Complications in internal fixation of proximal humeral fractures can lead to an unsatisfactory outcome. We retrospectively reviewed 22 patients at a mean follow-up of 13 months (range 3–30). The average age was 58 years (36–86) in 10 male and 12 female patients. The mechanism of injury involved a simple fall in 17, MCA in 3, assault in 1 and metastasis in 1. The operation was performed at a mean of 11 days after the injury (range 1–29). There were 12 3-part, 6 2-part, 2 4-part fractures, 1 fracture dislocation and 1 pathological fracture. Only 13 out of 22 patients (59%) did not develop any complications. We had hardware problems in 5 patients including hardware pull-out, plate prominence, screw penetration, loosening or breakage. 2 wound infections, 1 axillary nerve palsy and 1 peri-operative death. 3 patients (14%) had reoperations to remove the plate, 1 had revision fixation, 1 MUA, 1 open capsular release and 1 I+D of wound. Radiographic union was achieved in 18 patients (82%). We identified a relatively high rate of complications especially in alcoholic or unfit patients. Better patient selection and familiarity with the implant and operative technique are essential for a good outcome. Pain relief and union rate were satisfactory.

Aims: We present the results of the PFC Sigma knee replacement at a mean follow-up of 2.75 years (range: 1 to 6 years). Clinician and radiographic evaluation was carried out using the American Knee Society Clinical Rating and Radiographic Scoring Systems. Patient outcome was assessed using the Oxford-12 and SF-12 health-status questionnaires. Methods: A consecutive series of 293 Total Knee Replacements (TKR) in 247 patients was followed prospectively between September 1996 and September 2002. Our series included 138 females and 109 males with a mean age of 73.2 years. We operated on 214 patients with osteoarthritis, 20 with rheumatoid arthritis, 12 with post-traumatic arthritis and on one patient with erosive arthritis. The patella was resurfaced in 36 knees. 11 patients died during the follow-up period. Results: Subjective patient satisfaction score was based on improvement in pain and functional status. It was marked as excellent in 183 knees, good in 75, fair in 26 and poor in 9. Active extension lag improved from a mean of 8.5 to 3.3 degrees and flexion from 98.5 to 107.1 degrees. The mean Oxford-12 score improved from 44.17 to 24.68 and the SF-12 from 30.05 to 34.99. Radiolucent zones were observed around 2 tibial components. Post-operative complications included wound-healing problems in 25 patients, wound infection in 12, cardio-respiratory in 12, DVT in 11, non-fatal PE in 3, resolved CPN palsy in 3 and 1 death. Prosthesis complications included stiffness in 31, chronic pain in 18 (4 CRPS) and instability in 3 knees. 13 patients underwent MUA and 6 arthroscopic excision of intra-articular adhesions. 2 prosthetic infections were confirmed by bone-scan. Revision surgery was undertaken in 3 patients, 1 for established infection, 1 patella replacement and 1 tibial insert exchange. Conclusions: The early results of the PFC Sigma Knee Replacement show a high degree of patient satisfaction with a low rate of serious complications. Survivorship analysis will be undertaken in the future.