Authors: George S. Athwal MD FRSCS*, John W. Sperling MD, Damian M. Rispoli MD, Robert H. Cofield MD
Title: Acute Deep Infection Following Surgical Fixation of Proximal Humerus Fractures
Addresses: Hand and Upper Limb Centre, St Joseph's Health Care, University of Western Ontario, 268 Grosvenor Street, Room L009, London, Ontario, Canada, N6A 4L6
Purpose: The purpose of this study was to review the incidence, clinical presentation, bacteriology, treatment, and outcomes of patients with deep infection after the surgical treatment of proximal humerus fractures.
Methods: Between 1993 and 2003, five patients with acute deep infection following open reduction and internal fixation of proximal humerus fractures were identified. The medical records, laboratory data and radiographs were retrospectively examined. The mean age of the patients at the time of infection diagnosis was 50 years (range, 33 to 82 years) and the mean interval from proximal humerus fracture fixation to the time of infection diagnosis was 27 days (range, 14 to 40 days). All patients were available for final follow-up evaluation at a mean of 6.4 years (range, 32 months to 8.3 years).
Results: Four of five patients (80%) with acute infection following surgical treatment of proximal humerus fractures went on to nonunion requiring revision surgery. Coagulase-negative Stapylococcus species and Propionibacterium acnes were the most common organisms isolated. A mean of 3.3 surgical debridements were necessary for the eradication of infection. At a mean of 6.4 years final follow-up, the American Shoulder and Elbow Surgeons Score averaged 53 points (range, 33 to 75 points) and the Simple Shoulder Test score averaged 6.2 points (range, 1 to 10 points).
Discussion: Acute deep infection following open reduction and internal fixation of proximal humerus fractures is a devastating complication. Patients should be counseled that the results of treatment of deep infection are plagued with high complications rates, poor functional outcome and a notably high nonunion rate.