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A Comparison of the Lateral Decubitus and Beach-chair Positions for Shoulder Surgery: Advantages and Complications

Arthroscopic or open shoulder surgery can be performed using the lateral decubitus or beach-chair position. Advantages of the lateral decubitus position include better visualization and instrument access for certain procedures and decreased risk for cerebral hypoperfusion. Complications associated with this position include traction injuries, resulting in neurapraxia, thromboembolic events, difficulty with airway management, and the potential need to convert to an anterior open approach. One advantage of the beach-chair position is easier setup from a supine to upright position, which allows the surgeon the option to convert to an open procedure if necessary. Although rare, patients in this position may experience cerebral hypoperfusion and complications that range from cranial nerve injury to infarction. Other complications related to this position include cervical traction neurapraxia, blindness, and cardiac and embolic events. The surgeon must be cognizant of the complications associated with both positions and take extra care in the initial patient setup and coordination with the anesthesiologist to minimize the risk of complications and morbidity.

Intramedullary Fixation of Clavicle Fractures: Anatomy, Indications, Advantages, and Disadvantages

Historically, management of displaced midshaft clavicle fractures has

consisted of nonsurgical treatment. However, recent literature has

supported surgical repair of displaced and shortened clavicle

fractures. Several options exist for surgical fixation, including plate

and intramedullary (IM) fixation. IM fixation has the potential

advantages of a smaller incision and decreased dissection and soft-tissue

exposure. For the last two decades, the use of Rockwood and

Hagie pins represented the most popular form of IM fixation, but

concerns exist regarding stability and complications. The use of

alternative IM implants, such as Kirschner wires, titanium elastic nails,

and cannulated screws, also has been described in limited case

series. However, concerns persist regarding the complications

associated with the use of these implants, including implant failure,

migration, skin complications, and construct stability. Second-generation

IM implants have been developed to reduce the limitations

of earlier IM devices. Although anatomic and clinical studies have

supported IM fixation of midshaft clavicle fractures, further research is

necessary to determine the optimal fixation method.