Introduction: Despite a multitude of reports detailing the management of infected hips and knees with or without arthroplasty, only little information is available on how to deal with infected shoulders. Besides primary haematogenous infection, the increasing number of surgical procedures (infiltration, arthroscopy, ORIF, total- or hemi arthroplasty) confront the orthopaedic surgeon increasingly with this devastating complication. Our goal is to present our experience with the use of a cement spacer in the treatment of infected shoulder joints.

Material and Methods: Between 1995 and 2005 9 patients were diagnosed with deep shoulder infection. The study includes 5 women and 4 men. The mean age at the time of diagnosis of the infection was 65 years (range, 51–78 years). Only 2 patient had had no prior surgery of the shoulder. 5 patients had an infection of a shoulder arthroplasty and 2 patients had been treated with ORIF for fracture.

All of the patients underwent resection the humeral head or retrieval of the arthroplasty with large debridement followed by implantation of an antibiotic impregnated polymethyl methacrylate spacer. After a mean duration of two months of antibiotics and after normalisation of the CRP a delayed reimplantation of a prosthesis was performed in 6 patients. One patient is awaiting arthroplasty, while two patients are satisfied with the functional result obtained with the spacer and do not want further surgery.

Results: None of the patients developed recurrent infection at an average follow-up time of 36 months. Shoulder function was judged objectively and subjectively to be at least satisfactory in all of the patients.

Conclusions: Staged treatment of infected shoulders using antibiotic impregnated polymethyl methacrylate spacers showed in our small group of patients, good and reproducible results. The individually moulded and fitted spacer filling the joint cavity and restoring the normal anatomy of the shoulder after joint debridement makes secondary procedures much easier. In the cases of exchange prosthetic reconstruction no recurrent infection has been experienced and all of the patients have substantial pain relief and an adequate shoulder function. Based on this experience the authors think that staged treatment and the use of a cement spacer in infected shoulder joints is a valid approach.

Background: We evaluate the role of percutaneous þxation of Acetabular fractures in a selected group of patients in which conservative management seemed unlikely to yield a satisfying outcome. Method: Between July 1998 and July 2001, 17 consecutive patients having suffered an Acetabular fracture underwent ßuoroscopic guided percutaneous þxation to stabilize the fracture. The mean age of the patients was 81 years (range 67 to 90). In all cases the fracture was non-displaced or minimally displaced (< 2 mm). The operative indication was based on our experience that these patients would have a less favorable outcome with conservative management due to their diminished general health and important associated morbidity. Percutaneous þxation was performed at a mean of four days post injury (range 2–6). In all cases, 2 cannulated cancellous 7.3 mm were used, one to þx the anterior column and the other, inserted in a retrograde fashion to stabilize the posterior column. Bed to armchair transfer began after 24 hours. Weight bearing as tolerated was allowed at 4 weeks from surgery. Two patients died of unrelated causes in the postoperative period and one patient was lost to follow-up, leaving fourteen patients who could be followed for a mean of 1,5 years (range 6 months-3 years). Results: Soft tissue dissection was minimal. There were no intra-operative or post-operative complications. At latest follow-up there was no evidence radiographically of displacement of fragments, degenerative changes or screw failure. Fracture union was achieved at a mean period of 12 weeks (range, 8–15 weeks) after surgery. In one case the tip of the posterior screw penetrated the sacroiliac joint, but no clinical adverse effects were noted. Clinical results was satisfactory in thirteen patients, and fair in one patient, as assessed by the Matta modiþcation of the rating system described by dñAubigne and Postel. Conclusion: Our results show that the percutaneous þxation is a valid therapeutic option in selected Acetabular fractures, and in the future broader indications may be found for this technique.