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