Outcomes of One-Stage Infected Humerus Nonunion Repair in Patients with Prior Operative Fracture Fixation.

Objective

To examine the clinical outcomes of one-stage repair for infected humeral nonunion following failed prior ORIF.

Methods

Design: Retrospective study. SETTINGS Tertiary referral hospital. PATIENTS SELECTION CRITERIA Included were patients with infected humeral nonunion after an initial fixation of fracture, who underwent surgical repair at the study site between 2016-2024. OUTCOME MEASURES AND COMPARISONS Primary outcomes were union, infection eradication, number of surgeries, and duration of antibiotic therapy.

Results

Fifteen patients (80% male) who underwent humeral nonunion repair surgery, with positive intraoperative cultures were included. The mean age was 48.1 years (range 26-70) and 80% were male. Two patients (13.3%) were active smokers, and two (13.3%) had diabetes mellitus. Nine (60%) patients sustained OTA/AO type 12 fractures, four (26.7%) type 11 fractures, and two (13.3%) type 13 fractures. Twelve (80%) had closed fractures and 3 (20%) had open fractures. The most common initial fixation was plate and screw fixation (n=11, 73.3%), followed by intramedullary nail (n=4, 26.7%). Inflammatory markers were normal in seven patients (46.7%), elevated in three (20%), and unavailable in five (33.3%).A one-stage infected nonunion repair was planned for all cases (100%), with plate and screws (n=13, 86.7%), or intramedullary nailing (n=2, 13.3%). Bone graft was used in 13 (86.7%) cases and local antibiotics in two (13.3%). Cutibacterium acnes grew in 80% of cultures, followed by Staphylococcus aureus (13.3%) and Staphylococcus epidermidis (6.7%).Thirteen patients (86.7%) achieved union. In 10 cases (66.7%), the index single-stage repair was sufficient to achieve union, while 3 cases required additional interventions to achieve union. Mean antibiotic treatment duration was 8.1 months (SD 7.1 months, range 1.2-26.4). Two patients (13.3%) developed recurrent infection, and five patients (33.3%) required unplanned reoperations to promote union or treat infection.

Conclusions

This study found a high ultimate union rate (86.7%) for one-stage infected humeral nonunion repair after prior failed osteosynthesis although 1 in 3 patients required unplanned reoperation for recurrent infections or recalcitrant nonunion.Level of Evidence Therapeutic level IV study.