Successful treatment of prosthetic joint infections (PJIs) requires surgical intervention and prolonged antimicrobial therapy (AT), although the most suitable management has not been clearly defined yet. The aim of the study is to review our experience in the management of AHPJIs.

From 01/01/2004 to 31/12/2006 all patients with PJIs were prospectively evaluated in 8 Spanish hospitals by the REIPI. We focused here on AHPJIs. Diagnostic of infection was based on clinical-microbiological evidence.

Forty-nine patients, 30 (61.2%) women, median age: 75.35 years (range: 31–92), were diagnosed of AHPJIs: 22 (44.8%) hips, 26 (53%) knees and 1 (2%) elbow implants. Following total joint replacement our patients had a median infection-free period of 4.9 years (range 0.3 to 18.7). The comorbidities were: 9 (18.3%) rheumatoid arthritis, 7 (14.3%) diabetes, and 6 (12.2%) chronic renal failure. Clinical features were acute in all cases: pain 100%, inflammatory signs 75.5%, and fever 70%. In 27 (55%) of the cases a distant previous infection caused by the same microorganism could be identified. The etiology was: S. aureus 18 (36.7%), streptococcal infections 13 (26.5%), coagulase-negative staphylococci 2 (4%), gram-negative bacilli 11 (22.4%), anaerobes 2 (4%), and mixed infections in 3 (6.1%) cases. Thirty (61.1%) patients underwent early drainage/debridement with retention of the implant, 11 (22.4%) two-stage replacement, 6 (12.5%) arthrodesis, 1 (2.1%) resection arthroplasty, and 1 unknown. Patients were treated with specific AT (median duration of 10.6 weeks) according to the isolated microorganism. At 1 year follow-up 25 (51%) were cured, 7 (14.3%) relapsed after a conservative approach (3 required an arthrodesis and 1 a two-stage replacement), 5 (10.2 %) died and 5 (10.2%) had a re-infection; in 7 the evolution was unknown.

AHPJs can be successfully treated in most cases with surgical debridement plus an antibiotic course. If a relapse is observed, removal of the prostheses could be necessary.

Aims: The treatment of proximal humeral fracture is controversial. We proposed a syntesis with a solid nail system in order to achieve a good functional recovery Material and methods: Prospective study of 12 patients, mean age of 51 years (33 y–85y), since 2000 – 2002. All alleatory included according surgeon assignation. The men/women: 6/6. The right/left side 5/7.

Follow up period: 8 month (6m–15m).

Associated pathology: 1 ipsilateral linfedema and 1 TCE, (politrauma) X-Ray evaluation: P.A., axilary and lateral scapular view. CT scan was made to evaluate fracture patterns.

Neer classification: 6: 3-Neer; 5: 4-Neer and 1: 2-Neer part non union fracture.

Polarus nail were used in all. All (except 2)start functional recovery in first postoperative day. Constant test and x-Ray were made at regulars period.

Results: All consolidated: mean 5 weeks (5–11 w) without residual mal union. In two: nail with little proximal procidence without repercussion. In 1 was necessary the extraction of one screw All recovery its functional range of movement after 3 month. Two: limited range of movement, both have returned to habitual home activities. The Constant test was improving, mean of 74% (54–94%) Conclusions: The Polarus nail is an excellent synthesis for these fractures: it’s minimally invasive, gives a solid synthesis without hardware failures and facilitates an early rehabilitation program.

Introduction and Objectives: Non-unions of long bones represents a challenge for the orthopaedic surgeon due to the difficulty of treatment and high use of resources (human, surgical, etc.) which certainly raises health care costs. The development of morphogenetic proteins for the treatment of this clinical condition provides a powerful means of achieving the desired result: consolidation of the non-union.

Materials and Methods: From June 2002 to May 2003, we treated 5 cases of non-union of long bones (2 of the humerus, 1 femur, 1 tibia, and one knee arthrodesis). The group included 3 males and one female, ranging in age from 23 to 71 years (mean 47.2 years). Three of the subjects had previously undergone surgery between 1 and 7 times. One case presented with a bone defect in the distal third of the humerus. All cases were treated using mechanical stabilisation of the fracture. In one case, a bone bank graft was used, and in another, an autologous graft was used.

Results: Bone healing was achieved in all cases, except in one humerus.

Discussion and Conclusions: BMP-7 (OP-1) appears to be an advance in the treatment of long bone non-unions. Though it does not eliminate the need for adequate surgical treatment of non-unions (resection of the focus, exposure until bleeding bone, and mechanical stabilisation), this method does favor osteogenesis at the fracture site and avoids the morbidity associated with extraction of autologous bone from the iliac crest.