Proximal humeral locked plates have been advocated as an improved option for treating displaced proximal humeral fractures. After a number of failures using other methods we moved to this option in 2003.

We reviewed all patients treated with this method, since we started in 2004. 16 patients were available for follow up. Using the Simple Shoulder Test and the Oxford Shoulder Score we assessed their level of function and pain. X-rays were checked for loss of fixation and union. The average follow up was 13 months post-surgery; the average age was 61 years. Using Neer’s classification, seven had 2 part fractures, seven had 3 part fractures and two had 4 part fractures.

All fractures united and the patients reported good shoulder function. None had loss of fixation. There were no cases of sepsis. There were two patients awaiting hardware removal and one patient has already had removal for subacromial impingement.

The results in this limited series compare favourably with the reported literature and we had no loss of fixation compared to our previous treatment.

We reviewed 600 children with 640 sites of acute haematogenous osteomyelitis treated between 1983 and 2002. Neonates and patients with septicaemia were excluded.

The mean age of the children was 7 years (3 months to 13 years). The male to female ratio was 2.3:1.

The diagnosis was made clinically and with the help of special investigations. The while cell count was elevated in 75% and the ESR in 98%. Blood cultures were positive in 79%. Radiographs showed metaphyseal rarefaction and/or periosteal reaction in 19% and isotope scan was positive in 43%. No aspiration was done to establish the diagnosis. In nine sites (1.5% of operated sites) the diagnosis was regarded as incorrect (no growth or subsequent bony changes on radiographs).

The distal femur was the most common site (25%), followed by the distal tibia (20%), proximal tibia (19%), proximal femur (7%), proximal humerus (5%), forearm (5%), distal fibula (4%), pelvis (4%), calcaneum (3%) and other (8%). Staphylococcus aureus was cultured in 89% of sites.

Treatment was with intravenous cloxacillin, followed by oral flucloxacillin for 6 weeks. Surgery was performed at 94.5% of sites. The 5.5% sites that were not operated upon were in the pelvis or were early limb sites with no swelling. At surgery, 21% of sites were found to have intra-osseous pus. In the remaining 79%, there was subperiosteal pus at 41% of sites and extraperiosteal pus at 38%. Patients were followed up until adequate bone stock was present on radiographs and no sinus or sequestrum was present. Poor results (sequestrum and/ or pathological fracture) occurred in 8.3% (53 sites). Poor results were not site-specific, but 99% occurred in patients with subperiosteal or extraperiosteal pus.

We reviewed 821 children with 869 sites of septic arthritis treated from 1983 to 2002. Neonates and patients with septicaemia and penetrating injuries were excluded.

There were two age groups: 46% of the children were two years or younger (mean 1.1 years) and 54% were between 3 and 12 years (mean 6.8 years). The male to female ratio was 1.7:1.

The diagnosis was made clinically and with the help of special investigations. The white cell count was elevated in 67% and the ESR in 96%. Blood culture was positive in 28%. Radiographs demonstrated widening of joint spaces in 19% and isotope bone scan was positive in 11% of sites, mainly in the hip. No diagnostic joint aspiration was done. In 42 sites (4.6%) the diagnosis was regarded as incorrect because there was no growth or white cells.

The most common site of septic arthritis was the knee (37%), followed by the hip (30%), ankle (14%), elbow (10%), shoulder (5%), wrist (3%) and subtalar joint (1%).

Treatment was with open arthrotomy and antibiotics (cloxacillin and/or ampicillin). Bacteriologically the most common finding was no growth (50% in each age group). In the younger group the most common finding was Haemophilus influenzae (24.5%). Staphylococcus aureus was found in 37% of the older group. From 2000 the incidence of H. influenzae declined, probably owing to the introduction of vaccine in 1998.

Results at 30 sites (3.5%) were poor. There was avascular necrosis in 18 hips, chondrolysis in five hips and three ankles, and stiffness in two knees, an ankle and a subtalar joint.

Further analysis showed that poor results were more likely to occur in older patients with S. aureus and where there was a delay in treatment. Where good results were achieved, the mean delay was 3.5 days. It was 9.3 days where results were poor.