Purpose of the study: Infection is a rare complication of shoulder athroplasty (3% of reverted prostheses), potentially responsive to diverse therapeutic strategies. This work evaluated the clinical and infectious outcomes obtained after management of infectious complications of reverted total shoulder arthroplasty.

Material and methods: This series included 11 reverted shoulder arthroplasties reviewed at mean 39 months. The bacteriological analysis identified predominantly Pro-pionibacterium acnes (54%). Three patients presented an acute infection, five a subacute infection, and three a chronic infection. In this series, six patients underwent a wash-out debridement procedure, two a two-phase reimplantation, and three a one-phase reimplantation.

Results: At last follow-up, three patients died, eight were reviewed. In the wash-out debridement group, one patient developed recurrent infection and two had repeated dislocations; the mean Constant score was 62 points and the ASES score 16/30. In the two-phase reimplantation group, there was no recurrent infection, the spacer broke in one patient, and the mean Constant score was 45 and the ASES score 10/30. In the one-phase reimplantation group, there were no cases of recurrent infection; the mean Constant score was 51 and the ASES score 11.

Discussion: The therapeutic strategy remains a controversial issue for the infected shoulder arthroplasty. Experience with infected knee and hip prostheses is essential. For infected shoulder prostheses, resection was for a long time the advocated solution, allowing cure and pain relief at the cost of major loss of shoulder mobility. Recent series have reported the effect of wash-out, debridement and reimplantation, allowing restoration of function. In the series reported here, the objective was to restore shoulder function as best as possible while achieving cure of the infection.

Conclusion: Although techniques for surgical revision were inspired by experience with the hip and knee, the problems with shoulder infections are different. The unique goal of curing the infection must be revisited. Shoulder function, and in particular range of motion conditioning the functional outcome, should dictate the surgical strategy for these infections.

Introduction: diaphyseal bone defect is one of the most difficult challenge in Orthopaedic and Traumatologic Surgery. One of the techniques for reconstruction of bone defect described by Masquelet is a two-stage procedure: induction of a membrane around a ciment spacer and autologous cancellous bone graft with external fixator. The aim of the study is to evaluate a modified technique with intramedullary nailing for tibial bone defect.

Materials and Methods: between 2001 and 2006, 13 patients presented important tibial bone defect. On radiological examination, the mean size was 18,5 cm³ (12–30 cm³). Initially, there were 12 opened fractures (1 Gustilo 1, 2 Gustilo II, 9 fractures Gustilo III), and one osteomyelitis following a compartment syndrome. The mean age of the patients at the procedure was 41 years old (18–74). Our modified technique was as follows:

several debridment and stabilization of bone fragments with a temporary external fixator

10 patients had hyperbare oxygenotherapy. All patients were evaluated radiographically and by physical examination. using SF-36 questionnary.

Results: There was no amputation but 4 complications. There were 3 deep infections: one just between the 2 stages and one 2 years after the second stage: both were treated by nail exchange and adapted intra-venous anti-biotherapy. The third one was the complete bone graft resorption because of an infection just after the second stage (the only failure of the method). The fourth complication is the nonunion 13 months after the second stage: nails has broken and has been changed. Bone healing was obtained in 12 patients at mean follow-up was 32 months (12–69). They were able to walk 4,3 months after bone grafting. 8 patients answered to the SF-36 questionnary: overall function was limited with a mean score of 99.8.

Discussion: and conclusion: Our modified technique gave satisfactory results at medium term. Nailing, comparing to external fixator, offers a better stabilization of bone fragments, better control of axis and length of lower limb, and an easier access for plastic surgery and nurse care. Others bone reconstruction treatment like ilizarov bone transport, free vascularized fibula fiap or allograft are still possible if failure. However, the rate of deep infections are quite high (4/13) may be questionable. Sacrifice of intramedullary blood supply and the difficulties to confirm union on radiological exams are still problematics.

Introduction: The conventional treatment of humeral shaft nonunion is plating and cancellous bone grafting. This option is very efficient but not absolutly safe. In case of initial treatment by nailing, a secondary compression at the site of the fracture could be an alternative.

Materials and Method: Between January 2000 and december 2003, in a prospective study, 56 patients have been operated for an acute humeral shaft fracture using retrograde locking nailing (UHN^®, Synthes™). 4 patients (7%) had an aseptic and tight nonunion. All of them were treated by secondary closed compression without bone graft. The mean age of the patients was 42 years-old at the procedure (range 17 to 73). All the patients were reviewed with clinical and radiological exams, using the DASH and Rommens scores and standard radiographs.

Results: No per or post operative complication occurred. Bone healing was obtained in all cases within 4 months. At an average follow-up of 66 months (range 51 to 74), the average DASH score was 29.6/100 (range 8.3 to 60.8) and the Rommens score was excellent in 3 patients and moderate in one because of history of Complex Regional Pain Syndrome.

Discussion and Conclusion: One of the characteristics of the retrograde nailing with UHN is to permit an initial or secondary axial compression at the site of the fracture. Secondary compression in the treatment of non union offers the advantages of a closed procedure which avoids any radial nerve injury, and preserves the bone vascular supply. In the present preliminary series, the isolated secondary compression appeared as a simple and safe procedure which allowed bone healing in all cases.

Introduction: The surgical gold standart treatment of the thumb osteoarthritis is the trapeziectomy with tendon interposition and ligament reconstruction. The trapeziometacarpal prosthesis is an option badly estimated in the literature.

Between 1994 and 2001, 43 non-cimented trapeziometacarpal prosthesis ARPE® (Biomet^™) was implanted by the same operator for isolated trapezio-metacarpal degenerative osteoarthritis. The minimal follow-up is 5 years.

The aim of this study is to evaluate the fonction of the thumb with a 5 year-old or more trapeziometacarpal prosthesis. The technique is described and the revisions are analysed.

Material and methods: 33 women and 2 men, mean age 59,4-years, were operated after failure of the conservative treatment. There are 7 lost sight (9 prosthesis) and 2 deaths (2 prosthesis). 27 other patients (32 prostheses) were examined by the author with an original revision questionnary associated to the score of DASH. The average follow up for the 25 prosthesis always implanted is 86 months.

7 revisions (16%) were necessary on average after 34 months (1 month in 10 years) : 5 for loosenning, 1 for premature dismantling and 1 for recurrent partial dislocation. 6 were treated by trapeziectomy with tendinous interposition of palmaris longus according to the technique of F.E. Jones.

Results: The mobility is perfect for all patients but one. There is no tendancy for the cup or steem to sink into the bone but there is often some medial calcifications around the trapezium. Average DASH score is 27.4/100. There is no infection and only one dislocation at 1 months (reduction by closed procedure). The survival of the prosthesis is 85% in 5 years.

In the first 13 months, 4 revisions is necessary. The ablation of the cup is easy but the extraction of de metacarpal still is often difficult. The scaphometacarpal height is constantly lowered (34,5 % on average). Aesthetically, 2 patients are disappointed and preferred their thumb with prosthesis.

Discussion and conclusion: The prosthesis ARPE ® is an effective option in this series for the treatment of the degenerative trapeziometacarpal osteoarthritis but its radioclinic control is necessary for the first year.