Surgical Technique for Open Reduction-Internal Fixation of an Unstable Displaced 3-Part Proximal Humeral Fracture Using a Proximal Humeral Locking Plate.

The proximal humeral locking plate (PHLP) is a recently developed fixed-angle implant that is an option for open reduction-internal fixation of an unstable displaced proximal humeral fracture. Various articles have reported successful outcomes using the PHLP when compared with other implant designs. However, many complications still occur with use of the PHLP, such as avascular necrosis of the humeral articular fragment, malreduction (particularly varus malalignment), and screw penetration. These complications are related to the difficulty in fixation of this particular type of fracture, as well as ineffective surgical technique. We have therefore proposed a step-by-step surgical technique for open reduction-internal fixation of an unstable displaced 3-part proximal humeral fracture using a PHLP. This technique focuses on the precise placement of the PHLP according to the plate design, as well as an effective intraoperative assessment, to improve surgical outcomes and prevent the various complications of proximal humeral fractures.

Integral Suture-Handling Techniques for Arthroscopic Sliding Knots.

In arthroscopic tissue repair, the final step is achieving adequate tissue approximation with a secure knot. The sliding knot is widely preferred over the nonsliding knot, with numerous publications describing knot configurations. However, in the literature there are few published descriptions of suture-handling techniques, even though they are fundamental to arthroscopic knot tying. We describe integral suture-handling techniques for arthroscopic sliding knots to improve the surgeon's performance in knot tying.

Arthroscopic Bone Grafting for Anteroinferior Glenoid Defect Using Template.

Significant anteroinferior glenoid bone loss is widely accepted as a major pathology of recurrent anterior shoulder dislocation, particularly after failed arthroscopic Bankart repair. Numerous surgical techniques for glenoid bone grafting have been described and have been reported to yield successful outcomes. Both open and arthroscopic approaches have been used, with the coracoid and the iliac crest being commonly used for bone graft. When compared with open surgery, an arthroscopic approach has many advantages. These include a smaller incision, better visualization, the ability to correct any concomitant pathology, and most important, preservation of the subscapularis muscle function. However, technical challenges and the steep learning curve of this complex arthroscopic procedure can be huge obstacles for shoulder arthroscopists. We describe, step by step, a simplified arthroscopic bone graft technique for repair of an anteroinferior glenoid defect using a template as a helpful tool.