Between January 1991 and December 2002, we treated 92 acute, displaced, closed humeral shaft fractures (AO classification type A). We used three fixation methods: dynamic compression plates (DCP) in 36 patients, Ender nails (EN) in 32 patients and interlocking nails (ILN) in 24 patients. The patients were followed for a minimum of 24 months. At one year, all fractures except two (one DCP/one ILN) had united. Patients treated with EN had shorter mean operation time, 51 (35-110) min; less mean blood loss, 70 (30-170) ml and shorter mean hospital stay, 5.8 (3-12) days. There were three iatrogenic radial nerve palsies: two in the DCP group and one in the ILN group. There was one wound infection. There were three cases with impingement of the shoulder but range of motion was restored after nail removal. For patients with multiple trauma or high operative risk, EN fixation served as a safer and faster procedure. ILN fixation offered a stable fixation via a smaller incision but more fracture comminution might happen.

A 73-year-old male patient presented with a pulsating abdominal mass and intractable low back pain for several days. Magnetic resonance imaging revealed an infected abdominal aortic aneurysm invading the second, third, and fourth lumbar vertebrae. He underwent radical debridement of the infected aneurysm with reconstruction using vascular bypass, partial corpectomy of the L2 to L4 vertebrae, anterior reconstruction with autogenous fibular shaft, and posterior instrumentation with posterolateral fusion. Culture of the necrotic tissues grew oxacillin-resistant Staphylococcus aureus. He received intravenous vancomycin infusion for 4 weeks and oral ciprofloxacin for 6 months postoperatively. After a 15-month follow-up, no apparent signs of further infection were noted. C-reactive protein and erythrocyte sedimentation rate returned to normal during follow-up. No neurologic symptoms other than mild low back soreness were noted. The stability of the lumbar spine was maintained using long segment reconstruction with autogenous fibula shaft and posterior instrumentation along with posterolateral fusion. Infected aortic aneurysm with vertebral osteomyelitis is a rare clinical entity. Prompt diagnosis and adequate treatment are essential.