Can a graft from the fibula help an infected upper-arm fracture heal after several failed operations?

Details

Purpose: The study reviewed outcomes in 7 patients who underwent revision surgery for infected non-union of the humerus—the upper-arm bone—using a fibular graft as a supporting strut inside the bone.

Methods: Researchers reviewed records of 7 men aged 29–59 years (mean, 40) with infected non-union of the humeral shaft. Fixation used a compression plate and a non-vascularised fibular graft as an intramedullary strut. The men had undergone a mean of 2.7 previous surgeries (range, 2–4).

Three patients had previously had actively draining sinuses, or drainage tracts; their C-reactive protein levels were normal and tissue cultures were negative. The remaining 4 patients had actively draining sinuses and first underwent implant removal and debridement. Tissue cultures confirmed infection in 3 of these 4 patients. The mean interval between debridement and the index fixation surgery was 5 months (range, 3–10).

Results: The harvested fibular grafts had a mean length of 13 cm (range, 12–15). All 7 non-unions healed, with a mean healing time of 5.4 months (range, 4–8). Mean follow-up was 15 months (range, 13–24).

All patients had weakness of the extensor hallucis longus, the muscle that extends the big toe; this improved to near normal at month 3. The abstract reported no donor-site morbidity. Three patients with active infection at presentation underwent repeat surgery. Two had wound washouts, and their non-unions subsequently healed successfully. One underwent implant removal after bone union because of an active sinus. Six patients returned to their pre-injury activity level, and one sustained a brachial plexus injury.

Conclusion: The authors concluded that fixation with a compression plate and a non-vascularised fibular graft as an intramedullary strut achieved a good outcome for infected non-union of the humerus despite multiple previous failed surgeries.