Osteomyelitis with abscess associated with acute closed upper humerus fracture in an adult: A case report

Abstract

A 64-year-old female presented with malaise and fever 11 days after a closed, minimally displaced humerus surgical neck fracture. MR imaging revealed an abscess around the fracture, which is a very rare occurrence in adults. Two open debridements and IV antibiotics eradicated the infection. Reverse total shoulder arthroplasty was eventually performed for fracture nonunion.

Keywords: abscess; acute osteomyelitis; fracture nonunion; infection; proximal humerus fracture.

FIGURE 1

Radiographs showing our patient's minimally displaced and mildly comminuted two‐part surgical neck humerus fracture in anterior–posterior (A, B) and lateral (C) views. Asterisks (*) indicate the coracoid process and arrows indicate the fracture. Mild lucency along the fracture site seems consistent with fracture of poor‐quality bone, but some readers might consider this as subtle lysis to be consistent with a subacute infection.

FIGURE 2

Sequential T2 (fluid enhancing) MR images in coronal view (A is most proximal, D is most distal). Asterisks (*) indicate the coracoid process, longer arrows indicate a Jackson–Pratt drain within the glenohumeral joint (A, B), and shorter arrows indicate the abscess. The abscess clearly extends into the medullary region of the bone at the fracture site (e.g., vertical arrows in B and C). The scan was obtained 13 days after the fracture.

FIGURE 3

T2 MR images in axial view (A is most posterior, B is just anterior to A, and C is most anterior). Asterisks (*) indicate the coracoid process and the long arrows indicate the Jackson–Pratt drain and the short arrows indicate the abscess. The scan was obtained 13 days after the fracture.

FIGURE 4

Anterior–posterior (A) and lateral (B) radiographs obtained at 2 weeks after the final debridement surgery (skin staples can be seen). The intramedullary calcium sulfate beads are indicated by the arrows. Note some of the beads subsided into the proximal diaphyseal medullary canal.

FIGURE 5

Anterior–posterior (A) and lateral (B) radiographs obtained at 4 months after the final debridement surgery. The fracture is clearly a displaced atrophic nonunion and a pseudarthrosis has formed.