Evidence-based medicine in orthopaedics.

Evidence-based medicine (EBM) is medicine based on the sum of personal clinical experience and clinical studies with the best possible design (preferably, but not necessarily, randomised controlled trials or RCTs), while focusing on the expectancies of patients and institutions.

The Boytchev procedure for recurrent anterior dislocation of the shoulder. A controversial technique.

In the Boytchev technique the conjoined tendons of the coracobrachialis and short head of the biceps, together with the tendon of the pectoralis minor and the detached tip of the coracoid process are rerouted behind the subscapularis muscle, and reattached to the coracoid process with a screw. During a 10-year period 37 patients with recurrent anterior dislocation underwent a Boytchev procedure. Twenty-six patients (with 27 shoulders) were available to follow-up.

The hung up shoulder: anterior subluxation locking in abduction.

The hung up shoulder, or anterior subluxation locking in abduction, is a bizarre clinical picture which is not frequently seen. It is probably due to the fact that, in the subluxed position, the subscapularis muscle becomes an abductor, rather than an internal rotator. External rotation might shift the subscapular muscle fibres towards the proximal aspect of the humeral head, while joint laxity favors subluxation.

Dystrophic kyphoscoliosis in neurofibromatosis type I: a report of two cases and review of the literature.

We report two cases of dystrophic scoliosis in neurofibromatosis, each of particular interest. In the first, kyphosis was present with vertebral rotatory subluxation but no neurologic impairment, while the second patient showed manifest paraplegia due to rapidly progressive kyphoscoliosis. The importance of early surgical stabilisation, both front and back if possible, is stressed.