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.
Highlights
Chronic osteomyelitis in the humerus, which has complex neuroanatomy and a good soft tissue envelope, represents a unique clinical challenge
Currently, humeral osteomyelitis is relatively rare compared with the incidence of osteomyelitis of the lower limbs
We retrospectively reviewed a large adult case series of humeral osteomyelitis, and we shared our experiences in treating patients and further investigated factors associated with the outcomes
Summary
Chronic osteomyelitis in the humerus, which has complex neuroanatomy and a good soft tissue envelope, represents a unique clinical challenge. Humeral osteomyelitis is relatively rare compared with the incidence of osteomyelitis of the lower limbs. The incidence of humeral osteomyelitis has been reported to compose only 2.6–13.3% of all osteomyelitis cases [1, 2], but the humerus is the most commonly affected bone in the upper limbs. The management strategies for humeral osteomyelitis mainly originate from those of osteomyelitis in the lower limbs, and of these strategies, radical debridement, delayed bone defect repair and long-term antiinfective therapy are well acknowledged [3,4,5]. When dealing with humeral osteomyelitis, the surrounding neuroanatomy (radial nerve) of the humerus further complicates the treatment, may be injured and may affect the treatment outcome [6]. The good soft tissue envelope and good blood supply of the humerus may allow some deviations from the general management principles
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