Aim: To assess trends in acute pyogenic osteomyelitis (OM) over the last six years in the Top End catchment area of the Royal Darwin Hospital (RDH).

Methods: One hundred and seventy-five medical records were assessed to investigate the trends in acute pyogenic OM. The outcome was determined on the basis of resolution of symptoms and signs and lack of recurrence/ representation at RDH. The follow-up period for subjects varied between six years and six months and depended on the time of presentation within the six-year span of the study.

Results: One hundred and one cases of acute pyogenic OM were found to meet the inclusion criteria. An average yearly incidence of 1.3 +/−0.7(CI95%) cases per 1000 cases was noted. Of these, 79.2% of cases were male, 70.3% in the age group 0–30 years and 67.3% ATSI. The most common sites affected were the lower extremities (62.3%) and the hands (32.6%). The average delay in presentation after the onset of symptoms was 30.5 days +/−12.8 days (CI 95%). A microbe was identified in only 50% of cases. Staphylococcus aureas was the causative organism in 83.6% of cases. All patients were treated with antibiotics or surgery. The average time for treatment with IV antibiotics was 9.8 days +/− 1.5 (95% CI). The average time for oral antibiotic treatment was 5.4 weeks +/− 0.7 (95%CI). 52.4.% of patients required surgery, with 16% requiring more than one operation and 10.2% requiring terminalisation or amputation of digits. There was a recurrence rate of 3.9%.

Conclusions: OM in the Northern Territory occurs predominantly in males aged less than 30 years, and most commonly in the ATSI population. The most common organism is Staphylococcus aureas. Intravenous therapy for 10 days and oral therapy for six weeks has been shown to be adequate, giving a recurrence rate of 3.9%.

Aim: To review the experience of a tertiary referral shoulder practice in managing a group of patients each of whom presented with disabling pain and loss of function following excision of the distal end of the clavicle.

Methods: A retrospective analysis was performed of eight male patients (average age 46) who underwent this procedure between August 1998 and December 1999. All patients were assessed using a standard protocol pre and post-operatively.

The surgical technique involved an arthrodesis at the acromio-clavicular joint and coraco-clavicular space using autogenous iliac crest bone graft and fixation with both tension band wires and a cancellous screw.

Results: The minimum follow-up was six months and clinical assessments demonstrated painful instability of the residual clavicle predominantly in the antero-posterior plane presumably because of disruption of the posterior acromio-clavicular joint capsule which is the major restraint to posterior translation of the clavicle. The patients had undergone on average 3.1 operations and had had symptoms for an average of 79 months before the fusion.

The fusion rate was 75% (six out of eight). Pain, measured using a Visual Analogue Scale (0 to 10), was reduced from 8.5 pre-operatively to 3.1 post-operatively. The patient’s perception of instability reduced from an average of 9.0 to an average of 1.0. The range of motion increased in five patients, decreased in two and remained the same in one. All of the patients would have the operation again and seven out of eight were very satisfied. The complications included the two non-unions, mild sterno-clavicular pain in two cases and a need to remove K-wires in seven instances.

Conclusions: Acromio-clavicular and coraco-clavicular fusions are worthwhile salvage techniques in the difficult situation of painful instability of the distal clavicle after multiple previous procedures. This complication can be avoided primarily by preservation of the posterior acromio-clavicular joint capsule.