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Case Reports
. 2021 Feb 10:32:100427.
doi: 10.1016/j.tcr.2021.100427. eCollection 2021 Apr.

Salvage of a recalcitrant humeral shaft septic nonunion using a linked nail-plate fixation construct with intercalary allograft

Sandip P Tarpada  1   2 , Abraham M Goch  1   2 , Jeremy Loloi  1   2 , Milan K Sen  2
Affiliations
Case Reports

Salvage of a recalcitrant humeral shaft septic nonunion using a linked nail-plate fixation construct with intercalary allograft

Sandip P Tarpada et al. Trauma Case Rep. .

Erratum in

Abstract

Open humeral shaft fractures comprise approximately 2% of all fractures of the humerus. Nearly 20% of open humeral shaft fractures will develop deep infection, increasing the risk of nonunion regardless of treatment method. Recalcitrant septic nonunion of the humeral shaft is a complex and challenging problem. Operative treatment should aim to eradicate infection, address bony defects, and establish a stable construct that affords early motion. We describe the case of a 38-year-old male with a recalcitrant humeral shaft septic nonunion following fixation of an open humeral shaft fracture. Management of the infection consisted of periodic surgical debridement and IV antibiotics, resulting in a 10 cm segmental defect. Definitive fixation was achieved using the combination of an antegrade intramedullary nail, intercalary femoral shaft allograft, compression plating, and autologous bone graft. In addition to achieving bony union, the patient regained his pre-injury ROM and function, which was clinically sustained at 2-year follow-up.

Keywords: Allograft; Humerus; Infection; Nonunion; Reconstruction.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
(Left): Lateral left humerus radiograph showing a Gustillo-Anderson grade 2 open distal humerus fracture.
Fig. 2
Fig. 2
(Left): AP and Lateral left humerus radiographs status post distal humeral debridement, open reduction and internal fixation, and antibiotic bead placement.
Fig. 3
Fig. 3
A-C (Left): AP and Lateral humerus radiographs at 3 months postoperatively (a,b), and CT scan at 4 months postoperatively (c) showing delayed fracture union.
Fig. 4
Fig. 4
(Above): AP and Lateral humerus radiographs status post debridement, hardware removal, and insertion of antibiotic beads and rod, 6 months following index procedure.
Fig. 5
Fig. 5
(Left): AP and Lateral humerus radiographs status post repeat debridement with removal of rod and antibiotic beads, and placement of an antibiotic spacer, 9 months following index procedure.
Fig. 6
Fig. 6
(Left): AP and Lateral humerus imaging status post repeat debridement and removal of antibiotic spacer, 12 months following index procedure.
Fig. 7
Fig. 7
(Above): Intraoperative fluoroscopic images demonstrating reaming of proximal and distal humeral segments (a,c), followed by sequential wire cannulation of proximal humerus, intercalary graft, and distal humerus (c) for passing of an intramedullary nail and subsequent plate and screw augmentation (d,e) for rigid fixation at the bone-allograft junction.
Fig. 8
Fig. 8
(Above): AP and Lateral left humerus radiographs at 1-month (A), 6-month (B), and 12-month (C) postoperative visits demonstrating progressive healing and allograft incorporation.
Fig. 9
Fig. 9
(Above): Clinical pictures at one year postoperative visit demonstrating elbow range of motion of 0–110 degrees.
Fig. 10
Fig. 10
(Left): AP and Lateral left humerus radiographs at 24-month follow up demonstrating complete healing and allograft incorporation.
See this image and copyright information in PMC

References

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