Volume 24, Issue 105, September - October, 2020

Infected non union in an operated compound fracture of shaft of humerus: A case report

Kiran Saoji¹, Mohit Dadlani², Gajanan Pisulkar³, Aditya Kekatpure⁴, Amit Saoji⁵

¹Professor and Head, Department of Orthopaedics, Jawaharlal Nehru Medical college, Datta Meghe Institute of medical sciences (Deemed University), Sawangi, Meghe, Wardha, Maharashtra, India; Email: kiran.saoji@gmail.com, 9422103298
²Junior Resident, Department of Orthopaedics, Jawaharlal Nehru Medical college, Datta Meghe Institute of medical sciences, (Deemed University), Sawangi, Meghe, Wardha, Maharashtra, India; Email: dadlanimohit786@gmail.com, 7987539587
³Professor, Department of Orthopaedics, Jawaharlal Nehru Medical college, Datta Meghe Institute of medical sciences (Deemed University), Sawangi, Meghe, Wardha, Maharashtra, India; Email: glpworld1@gmail.com, 9822235475
⁴Assistant Professor, Department of Orthopaedics, Jawaharlal Nehru Medical college, Datta Meghe Institute of medical sciences (Deemed University), Sawangi, Meghe, Wardha, Maharashtra, India; Email: adityalkekatpure@gmail.com, 8080426213
⁵Senior Resident, Department of Orthopaedics, Jawaharlal Nehru Medical college, Datta Meghe Institute of medical sciences (Deemed University), Sawangi, Meghe, Wardha, Maharashtra, India; Email: saojiamit04@gmail.com, 9860380444

ABSTRACT

Introduction: Infected non-union of humerus is a chronic disorder, which pose many difficulties to the patient and the surgeon and the treatment is long term and time consuming. It is one of the most common complications of humerus fractures. Some risk factors include age, sex, tobacco smoke, metabolic disorders, nutritional deficiencies, fracture type, soft tissue injury, type of surgical treatment and presence of infection. We present the case of infected non-union in an operated case of compound fracture of shaft of humerus treated in two stages with Infection control in first stage and then definitive treatment in second stage. Case: A 35 year old female presented to AVBRH OPD with complains of pain and fullness over right mid-arm who was follow up case of compound grade II shaft humerus fracture right side and she was managed with ORIF with plating at govt hospital in Chandrapur 9 months ago. On examination, tenderness and abnormal mobility was present at fracture site, overhead abduction and forward flexion was 90 degrees and further movements were painful and restricted. The radiograph showed Non-Union of mid-shaft of humerus with implant in situ. The patient, in first stage was managed with Debridement of Non-Union site and Sinus tract excision and insertion of Calcium sulphate antibiotic (Vancomycin) beads at and around the fracture site. Postoperatively, patient’s arm was immobilized by above elbow slab. The pus culture shows No growth. Patient continued having copious amount of discharge from the wound for around 2-3 weeks and suture removal was done after 3 weeks of surgery. Patient was continued on antibiotics for 6 weeks. On follow up at 6 weeks, wound was completely healed and discharge was absent and the pain and swelling was reduced but still the tenderness and abnormal mobility at fracture site was present. Functional humerus brace with mobilization of shoulder, elbow, wrist and fingers was advised with continuation of antibiotics. Then the patient was recalled after 6 weeks for definitive treatment. After 6 weeks, the patient was managed with removal of old plate and ORIF with LCDCP with cancellous bone grafting. Then the patient was discharged with continuation of functional humerus brace application and finally showing an excellent outcome. Conclusion: The treatment of humerus-infected non-union is a challenge for the orthopedic surgeon. The use of an antibiotic-impregnated bead, associated to systemic antibiotic therapy, is a valid option of treatment.

Keywords: Non-Union, Humeral shaft fracture, Limited-Contact Dynamic Compression Plate (LCDCP).

Medical Science, 2020, 24(105), 3215-3221

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