JOT - 2026-08-19 - Journal Article
Outcomes of One-Stage Infected Humerus Nonunion Repair in Patients with Prior Operative Fracture Fixation.
Katzir A, Bilodeau RE, Bhadouriya RS, Kantor AH, Schlauch A, Klinger CE, Page BJ, Ricci WM
Topics
Key Takeaway
One-stage repair of infected humeral nonunion achieved 86.7% ultimate union but required unplanned reoperation in 33.3% of patients, with Cutibacterium acnes identified as the causative organism in 80% of cultures.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This retrospective series examined outcomes of one-stage infected humeral nonunion repair in 15 patients with prior failed ORIF at a single tertiary center from 2016–2024. All patients underwent single-stage debridement, fixation revision (86.7% plate/screw, 13.3% IMN), and bone grafting (86.7%), with local antibiotics used in only 13.3%. Ultimate union was achieved in 86.7%, but only 66.7% succeeded with the index procedure alone; 33.3% required unplanned reoperations, and recurrent infection occurred in 13.3%.
Key Limitation
The sample size of 15 patients from a single tertiary center, with no control group and missing inflammatory marker data in one-third of cases, precludes any generalizable conclusions about patient selection criteria for single- versus two-stage repair.
Original Abstract
OBJECTIVE
To examine the clinical outcomes of one-stage repair for infected humeral nonunion following failed prior ORIF.
METHODS
Design: Retrospective study.
SETTINGS
Tertiary referral hospital.
PATIENTS SELECTION CRITERIA
Included were patients with infected humeral nonunion after an initial fixation of fracture, who underwent surgical repair at the study site between 2016-2024.
OUTCOME MEASURES AND COMPARISONS
Primary outcomes were union, infection eradication, number of surgeries, and duration of antibiotic therapy.
RESULTS
Fifteen patients (80% male) who underwent humeral nonunion repair surgery, with positive intraoperative cultures were included. The mean age was 48.1 years (range 26-70) and 80% were male. Two patients (13.3%) were active smokers, and two (13.3%) had diabetes mellitus. Nine (60%) patients sustained OTA/AO type 12 fractures, four (26.7%) type 11 fractures, and two (13.3%) type 13 fractures. Twelve (80%) had closed fractures and 3 (20%) had open fractures. The most common initial fixation was plate and screw fixation (n=11, 73.3%), followed by intramedullary nail (n=4, 26.7%). Inflammatory markers were normal in seven patients (46.7%), elevated in three (20%), and unavailable in five (33.3%).A one-stage infected nonunion repair was planned for all cases (100%), with plate and screws (n=13, 86.7%), or intramedullary nailing (n=2, 13.3%). Bone graft was used in 13 (86.7%) cases and local antibiotics in two (13.3%). Cutibacterium acnes grew in 80% of cultures, followed by Staphylococcus aureus (13.3%) and Staphylococcus epidermidis (6.7%).Thirteen patients (86.7%) achieved union. In 10 cases (66.7%), the index single-stage repair was sufficient to achieve union, while 3 cases required additional interventions to achieve union. Mean antibiotic treatment duration was 8.1 months (SD 7.1 months, range 1.2-26.4). Two patients (13.3%) developed recurrent infection, and five patients (33.3%) required unplanned reoperations to promote union or treat infection.
CONCLUSIONS
This study found a high ultimate union rate (86.7%) for one-stage infected humeral nonunion repair after prior failed osteosynthesis although 1 in 3 patients required unplanned reoperation for recurrent infections or recalcitrant nonunion.Level of Evidence Therapeutic level IV study.