The purpose of this study is to report the clinical and radiological outcomes of patients undergoing primary or revision reverse total shoulder arthroplasty using custom 3D printed components to manage severe glenoid bone loss with a minimum of 2-year follow-up.

After ethical approval (reference: 17/YH/0318), patients were identified and invited to participate in this observational study. Inclusion criteria included: 1) severe glenoid bone loss necessitating the need for custom implants; 2) patients with definitive glenoid and humeral components implanted more than 2 years prior; 3) ability to comply with patient reported outcome questionnaires. After seeking consent, included patients underwent clinical assessment utilising the Oxford Shoulder Score (OSS), Constant-Murley score, American Shoulder and Elbow Society Score (ASES), and quick Disabilities of the Arm, Shoulder, and Hand Score (quickDASH). Radiographic assessment included AP and axial projections. Patients were invited to attend a CT scan to confirm osseointegration. Statistical analysis utilised included descriptive statistics (mean and standard deviation) and paired t test for parametric data.

3 patients had revision surgery prior to the 2-year follow-up. Of these, 2/3 retained their custom glenoid components. 4 patients declined to participate. 5 patients were deceased at the time of commencement of the study. 21 patients were included in this analysis. The mean follow-up was 36.1 months from surgery (range 22–60.2 months). OSS improved from a mean 16 (SD 9.1) to 36 (SD 11.5) (p < 0.001). Constant-Murley score improved from mean 9 (SD 9.2) to 50 (SD 16.4) (p < 0.001). QuickDASH improved from mean 67 (SD 24) to 26 (SD 27.2) (p = 0.004). ASES improved from mean 28 (SD 24.8) to 70 (SD 23.9) (p = 0.007). Radiographic evaluation demonstrated good osseointegration in all 21 included patients.

The utility of custom 3D-printed components for managing severe glenoid bone loss in primary and revision reverse total shoulder arthroplasty yields significant clinical improvements in this complex patient cohort.

Aims

Accurate measurement of the glenoid version is important in performing total shoulder arthroplasty (TSA). Our aim was to evaluate the Ellipse method, which involves formally defining the vertical mid-point of the glenoid prior to measuring the glenoid version and comparing it with the ‘classic’ Friedman method.

Aims

We present our experience of using a metal-backed prosthesis and autologous bone graft to treat gross glenoid bone deficiency.

Most arthroscopies are conventionally done using a 30-degree scope (30DS), which gives good field of view. This is used both for diagnostic and therapeutic procedures. For certain procedures 70-degree scopes (70DS) are used where visualisation with a conventional 30DS is insufficient and an increased field of view is required around corners. There have been studies done in past which have compared field of view of a 30DS and a 70DS. There has been no study so far that has compared blind spot created directly in front of a 30DS and 70DS. The aim of this study was to determine and compare blind spot created while doing arthroscopy using a 30DS and a 70DS.

A small box with a cannula at one end held firmly using plaster of Paris in horizontal position was made. This box was used to help hold 30DS and 70DS firmly in position while doing calculations. A scale was positioned on front of the scope to calculate the size of blind spot created at various distances. The 30DS and 70DS scopes were placed directly in contact with the scale at 0mm to start and markings on scale were used to calculate the diameter of blind spot created at various distances by moving the scopes at 5mm increment.

Our study shows that with a 30DS there is no blind spot in the front. With a 70DS there is a significant blind spot that increases in size linearly as the distance of scope increases from the object in vision. It goes up to 4.4cm in diameter when the 70DS is at a distance of 5cm. The 70DS however provides a very wide field of vision was compared to 30DS.

A 70DS provides a very large field of view and gives excellent visualization of structures around corners, but also has a significant blind spot directly in front of the scope tip which can be as large as 4.4cm at a distance of 5cm from the object in vision. Knowledge of this will help surgeons while using a 70DS and help avoid any missed pathology.

Aim: To review the outcomes for avulsion fractures of the tibial spine in children managed by arthroscopic internal fixation using a canulated screw.

Materials & Methods: A retrospective review was performed of 8 tibial spine avulsion fractures in children managed operatively by arthroscopic canulated screw fixation over a 4 year period. All fractures were graded grade III or IV (Meyer and McKeevers) in severity. Notes and radiographs were reviewed and Lysholm scores were obtained. The average age of our patients was 10.6 years and the average duration of follow up was 23.6 months (Range: 3–52 months). The average Lysholm score achieved was 88.9 (median 94.5, range 61–100) with the score demonstrably improving after the first year from injury. Bony healing was seen in all cases. One patient needed manipulation under anaesthesia to realize full movement.

Conclusions: On the basis of these results, we recommend arthroscopic canulated screw fixation as the treatment of choice for tibial spine avulsions. It takes over a year, however, to achieve optimal results. This series represents the largest collection of these uncommon injuries hitherto reported from the UK.

Introduction: Limb lengthening using external fixation may be associated with problems such as pin-track infections, poor patient acceptance, muscle transfixation, secondary axial deformity and re-fractures. Intramedullary lengthening nails have been designed to address these issues.

Aim: To review the outcomes for femoral limb lengthening in adults managed by intramedullary lengthening nails.

Materials and Methods: A retrospective review was undertaken for 8 femoral lengthening procedures performed using intra-medullary lengthening nails over a three-year period. The average age of our patients was 34 years and the average duration of follow up was 26.5 months (Range 8 to 40 months). Either an Albizzia nail (5 femurs) or an ISKD (3 femurs) nail was used for the procedure.

Results: Target lengthening was achieved in 7 out of 8 femurs with a average of 38 mm (Range 19 to 70 mm) length gained. The distraction index (length gained per day) was 0.68 on an average and the consolidation index (length of bone consolidating per day) being 0.27 on an average. Premature consolidation in 4 cases, runaway acute lengthening in one patient, prominent metalwork in 4 patients and a bent nail were frequent obstacles and meant multiple visits to theatre.

Conclusions: The desired femoral lengthening is achievable using intra-medullary lengthening nails, thereby avoiding problems associated with callostasis using external fixation methods. It is however, important to counsel patients regarding possibilities of significant obstacles and multiple visits to theatre during the process.