Closed Humeral Fracture Complicated with Acute Hematogenous Osteomyelitis: A Case Report

Abstract

Introduction: Acute hematogenous osteomyelitis (AHO) has been noted mainly in open fractures injuring soft tissue immunological defenses and in immuneincompetent patients. Osteomyelitis complicating closed fractures in immunocompetent adult patients is, therefore, a rare clinical entity with scarce literature.

Case report: We report a case of primary Staphylococcus aureus bacterial infection of a closed, humeral shaft fracture occurring in a previously healthy 28-year-old male patient. The patient was involved in a motorcycle accident and was admitted to the surgical ward with a chest drain. While hospitalized, a peak of fever was noted, but no source was found. Diagnosis of the closed fracture infection was noted on primary open reduction and internal fixation (ORIF), and although the patient was treated with antibiotics, local osteomyelitis developed. Treatment including serial debridements utilizing gentamycin beads and an additional ORIF procedure until the full union was achieved. The patient regained full, painless, motion of the arm and shoulder.

Conclusion: Although AHO complicating a closed fracture in immunocompetent adults is very rare, it should not be overlooked, and special attention should be sought in such cases. Meticulous debridement and rigid fixation are utmost for the eradication of infection and fracture union. Patients presenting with such infections should, therefore, be followed closely and treated promptly.

Keywords: Closed fracture; Humerus; osteomyelitis.

Figure 1

(a) Radiograph of the left arm after injury showing midshaft fracture of the humerus, (b) post-operative radiograph of the humerus following first open reduction and internal fixation with locking compression plate 3.5 mm plate, (c) 8 weeks post-operative radiograph of the left humerus, showing irregular fracture edges with bone resorption.

Figure 2

(a) Radiograph of the left humerus 14 weeks following the first operation the patient underwent revision surgery, (b) 44 weeks follow-up after the initial trauma, after revision surgery an intravenous antibiotic treatment. Fracture union was evidenced.

Figure 3

44 weeks follow-up after the initial trauma. Full range of motion of the elbow and the shoulder.