Introduction: Haemophilus influenzae type B has been the pathogen responsible for a significant proportion of cases of septic arthritis in children in the past. Vaccination was introduced in the United Kingdom in October, 1992 in order to combat meningitis and epiglottitis. This study looks at the effects of vaccination on childhood septic arthritis in Wales.

Methods: Data was collected prospectively from 1988 by the Public Health Laboratory Service in Wales. Data was analysed with a two-sample t-test.

Results: There were 17 cases in children in which 16 were attributed to type B. 14 cases occurred in the 5 years before mass immunisation. Only 2 cases occurred in the 8 years following immunisation. The incidence of Haemophilus influenzae septic arthritis in children has fallen significantly since the introduction of immunization (P=0.009).

Discussion: Vaccination has resulted in a significant fall in the incidence of Haemophilus influenzae type B septic arthritis in children in Wales. This may have consequences on guidelines for the empirical treatment of septic arthritis. If a child if found to have Haemophilus influenzae septic arthritis, this is suspicious of immunocompromise, or an alternate type infection. The novel way in which infection has been controlled may be one which can be used in future to control multi-resistant bacterial infection in orthopaedic surgery.

Aims: To assess shoulder function and pain following open reduction and internal fixation of displaced 2, 3 & 4 part fractures of the proximal humerus, using a new fixation plate designed to provide rotation and angle stability.

Methods: Patients treated by open reduction and internal fixation with a PlantTan plate (PTP) in our institution are currently being followed-up for a period of 2 years from time of surgery. Post-operatively Constant-Murley (0–100) and Visual analogue (0–100) scoring systems are being used to assess function and pain at 2, 6, 12, and 24 months post surgery. Complications have been carefully recorded.

Results: Currently 24 patients have been treated with a PTP. Results to 6 months post surgery are presented here. Mean patient age is 65 (31–89), 11 male, 13 female. Three were undertaken for non-union and 21 for acute fractures. At 2 months post surgery mean Constant-Murley Score (CMS) was 24 (12–49) on the fractured side compared to 89 (80–95) on the uninjured shoulder, with a mean Visual Analogue Score (VAS) of 37 (1–82). At 6 months mean CMS was 49 (28–75) for the fractured side compared to 88 (71–100) for the uninjured side, with a mean VAS of 26 (2–69). Three patients have died during the follow-up period; all deaths have been confirmed, by the coroner, as being unrelated to the procedure. Screws have backed out in 3 (12.5%) patients with 1 requiring implant removal and 1 requiring revision. There has been 1 (4.2%) case of frozen shoulder requiring MUA and 3 (12.5%) superficial wound infections. All 3 infections have resolved following a course of oral antibiotics.

Conclusion: We believe the PTP may prove to be a powerful tool in the management of proximal humeral fractures, however further evaluation including long-term follow-up is required. We aim to report on this in the future.