Prosthetic shoulder infection can cause significant morbidity secondary to pain and stiffness. Symptoms may be present for years before diagnosis because clinical signs are often absent and inflammatory markers may be normal. An emerging common culprit, Propionibacterium acnes, is hard to culture and so prolonged incubation is necessary. A negative culture result does not always exclude infection and new synovial fluid biochemical markers such as a defensin are less sensitive than for lower limb arthroplasty. A structured approach is necessary when assessing patients for prosthetic shoulder joint infection. This includes history, examination, serum inflammatory markers, plain radiology and aspiration and/or biopsy. A classification for the likelihood of prosthetic shoulder infection has been described based on culture, preoperative and intra-operative findings. Treatment options include antibiotic suppression, debridement with component retention, one-stage revision, two-stage revision and excision arthroplasty. Revision arthroplasty is associated with the best outcomes.

Background: Fracture of the proximal humerus combined with dislocation of the glenohumeral joint and a soft tissue or bony Bankart lesion are rare. Management options are largely surgical and different approaches to fixation have been described. The reported outcomes are generally poor. Methods: We present a series of three rare cases of traumatic dislocations of the shoulder associated with combined fractures of the proximal humerus and glenoid that were treated with surgical fixation. We describe the surgical technique and clinical outcomes. Results: Our patients had multiple medical comorbidities; and coupled with the burden of injury, made a slow post-operative recovery (mean Constant-Murley score of 48 points over a mean follow-up time of 20 months). Conclusion: A high index of suspicion and appropriate imaging is required to properly diagnose and surgically manage this uncommon pattern of injury. We recommend surgical treatment of these severe injuries, to stabilise the glenohumeral joint, and to achieve optimal clinical outcomes.