Posterolateral impingement is sometimes diagnosed as a cause of refractory elbow pain, often after other treatments have been tried for common conditions such as lateral epicondylitis (tennis elbow) or subtly different conditions common in throwing athletes, such as valgus extension overload syndrome. Arthroscopic surgical treatment is effective when targeting abnormal anatomy such as plical folds. Partial excision of the olecranon must be undertaken with caution because it can lead to instability. This systematic review of the current literature uses a narrative synthesis to identify anatomical morphological variations of the olecranon, humeral and capitellar geometry, and overloading of the lateral part of the elbow as causative factors for this condition and discusses how arthroscopic techniques can resolve symptoms. Further understanding of the static and dynamic anatomy of the lateral part of the elbow will help to develop future treatment and preventive strategies.

Background: Adult humeral shaft fractures have traditionally been managed conservatively, but surgical intervention is considered for displaced fractures or when conservative treatment is unlikely to be successful. The optimal surgical approach remains controversial, with open reduction and internal fixation (ORIF) using plates and screws considered the gold standard. However, concerns about soft tissue damage have led to the development of less invasive techniques, such as anterior bridge plating using minimally invasive plate osteosynthesis (MIPO). This study aimed to evaluate the outcomes of MIPO for humeral shaft fractures. Methods: A prospective cohort study included 43 patients who underwent anterior bridge plating with MIPO for closed, displaced humeral shaft fractures. Forty patients had full follow-up (functional and radiological) and three patients were lost to follow-up. Fractures were classified using the AO classification system. Surgical technique involved incision, reduction, and fixation with locking compression plates. Follow-up assessments were conducted at various intervals, and functional outcomes were evaluated. Results: Fracture union was achieved in 38 of 40 patients (95%). Two patients required secondary bone grafts for non-union. The mean time to union was between 12 and 16 weeks. Excellent shoulder function was observed in 82.5% of patients, and excellent elbow function in 77.5%. The range of motion on the operated side differed statistically significantly from the nonoperated side but was not clinically significant. Conclusions MIPO with anterior bridge plating is a viable option for the surgical management of humeral shaft fractures. It offers good fracture healing rates and satisfactory functional outcomes and avoids extensive soft tissue dissection associated with ORIF.Level of evidence: II.

Background: This study aimed to evaluate the changing experiences of shoulder surgeons working in a district general hospital. Methods: A consecutive series of 395 shoulders (225 male, 170 female) over a 19-year period (2000–2019) with a minimum follow-up of 2 years were analyzed. Outcome measures were length of stay, operating time, satisfaction visual analog score (VAS), pain VAS, Oxford Shoulder Score (OSS), Constant-Murley score, range of movement, complications, and implant survival. Results: The incidence of a diagnosis of osteoarthritis as the surgical indication increased over time. The number of cases by surgeon per year increased from three cases in 2,000 to a peak of 33 in 2011. Up to seven implant manufacturers were used. The incidence of hemiarthroplasties decreased, and more numerous reverse polarity and anatomic arthroplasties were performed (P<0.001). More glenoid and humeral components were cemented and more short-stem implants were used in later years (P<0.001). Length of stay was a median of 1 day with a trend towards daytime surgery in recent years. Patients were satisfied (VAS 8/10) and OSS improved by 8 points on average throughout the observation period. Conclusions Despite frequent introductions of new implants, patient outcome, satisfaction, and complication rates remained good. There appears to be a need for large-scale, generalizable studies to understand why technological advancements leading to changes in implants do not influence clinical outcomes.Level of evidence: III.

Posterolateral impingement is sometimes diagnosed as a cause of refractory elbow pain, often after other treatments have been tried for common conditions such as lateral epicondylitis (tennis elbow) or subtly different conditions common in throwing athletes, such as valgus extension overload syndrome. Arthroscopic surgical treatment is effective when targeting abnormal anatomy such as plical folds. Partial excision of the olecranon must be undertaken with caution because it can lead to instability. This systematic review of the current literature uses a narrative synthesis to identify anatomical morphological variations of the olecranon, humeral and capitellar geometry, and overloading of the lateral part of the elbow as causative factors for this condition and discusses how arthroscopic techniques can resolve symptoms. Further understanding of the static and dynamic anatomy of the lateral part of the elbow will help to develop future treatment and preventive strategies.

Background: Adult humeral shaft fractures have traditionally been managed conservatively, but surgical intervention is considered for displaced fractures or when conservative treatment is unlikely to be successful. The optimal surgical approach remains controversial, with open reduction and internal fixation (ORIF) using plates and screws considered the gold standard. However, concerns about soft tissue damage have led to the development of less invasive techniques, such as anterior bridge plating using minimally invasive plate osteosynthesis (MIPO). This study aimed to evaluate the outcomes of MIPO for humeral shaft fractures. Methods: A prospective cohort study included 43 patients who underwent anterior bridge plating with MIPO for closed, displaced humeral shaft fractures. Forty patients had full follow-up (functional and radiological) and three patients were lost to follow-up. Fractures were classified using the AO classification system. Surgical technique involved incision, reduction, and fixation with locking compression plates. Follow-up assessments were conducted at various intervals, and functional outcomes were evaluated. Results: Fracture union was achieved in 38 of 40 patients (95%). Two patients required secondary bone grafts for non-union. The mean time to union was between 12 and 16 weeks. Excellent shoulder function was observed in 82.5% of patients, and excellent elbow function in 77.5%. The range of motion on the operated side differed statistically significantly from the nonoperated side but was not clinically significant. Conclusions MIPO with anterior bridge plating is a viable option for the surgical management of humeral shaft fractures. It offers good fracture healing rates and satisfactory functional outcomes and avoids extensive soft tissue dissection associated with ORIF.Level of evidence: II.

Background: This study aimed to evaluate the changing experiences of shoulder surgeons working in a district general hospital. Methods: A consecutive series of 395 shoulders (225 male, 170 female) over a 19-year period (2000–2019) with a minimum follow-up of 2 years were analyzed. Outcome measures were length of stay, operating time, satisfaction visual analog score (VAS), pain VAS, Oxford Shoulder Score (OSS), Constant-Murley score, range of movement, complications, and implant survival. Results: The incidence of a diagnosis of osteoarthritis as the surgical indication increased over time. The number of cases by surgeon per year increased from three cases in 2,000 to a peak of 33 in 2011. Up to seven implant manufacturers were used. The incidence of hemiarthroplasties decreased, and more numerous reverse polarity and anatomic arthroplasties were performed (P<0.001). More glenoid and humeral components were cemented and more short-stem implants were used in later years (P<0.001). Length of stay was a median of 1 day with a trend towards daytime surgery in recent years. Patients were satisfied (VAS 8/10) and OSS improved by 8 points on average throughout the observation period. Conclusions Despite frequent introductions of new implants, patient outcome, satisfaction, and complication rates remained good. There appears to be a need for large-scale, generalizable studies to understand why technological advancements leading to changes in implants do not influence clinical outcomes.Level of evidence: III.

Posterolateral impingement is sometimes diagnosed as a cause of refractory elbow pain, often after other treatments have been tried for common conditions such as lateral epicondylitis (tennis elbow) or subtly different conditions common in throwing athletes, such as valgus extension overload syndrome. Arthroscopic surgical treatment is effective when targeting abnormal anatomy such as plical folds. Partial excision of the olecranon must be undertaken with caution because it can lead to instability. This systematic review of the current literature uses a narrative synthesis to identify anatomical morphological variations of the olecranon, humeral and capitellar geometry, and overloading of the lateral part of the elbow as causative factors for this condition and discusses how arthroscopic techniques can resolve symptoms. Further understanding of the static and dynamic anatomy of the lateral part of the elbow will help to develop future treatment and preventive strategies.

Background: Adult humeral shaft fractures have traditionally been managed conservatively, but surgical intervention is considered for displaced fractures or when conservative treatment is unlikely to be successful. The optimal surgical approach remains controversial, with open reduction and internal fixation (ORIF) using plates and screws considered the gold standard. However, concerns about soft tissue damage have led to the development of less invasive techniques, such as anterior bridge plating using minimally invasive plate osteosynthesis (MIPO). This study aimed to evaluate the outcomes of MIPO for humeral shaft fractures. Methods: A prospective cohort study included 43 patients who underwent anterior bridge plating with MIPO for closed, displaced humeral shaft fractures. Forty patients had full follow-up (functional and radiological) and three patients were lost to follow-up. Fractures were classified using the AO classification system. Surgical technique involved incision, reduction, and fixation with locking compression plates. Follow-up assessments were conducted at various intervals, and functional outcomes were evaluated. Results: Fracture union was achieved in 38 of 40 patients (95%). Two patients required secondary bone grafts for non-union. The mean time to union was between 12 and 16 weeks. Excellent shoulder function was observed in 82.5% of patients, and excellent elbow function in 77.5%. The range of motion on the operated side differed statistically significantly from the nonoperated side but was not clinically significant. Conclusions MIPO with anterior bridge plating is a viable option for the surgical management of humeral shaft fractures. It offers good fracture healing rates and satisfactory functional outcomes and avoids extensive soft tissue dissection associated with ORIF.Level of evidence: II.

Background: This study aimed to evaluate the changing experiences of shoulder surgeons working in a district general hospital. Methods: A consecutive series of 395 shoulders (225 male, 170 female) over a 19-year period (2000–2019) with a minimum follow-up of 2 years were analyzed. Outcome measures were length of stay, operating time, satisfaction visual analog score (VAS), pain VAS, Oxford Shoulder Score (OSS), Constant-Murley score, range of movement, complications, and implant survival. Results: The incidence of a diagnosis of osteoarthritis as the surgical indication increased over time. The number of cases by surgeon per year increased from three cases in 2,000 to a peak of 33 in 2011. Up to seven implant manufacturers were used. The incidence of hemiarthroplasties decreased, and more numerous reverse polarity and anatomic arthroplasties were performed (P<0.001). More glenoid and humeral components were cemented and more short-stem implants were used in later years (P<0.001). Length of stay was a median of 1 day with a trend towards daytime surgery in recent years. Patients were satisfied (VAS 8/10) and OSS improved by 8 points on average throughout the observation period. Conclusions Despite frequent introductions of new implants, patient outcome, satisfaction, and complication rates remained good. There appears to be a need for large-scale, generalizable studies to understand why technological advancements leading to changes in implants do not influence clinical outcomes.Level of evidence: III.

Posterolateral impingement is sometimes diagnosed as a cause of refractory elbow pain, often after other treatments have been tried for common conditions such as lateral epicondylitis (tennis elbow) or subtly different conditions common in throwing athletes, such as valgus extension overload syndrome. Arthroscopic surgical treatment is effective when targeting abnormal anatomy such as plical folds. Partial excision of the olecranon must be undertaken with caution because it can lead to instability. This systematic review of the current literature uses a narrative synthesis to identify anatomical morphological variations of the olecranon, humeral and capitellar geometry, and overloading of the lateral part of the elbow as causative factors for this condition and discusses how arthroscopic techniques can resolve symptoms. Further understanding of the static and dynamic anatomy of the lateral part of the elbow will help to develop future treatment and preventive strategies.