Thursday, April 21, 2011

Infected Humeral Nonunion

A sixty year old underwent attempted open reduction and internal fixation of a humeral shaft fracture. The fixation failed and was removed but resulted in an infected nonunion of the humerus with significant bone loss. Antibiotic beads had been placed and the patient had an open draining wound.

At this point, she presented to Harborview Medical Center for treatment of her complex nonunion.

She was treated with irrigation and debridement of the infection, stabilizing with a locked plate, insertion of antibiotic beads into the bone defect and bacteria-specific intravenous antibiotics.

After 10 weeks, she was brought to the operating room for bone grafting. An intramedullary fibular allograft as well as autograft from her ipsilateral femur were placed. Intraoperative cultures were negative for continued infection.

At seven month follow-up, she had successful healing of her humeral shaft fracture with no infection and no pain. She had returned to all baseline activities and was happy with her outcome.

Authored By: Daphne M. Beingessner, M.D.

Periprosthetic Fracture Nonunion

85 year old healthy, independent man, trip and fall 5 years after a total hip arthroplasty and ipsilateral total knee arthroplasty.  He did not have any previous hip pain.

Treated with internal fixation:

Construct failed at one month postoperatively:

Presented to Harborview 8 months after failure, now wheelchair bound. Nonunion was repaired with a locking condylar plate spanning the entire hip prosthesis with secure proximal fixation. At one year follow-up, patient was living independently and ambulating with a cane or walker as needed.

This case highlights the importance of appropriate proximal fixation and the importance of spanning the entire femur in the setting of a perprosthetic fracture.

We have successfully treated a series of these patients with this technique as published in the following article: Isolated locked compression plating for Vancouver Type B1 periprosthetic femoral fractures.

Bryant GK, Morshed S, Agel J, Henley MB, Barei DP, Taitsman LA, Nork SE. Injury. 2009 Nov;40(11):1180-6.

Authored By: Daphne M. Beingessner, M.D.