Infected gap nonunion of fractures proximal humerus in adolescent: an outcome of 12 cases

Authors

  • Sanjay Kumar Rai Department of Orthopaedics, Indian Naval Ship Hospital, RC Church, Colaba, Mumbai, Maharashtra
  • Rohit Vikas Department of Orthopaedics, Indian Naval Ship Hospital, RC Church, Colaba, Mumbai, Maharashtra
  • Naveen Shijale Department of Orthopaedics, Indian Naval Ship Hospital, RC Church, Colaba, Mumbai, Maharashtra

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20172874

Keywords:

Humerus shaft fracture infection, Gap nonunion, Fracture proximal 1/3 of humerus, Adolescent, Osteomyelitis humerus

Abstract

Background: There is little data about the risk factors, demographics, and prognosis for nonunions in children. Previous literature has reviewed time periods when contemporary techniques of internal fixation and management of open injuries had not been available. Infected gap nonunion of proximal 1/3 humerus in adolescent is not much reported the in literature. The purpose of our study was to evaluate the outcome of infected gap nonunion in 12 cases of adolescent treated by debridement and fibular graft and plating.

Methods: This study was conducted between 2009 to 2015, 12 cases of Infected gap nonunion of fractures proximal humerus was included in our study. Each child was followed up minimum for 12 months.  Although non unions in the pediatric population are rare, these data underscore the importance of careful evaluation and treatment of these fractures at risk for nonunion.

Results: In our series of 12 cases of infected nonunion of fracture humerus which were treated by bone grafting using fibula strut graft and plating resulted 99% union rate. The rate of union is depending on thorough debridement and fixation along with bone grafting.

Conclusions: Nonunion of pediatric fractures is a rare complication. Most studies on developing pediatric nonunions describe specific fractures that are particularly susceptible to nonunion and malunion, nonunion of humeral lateral condyle and open tibia fractures have received the most attention. Reports of nonunion among pediatric long bone fractures are rare, being either case reports or isolated entities in a larger series of predominantly adult fractures. Fibula is a popular substitute for this method because of its easy accessibility and minimal donor site morbidity.

Author Biographies

Sanjay Kumar Rai, Department of Orthopaedics, Indian Naval Ship Hospital, RC Church, Colaba, Mumbai, Maharashtra

lt Colonel

Rohit Vikas, Department of Orthopaedics, Indian Naval Ship Hospital, RC Church, Colaba, Mumbai, Maharashtra

Department of Orthopaedics, Lt Colone

References

Peltier LF. The classic. Ununited fractures in children. James Paget, 1891. Clin Orthop Relat Res. 1982;166:2-4.

Lewallen RP, Peterson HA. Nonunion of Long Bone Fractures in Children: A Review of 30 Cases. J Pediatr Orthop. 1985;5(2):135-42.

Al-Zahrani S, Harding MG, Kremli M, Khan FA, Ikram A, Takroni T. Free fibular graft still has a place in the treatment of bone defects. Injury. 1993;24:551-4.

Enneking WF, Eady JL, Burchardt H. Autogenous cortical bone grafts in the reconstruction of segmental skeletal defects. J Bone Joint Surg Am. 1980;62:1039-58.

Yadav SS. Dual fibular grafting for massive bone gaps in the lower extremity. J Bone Joint Surg Am. 1990;72:486-94.

Kocaoglu M, Eralp L, Rashid HU, Sen C, Bilsel K. Reconstruction of segmental bone defects due to chronic osteomyelitis with use of an external fixator and an intramedullary nail. J Bone Joint Surg Am. 2006;88:2137-45.

Lewallen RP, Peterson HA. Nonunion of long bone fractures in children: a review of 30 cases. J Pediatr Orthop. 1985;5(2):135-42.

Gamble JG, Rinsky LA, Strudwick J, Bleck EE. Non-union of fractures in children who have osteogenesis imperfecta. J Bone Joint Surg Am. 1988;7(3):439-43.

Haramati N, Roye DP, Adler PA, Ruzal-Shapiro C. Non-union of pediatric fibula fractures: easy to overlook, painful to ignore. Pediatr Radiol. 1994;24(4):248-50.

Adamczyk MJ, Riley PM. Delayed union and nonunion following closed treatment of diaphyseal pediatric forearm fractures. J Pediatr Orthop. 2005;25(1):51-5.

Pahlavan S, Baldwin KD, Pandya NK, Namdari S, Hosalkar H. Proximal humerus fractures in the pediatric population: a systematic review. J Child Orthop. 2011;5:187–94.

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Published

2017-06-23

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Section

Original Research Articles