To assess the efficacy of stabilising a femur following debridement of established osteomyelitis with a silver coated titanium plate.

A 19 year old male, with an established staphylococcus aureus osteomyelitis of the proximal femur, was treated with debridement and stabilisation of the proximal femur with a silver coated titanium plate, and intravenous then oral antibiotics.

The plate was removed six months postoperatively. Specimens were obtained for microbiology, histology and the implant sent for electron microscopic examination. Serum silver levels were obtained pre and post implantation and following plate removal.

The debrided defect of the femur healed. Specimens obtained at the time of removal showed no evidence of infection, either on culture or electron microscopic examination. Serum silver levels remained well below occupational safety guidelines.

This is an encouraging preliminary report of the potential for stabilisation of established osteomyelitis or infected non-union with a silver coated titanium implant.

Introduction: The Evan’s staple is an intramedullary device. It has two 20 cm tines connected by a horizontal bar with a hole mid-apex to facilitate insertion over a K-wire and enhance fixation to the humerus by means of a tension band.

Aim: To perform a retrospective review of the results of using the Evan’s staple as a means of fixation for displaced proximal humeral fractures.

Method: Between 1989 and 1997 at the Toronto East General Hospital, 56 patients with displaced proximal humeral fractures were treated with an Evans’ staple. This included 14 three-part and four four-part fractures and six fracture-dislocations. The age range at the time of operation was 18–94 years. The average duration of follow-up was 48.6 months, the range being 11–99 months. The study consisted of patient chart review, radiological review and use of the DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire.

Results: Complete radiological data were available for 26 patients and these showed a 100% union rate. The majority (77%) healed in neutral, the remainder in varying degrees of varus. Twenty-one patients returned the DASH questionnaire, with an average functional score of 37.8 (0= no disability, 100= severe disability). The complications included eight cases of impingement that required staple removal and one fracture distal to a staple caused by a subsequent fall.

Conclusion: The Evan’s staple is a viable means of fixation for displaced proximal humeral fractures.