Chronic
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.
METHODS: Twenty-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.
RESULTS: The 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).
CONCLUSIONS: Humeral 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.