Investigating clinical characteristics and prognostic factors in patients with chronic osteomyelitis of humerus

Abstract

BackgroundChronic osteomyelitis in the humerus, which has complex neuroanatomy and a good soft tissue envelope, represents a unique clinical challenge. However, there are relatively few related studies in the literature. This article retrospectively reviewed a large case series with the aims of sharing our management experiences and further determining factors associated with the outcomes.MethodsTwenty-eight consecutive adult patients with a mean age of 36 years were identified by reviewing the osteomyelitis database of our clinic centre. The database was used to prospectively identify all osteomyelitis cases between 2013 and 2017, and all data then was retrospectively analysed.ResultsThe mean follow-up period was 35 months (range 24–60). The aetiology was trauma in 43% (12) of the patients and haematogenous in 57% (16) of the patients, and Staphylococcus aureus was a solitary agent in 50% (14) of the patients. Host-type (Cierny’s classification) was IA in 8, IIIB in 11 and IVB in 9 patients. All patients required debridement followed by the placement of a temporary antibiotic-impregnated cement spacer (rod). Seventeen patients received a cement-coated plate for internal fixation after debridement, and 13 patients needed bone grafts when the spacer was staged removed. All patients attained an infection-free bone healing state at the final follow-up. The final average DASH (disabilities of the arm, shoulder and hand) score was 18.14 ± 5.39, while 6 patients (two developed traumatic olecranarthritis, four developed radial nerve injuries) showed the lowest levels of limb function (p = 0.000) and were unemployed. Three patients (type I; significant difference between type I versus type III and type IV patients, p < 0.05) experienced recurrence after debridement and underwent a second revision, which was not related to the bone graft (p = 0.226) or plate fixation (p = 0.050).ConclusionsHumeral chronic osteomyelitis can be treated with general surgery and anti-infective therapy; medullary (type I) infection presents a challenge, and the antibiotic-coated cement plate provides favourable fixation without increasing recurrence of infections. Clinicians should be aware of potential iatrogenic nerve injuries when treating these patients with complicated cases, and an experienced surgeon may improve the outcome.

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

“…Drilling in this location (as when employing intramedullary nailing for proximal two‐part humerus fractures) does not compromise humeral head blood flow 35 . Although this is an established method for debriding the medullary canal of the humerus and other long bones, 16,36 we felt that it would not have allowed for adequate debridement in our case (Figure 2).…”

“…Radiographs revealed a minimally displaced and mildly comminuted surgical neck fracture of the right humerus (Figure 1). Although examination of the radiographs revealed reduced bone density consistent with chronic alcoholism, 14 the admitting physicians and a radiologist concluded that the relatively obvious lytic changes that are typically seen in chronic osteomyelitis were not present 15,16 . After a 3‐day hospitalization that focused on correcting hyponatremia, she was discharged with the anticipation of nonoperative treatment.…”

A Case Report of Humerus Shaft Osteomyelitis Secondary to Local Skin Infection Treated with Saucerization.

“…Osteomyelitis involving humerus is rare clinical entity and management is derived from osteomyelitis involving tibia and femur, the overall incidence is 3.4% [ 8 ]. The patient presented with osteomyelitis secondary to local skin and soft-tissue infection which is less common than the post-traumatic forms presented in the literature [ 9 ].…”

Research Progress on Antibacterial Coatings for Preventing Implant-Related Infection in Fractures: A Literature Review

“…It has a broad antibacterial spectrum that covers most strains of bacteria, such as MRSA and methicillin-resistant S. epidermidis. Vancomycin bone cement plate has good therapeutic effects in the treatment of infected fractures, infected bone defects, fractures with osteomyelitis, infected nonunion, and various other diseases [88][89][90][91][92]. Compared with other commonly used antibiotics, such as gentamicin, vancomycin has a relatively lower toxic dose (1000 µg/mL) [93,94]; thus, coating vehicles with controlled vancomycin release are continually developed.…”