Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jun 22;21(1):393.
doi: 10.1186/s12891-020-03430-y.

High rate of unexpected positive cultures in presumed aseptic revision of stiff shoulders after proximal humerus osteosynthesis

Doruk Akgün  1 , Paulina-Maria Peters  2 , Nina Maziak  2 , Fabian Plachel  2 , Marvin Minkus  2 , Philipp Moroder  2
Affiliations

High rate of unexpected positive cultures in presumed aseptic revision of stiff shoulders after proximal humerus osteosynthesis

Doruk Akgün et al. BMC Musculoskelet Disord. .

Abstract

Background: The aim of this study was to investigate the prevalence of positive microbiology samples after osteosynthesis of proximal humerus fractures at the time of revision surgery and evaluate clinical characteristics of patients with positive culture results.

Methods: All patients, who underwent revision surgery after locked platting, medullary nailing or screw osteosynthesis of proximal humeral fractures between April 2013 and July 2018 were retrospectively evaluated. Patients with acute postoperative infections, those with apparent clinical signs of infection and those with ≤1 tissue or only sonication sample obtained at the time of implant removal were excluded. Positive culture results of revision surgery and its correlation with postoperative shoulder stiffness was analyzed in patients with an interval of ≥6 months between the index osteosynthesis and revision surgery.

Results: Intraoperatively obtained cultures were positive in 31 patients (50%). Cutibacterium acnes was the most commonly isolated microorganism, observed in 21 patients (67.7%), followed by coagulase negative staphylococci in 12 patients (38.7%). There were significantly more stiff patients in the culture positive group compared to the culture-negative group (19/21, 91% vs. 15/26, 58%, p = 0.02). Furthermore, 11 of 12 (91.7%) patients with growth of the same microorganism in at least two samples had a stiff shoulder compared to 23 of 35 (65.7%) patients with only one positive culture or negative culture results (p = 0.14).

Conclusion: Infection must always be considered as a possibility in the setting of revision surgery after proximal humerus osteosynthesis, especially in patients with postoperative stiffness.

Keywords: Positive culture; Proximal humerus fracture; Revision surgery; Stiffness.

PubMed Disclaimer

Conflict of interest statement

All authors declare that they have no competing interest to declare.

References

    1. Roux A, Decroocq L, El Batti S, Bonnevialle N, Moineau G, Trojani C, et al. Epidemiology of proximal humerus fractures managed in a trauma center. Orthop Traumatol Surg Res. 2012;98(6):715–719. doi: 10.1016/j.otsr.2012.05.013. - DOI - PubMed
    1. Palvanen M, Kannus P, Niemi S, Parkkari J. Update in the epidemiology of proximal humeral fractures. Clin Orthop Relat Res. 2006;442:87–92. doi: 10.1097/01.blo.0000194672.79634.78. - DOI - PubMed
    1. Kirchhoff C, Braunstein V, Kirchhoff S, Sprecher CM, Ockert B, Fischer F, et al. Outcome analysis following removal of locking plate fixation of the proximal humerus. BMC Musculoskelet Disord. 2008;9:138. doi: 10.1186/1471-2474-9-138. - DOI - PMC - PubMed
    1. Launonen AP, Lepola V, Flinkkila T, Strandberg N, Ojanpera J, Rissanen P, et al. Conservative treatment, plate fixation, or prosthesis for proximal humeral fracture. A prospective randomized study. BMC Musculoskelet Disord. 2012;13:167. doi: 10.1186/1471-2474-13-167. - DOI - PMC - PubMed
    1. Tepass A, Blumenstock G, Weise K, Rolauffs B, Bahrs C. Current strategies for the treatment of proximal humeral fractures: an analysis of a survey carried out at 348 hospitals in Germany, Austria, and Switzerland. J Shoulder Elb Surg. 2013;22(1):e8–14. doi: 10.1016/j.jse.2012.04.002. - DOI - PubMed

MeSH terms