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Fractures of the proximal humerus are common in the middle age population and usually result from a fall. The fracture may involve the humeral head, lesser tuberosity, greater tuberosity, surgical head or anatomical head of the humerus. Neer’s classification is used to guide treatment and it is based on the number of segments displaced (one to four part fractures). An axillary x-ray is necessary to exclude fracture dislocation. In this chapter the surgical management of proximal humeral fractures is discussed.

The most common mechanism of sternoclavicular joint (SCJ) dislocation is a fall on the shoulder. Anterior dislocations compare to posterior dislocations are more common. The clinical signs in anterior SJC dislocation are usually both visible and palpable. Posterior SCJ dislocations can be complicated with vascular injury induced by the displaced medial clavicle posteriorly. Early closed reduction is usually successful and stable. In cases where closed reduction is not possible, open reduction and stabilisation must be considered. In this chapter tips and tricks on the management of sternoclavicular joint dislocations are presented.

BACKGROUND: The UK hip fracture best practice tariff (BPT) aims to deliver hip fracture surgery within 36 h of admission. Ensuring that delays are reserved for conditions which compromise survival, but are responsive to medical optimisation, would help to achieve this target. We aimed to identify medical risk factors of surgical delay, and assess their impact on mortality. MATERIALS AND METHODS: Prospectively collected patient data was obtained from the National Hip Fracture Database (NHFD). Medical determinants of surgical delay were identified and analysed using a multivariate regression analysis. The mortality risk associated with each factor contributing to surgical delay was then calculated. RESULTS: A total 1361 patients underwent hip fracture surgery, of which 537 patients (39.5 %) received surgery within 36 h of admission. Following multivariate analyses, only hyponatraemia was deduced to be a significant risk factor for delay RR = 1.24 (95 % CI 1.06-1.44). However, following a validated propensity score matching process, a Pearson chi-square test failed to demonstrate a statistical difference in mortality incidence between the hypo- and normonatraemic patients [χ (2) (1, N = 512) = 0.10, p = 0.757]. CONCLUSIONS: Hip fracture surgery should not be delayed in the presence of non-severe and isolated hyponatraemia. Instead, surgical delay may only be warranted in the presence of medical conditions which contribute to mortality and are optimisable. LEVEL OF EVIDENCE: III.