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.

We report the results of low friction arthroplasty in 72 old tuberculous hips and 42 hips with old quiescent septic arthritis. Follow-up was for a minimum of two years. Recrudescence of tuberculosis was seen in only one patient, but deep infection occurred in four of the hips with previous septic arthritis. The reasons for this are discussed. It is recommended that patients with old tuberculous hips should have a course of anti-tuberculous drugs before operation, that patients with previous septic infection should have prophylactic antibiotics and antibiotic-loaded cement and that the operation should be performed by an experienced surgeon.

Traditional posterior approaches to the neck use a vertical craniocaudal incision which often leaves an unsightly scar. An incision along Langer's transverse lines of tension divides only the cross-fibres of the dermis and we have found the results of this approach encouraging: wound healing was uncomplicated and the cosmetic appearance excellent.