Purpose: The purpose was to investigate the relationship between distal radius fracture malunion and arm-related disability.

Methods: This prospective population-based cohort study included 143 patients above 18 years with acute distal radius fracture treated at one emergency hospital with either closed reduction and cast (55 patients) or with closed reduction and external and/or percutaneous pin fixation (88 patients). The patients were evaluated with the disabilities of the arm, shoulder and hand (DASH) questionnaire at baseline (inquiring about disabilities before fracture) and at 6, 12 and 24 months after the fracture. The 12-month follow-up also included the SF-12 health status questionnaire as well as clinical and radiographic examination. The patients were classified according to the degree of malunion (defined as dorsal tilt > 10 degrees or ulnar variance > 0 mm) into three groups; no malunion, malunion involving either dorsal tilt or ulnar variance, and malunion involving both dorsal tilt and ulnar variance. A Cox regression analysis was performed to determine the relationship between the 1-year DASH score (≥ 15 or < 15) and malunion adjusting for age, sex, fracture AO type, and treatment method and the relative risk (RR) of obtaining the higher DASH score was calculated. The number needed to harm (NNH) associated with malunion was calculated.

Results: The mean DASH score at 1 year after fracture was about 10 points worse with each degree of increased malunion. The degree of malunion also correlated with SF-12 score, grip strength and supination. The regression analysis showed significantly higher disability with each degree of malunion compared to no malunion; for malunion involving either dorsal tilt or ulnar variance the RR was 2.4 (95% CI 1.0–5.7; p=0.038), and for malunion involving both dorsal tilt and ulnar variance the RR was 3.2 (95% CI 1.4–7.5; p=0.007). The NNH was 2.5 (95% CI 1.8–5.4).

Conclusion: Malunion after distal radius fracture was associated with higher arm-related disability.

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: Extracapsular fractures of proximal femur are known to have a significatively high morbidity and mortality rate at one year, and this rate is higher in case of non operative treatment. The standard gamma nail (SGN) was originally designed to provide a stable implant which allows early mobilisation and weight bearing of the elderly patients. The design of SGN however, appeared to be associated with intraoperative or postoperative femoral shaft fractures in up to 17%, requiring further surgery and compromising the outcome in these elderly patients. The trochanteric nail (TGN) was developed to overcome the problems encountered with the use of the SGN.

We report our experience in the use of the TGN in the treatment of extracapsular fractures of proximal femur. Methods: Between December 1999 and January 2001, eighty-seven consecutive patients with an extra-capsular fracture of the femur (in one case bilateral) and one patient with a proximal femoral metastasis were treated with a TGN. Nine patients died within four months of the operation and 3 were lost at follow-up. Seventy-five patients, for a total of 76 fractures were followed clinically and radiographically until the end of treatment, for a mean follow-up period of 10 months. Results: In none of 88 cases did an intraoperative shaft femur fracture occur, nor was this complication observed in the 76 femurs evaluated at follow-up. Postoperative infection was never found and union was achieved in every case. Two cases of cutting-out were reported and both were caused by incorrect placement of implant. Only nine patients (12%) required two crutches or walker at the last follow-up. Conclusion: The TGN is a promising alternative for the treatment of extracapsular fractures of the proximal femur. This implant enables the surgeon to treat most of intertrochanteric and high subtrochanteric fractures with a less invasive technique, and permits early mobilisation and unprotected weight-bearing, without the complications observed with the use of the SGN.