to identify a practical method for decreasing the curing time for TAs.

Distal femoral varus osteotomy is a procedure intended to relieve pain, correct valgus deformity, and delay or possibly prevent the progression of lateral compartment osteoarthritis in the knee. It is indicated in patients who are considered too young or are too active to be considered candidates for total knee arthroplasty. It also allows protection of the lateral compartment in cases of meniscal or cartilage allograft. In patients who are a good candidate for total knee replacement, TKR is the procedure of choice. A sloping joint line requires that the correction be performed above the knee. Several methods of distal femoral varus osteotomy have been proposed. These include a medial closing wedge, a lateral opening wedge, and a dome osteotomy. In the author's experience, the medial closing wedge has proven reliable. This technique uses a 90-degree blade plate, and does not require any angle measurements during surgery. Fixation is secure, allowing early motion. Healing proceeds rapidly in the metaphyseal bone, and non-unions have not occurred. The desired final alignment was zero degrees, which was reliably achieved using this method. Medium to long-term results are generally satisfactory. When conversion to total knee replacement is required, standard components may generally be used, and function was not compromised by the prior osteotomy. Distal femoral varus osteotomy is a successful procedure for lateral compartment osteoarthritis in a valgus knee. It is indicated in patients who are too young or active for total knee arthroplasty, and provides an excellent functional and cosmetic result

Lateralization of the reverse arthroplasty may be desirable to more effectively tension the remaining rotator cuff, decrease scapular notching, improve the cosmetic appearance of the shoulder, and improve stability as well as the arc of motion prior to impingement. There are two primary options to lateralise a reverse shoulder arthroplasty: bone graft with a long post (BIO-RSA) vs. using metal. The two metal options generally include a thicker glenosphere or a thicker glenoid baseplate. Potential benefits of a BIO-RSA include lateralization of the glenoid center of rotation but without placing the center of rotation lateral to the prosthetic-bone interface. By maintaining the position of the center of rotation, the shear forces at the prosthesis-bone interface are lessened and are converted to compressive forces which will minimise glenoid failure. Edwards et al. performed a prospective study on a bony increased offset reverse arthroplasty. Among the 18 shoulders in the BIO-RSA group, the incidence of notching was 78% compared to controls 70%. The graft completely incorporated in 12 (67%), partially incorporated in 4 (22%), and failed to incorporate in 2 (11%). Frankle et al. reported on the minimum 5-year follow-up of reverse arthroplasty with a central compression screw and a lateralised glenoid component. The survivorship was 94% at 5 years. There were seven (9%) cases of scapular notching and no patient had glenoid baseplate loosening or baseplate failure. The authors noted that the patients maintained their improved function and radiographic results at a minimum of five years. In summary, lateralisation of the glenosphere is an attractive option to improve the outcome of reverse arthroplasty. Benefits of lateralisation with metal rather than bone graft include elimination of concern over bone graft healing or resorption. In addition, the procedure has the potential to be more precise with the exact offset amount known pre-operatively as well as improved efficiency of the procedure. Preparing the graft takes additional OR time and there is variable quality of the bone graft

Distal femoral varus osteotomy is a procedure intended to relieve pain, correct valgus deformity, and delay or possibly prevent the progression of lateral compartment osteoarthritis in the knee. It is indicated in patients who are considered too young or are too active to be considered candidates for total knee arthroplasty. It also allows protection of the lateral compartment in cases of meniscal or cartilage allograft. In patients who are a good candidate for total knee replacement, TKR is the procedure of choice. A sloping joint line requires that the correction be performed above the knee. Several methods of distal femoral varus osteotomy have been proposed. These include a medial closing wedge, a lateral opening wedge, and a dome osteotomy. In the author's experience, the medial closing wedge has proven reliable. This technique uses a 90-degree blade plate, and does not require any angle measurements during surgery. Fixation is secure, allowing early motion. Healing proceeds rapidly in the metaphyseal bone, and non-unions have not occurred. The desired final alignment was zero degrees, which was reliably achieved using this method. Medium to long-term results are generally satisfactory. When conversion to total knee replacement is required, standard components may generally be used, and function was not compromised by the prior osteotomy. Distal femoral varus osteotomy is a successful procedure for lateral compartment osteoarthritis in a valgus knee. It is indicated in patients who are too young or active for total knee arthroplasty, and provides an excellent functional and cosmetic result

Aims

The aim of this study was to present the first retrieval analysis findings of PRECICE STRYDE intermedullary nails removed from patients, providing useful information in the post-market surveillance of these recently introduced devices.

Treatment of osteoarthritis of the knee remains a challenging problem since the evolution of the disease may be different in each compartment of the knee, as well as the state of the ligaments. Total knee arthroplasty may provide a reliable long-lasting option but do not preserve the bone stock. In another hand, compartmental arthroplasty is a bone and ligament sparing solution to manage limited osteoarthritis of the knee affecting the medial, lateral or the patello-femoral compartment.1, 2, 3. Patient's selection and surgical indication are based on the physical examination and on the radiological analysis including full-length x-rays and stress x-rays. Clinical experience has shown the need for high flexion in patients who have both high flexibility and a desire to perform deep flexion. Additionally the shape differences related to anatomy or the patient expectations after the surgery may also affect the surgeon decision. 4. The limited incision into the extensor mechanism allows a quicker recovery which represents a functional improvement for the patient additionally to the cosmetic result. A dedicated physiotherapy starting on the following day allowing weight bearing exercises protected by crutches and focusing on early mobilization and range of motion combined to a multimodal pain management approach is critical despite the type of individualized solution chosen for the patient knee. 5. Since bony landmarks may be different form a patient to another one as well as anatomical shapes, several tools have been developed in order to provide the surgeons an assisted tool during the surgery adapted to each knee, this include navigation, patient specific instrumentation and robotic surgery

Wound closure is typically not the surgeon's favorite part of the case. It is critical, however, for preventing infection, avoiding early re-operation and is the portion of the procedure that is most directly visible to the patient. The purpose of this study was to investigate the use of bidirectional, barbed suture for wound closure in primary total hip (THA) and knee arthroplasty (TKA) to determine whether its use is safe, cosmetic and associated with time savings when compared with traditional suture. We carried out a blinded, randomised controlled trial comparing bidirectional, barbed suture (Quill™ SRS; Angiotech Pharmaceuticals) and a traditional absorbable layered closure following primary THA and TKA. We randomised 20 THAs (10 Quill; 10 traditional) and 31 TKAs (16 Quill; 15 traditional). Power analysis determined that a minimum of 23 patients per arm of the study were required to show a significant difference in closure times using an alpha of 0.05 and a beta of 0.80. Wound closure in the Quill group was significantly faster than traditional suture by a mean of 4.1 minutes (9.2 vs. 13.2 minutes; p = 0.0005). Traditional closure required a mean 5.6 sutures, compared to a mean 2.7 sutures (p < 0.0001). The unit cost of the barbed suture was 5–12 times that of conventional suture. One patient who had undergone Quill closure developed a superficial reaction that was managed non-operatively. Our results have been confirmed by a similar recently published randomised study by Gilland et al, who showed a mean reduction in closure time of 4.7 minutes. However, these authors concluded that overall costs were lower with a barbed suture based on a reduction in operative times. This method of closure has also been shown to provide a stronger and more water-tight closure than traditional interrupted sutures

The approach to total hip arthroplasty (THA) should allow adequate visualization and access so as to implant in optimal position whilst minimizing muscle injury, maintaining or restoring normal soft tissue anatomy and biomechanics and encouraging a rapid recovery with minimal complications. Every surgeon who performs primary hip arthroplasties will expound the particular virtues of his or her particular routine surgical approach. Usually this approach will be the one to which the surgeon was most widely exposed to during residency training. There is a strong drive from patients, industry, surgeon marketing campaigns, and the media to perform THA through smaller incisions with quicker recoveries. The perceived advantage of the anterior approach is the lack of disturbance of the soft tissues surrounding the hip joint, less pain, faster recovery with the potential for earlier return to work, shorter hospital stay and improved cosmetic results. The potential disadvantages include less visibility, longer operation time, nerve injuries, femoral fractures, malposition and a long learning curve for the surgeon (and his / her patients). The anterior approach was first performed in Paris, by Robert Judet in 1947. The advantages of the anterior approach for THA are several. First, the hip is an anterior joint, closer to the skin anterior than posterior. Second, the approach follows the anatomic interval between the zones of innervation of the superior and inferior gluteal nerves lateral and the femoral nerve medial. Third, the approach exposes the hip without detachment of muscle from the bone. The mini-incision variation of this exposure was developed by Joel Matta in 1996. He rethought his approach to THA and his goals were: lower risk of dislocation, enhanced recovery, and increased accuracy of hip prosthesis placement and leg length equality. This approach preserves posterior structures that are important for preventing dislocation while preserving important muscle attachments to the greater trochanter. The lack of disturbance of the gluteus minimus and gluteus medius insertions facilitates gait recovery and rehabilitation, while the posterior rotators and capsule provide active and passive stability and account for immediate stability of the hip and a low risk of dislocation. A disadvantage of the approach is the fact that a special operating table with traction is required. Potential complications include intraoperative femoral and ankle fractures. These can be avoided through careful manipulation of the limb. If a femoral fracture occurs, the incision can be extended distally by lengthening the skin incision downward along the anterolateral aspect of the thigh, and splitting the interval between the rectus femoris and the vastus lateralis. The choice of approach used to perform a primary THA remains controversial. The primary goals are pain relief, functional recovery and implant longevity performed with a safe and reproducible approach without complications. The anterior approach is promising in terms of hospital stay and functional recovery. Although recent studies suggest that component placement in minimally invasive surgery is safe and reliable, no long-term results have been published. Further follow-up and development is necessary to compare the results with the posterior approach as most of the positive data is based on comparisons with the anterolateral approach. The proposed benefits of the anterior approach are not supported by the current available literature. The issues regarding the difficult learning curve, rate of complications, operative time, requirement for trauma tables and image intensifier should be taken into account by surgeons starting with the anterior approach in THA

Introduction. Clavicle fractures accounting for 3–5% of all adult fractures are usually treated non-operatively. There is an increasing trend towards their surgical fixation. Objective. The aim of our study was to investigate the outcome following titanium elastic stable intramedullary nailing (ESIN) for midshaft non-comminuted clavicle fractures with >20mm shortening/displacement. Methods. 38 patients, which met inclusion criteria, were reviewed retrospectively. There were 32 males and 6 females. The mean age was 27.6 years. The patients were assessed for clinical/radiological union and by Oxford Shoulder and QuickDASH scores. 71% patients required open reduction. Results. 100% union was achieved at average of 11.3 weeks. The average follow-up was 12 months. The average Oxford Shoulder and QuickDASH scores were 45.6 and 6.7 respectively. 47% patients had nail removal. One patient had lateral nail protrusion while other required its medial trimming. Conclusion. In our hands, ESIN is safe and minimally invasive with good patient satisfaction, cosmetic appearance and overall outcome