Most people seek after what they do not possess and are enslaved by the very things they want to acquire

Anwar Sadat
1918 -1981 – (Egyptian President, Politician and Military Officer)

The Bone & Joint Journal 360 provides a treasure trove of academic content in its back catalogue, all of which is hugely synergistic with our own techniques. This month, it is a pleasure to revisit some of the high points in shoulder and upper limb content from both publications.

If you are only going to read one article on total elbow replacement then Total elbow arthroplasty – A narrative review by A C Watts and T Luokkala from Wrightington, first published by The Bone & Joint Journal 360 in 2017 has to be that article.

Every aspect from the evolution of the modern elbow replacement to the current state of the art is covered. There is an excellent description of constrained versus linked prostheses and the implications of these different design rationales, as well as the fact there does not exist any strong data to support the well-reasoned advantages of one design over the other. It’s also interesting to read that the same design lessons were learnt as with ankle replacement (itself very well covered in their review article of 2015 Ankle replacement: Where are we now.

The initial designs in both cases were simple hinges allowing only uniplanar movement and ignoring rotational forces. Because these forces were not permitted at the humero-ulnar articulation, they inevitably became focused onto the weaker bone implant interface leading to widespread early implant failure, just as with ankle replacements. The various differentiating features between modern elbow replacements are also clearly discussed with respect to the three most commonly used elbow replacements, the Coonrad-Morrey (Zimmer-Biomet), the Latitude EV (Tornier/Wright medical), and the Discovery total elbow replacement (Biomet). The articles’ literature review is comprehensive and well-chosen and gives an excellent perspective on the range of reported longevity in elbow replacements (slightly less than the orthopaedic gold standards of hip and knee replacement) and the common complications (permanent ulnar nerve neuropathy in up to 5% of cases, a deep infection rate of 3% and aseptic loosening in the region of 5%).

Another definitive upper limb paper from Bone & Joint Journal 360’s back catalogue is “Clavicle and proximal humeral fractures – what is the evidence?”  by Ben Ollivere and co-authors at Nottingham University Hospital, Nottingham, UK. This forensic review of the key literature relating to fixing middle third clavicular fractures is something that needs to be read by anybody managing these injuries. It is particularly useful to see these all so well précis’d, their key findings therefore easily compared.  Having the key studies comparing plate fixation to elastic stable intramedullary nailing of the clavicle critiqued, in particular, makes very useful reading.  The coverage of proximal humeral fractures is no less useful and once read will give the reader an excellent vantage point for considering how they might want to manage these often disabling injuries.

Chris Littles’ elbow replacement technique details every aspect of the operation and focuses on the insights and nuances that he has found make the difference between success and failure with elbow replacement.  Sam Chan’s Synthes superior clavicle plate should be read for additional operative insights into clavicle fixation (as well as Mark Crowthers use of the Stryker Variax 2 plate for this indication), as should his demonstration of the Synthes Philos plate for proximal humeral fractures .Mark Crowther’s Lima SMR reverse shoulder replacement for proximal humeral fracture. documents well the arthroplasty option for proximal humeral fractures