Background Complete proximal avulsions of the ham-

The proximal humeral fracture occurs very often especially in elderly patients suffering from osteoporosis. Minimally invasive internal fixation with the Targon®-PH proximal humeral nail may lead to quick recovery. Thirty-nine patients with unstable humeral head fractures with two or four fragments were included into this study. The application of the humeral nail was achieved by deltoid split technique. Patients were followed-up clinically and radiologically including a Constant Score. The mean age was 72.9±3.3years of the male and 74.9±1.8years of the female patients. The subjective parameters of the Constant-Murley Score were significantly lowered in both the female and the male sample compared with the healthy side (female 30.0±1.1 vs. 33.7±0.7; P<0.05; and male 30.3±1.4 vs. 34.0±0.7; P<0.05). The objective parameters were significantly lowered also in both the female and the male sample compared with the non-operated side (female 34.5±2.0 vs. 45.2±1.1; P<0.001; and male 37.7±5.4 vs. 50.6±1.7; P<0.05). Even under lowered functionality, the subjective satisfaction was high; therefore, nailing of proximal humeral head fractures may represent a method for early functional recovery in elderly patients

Septic polyarthritis associated to Streptococcus pneumoniae pneumonia is rarely seen and deserves description. In the present report, the case of a 77-year-old man with a 3-day clinical history of arthritis lacking anamnesis of trauma is discussed. Physical examination showed inflammatory signs and elevated inflammatory parameters in blood samples. The patient experienced pneumonia with blood cultures positive for S pneumoniae simultaneously. Arthrotomy revealed putride arthritis with S pneumoniae in culture. Therapy was initiated with intravenous benzylpenicillin. Surgical drainage and frequent retesting managed the local infection. Antibiotics had to be changed according to the specific sensitivity to ceftriaxone. Antimicrobial therapy was given intravenously for a total of 6 weeks.On follow-up no inflammatory signs were observed after 4 and 9 months. A bistrategical approach with surgical drainage and frequent retesting and antimicrobial chemotherapy may lead to a good result in the treatment of pneumococcal septic arthritis.