title: Non-vascularised fibular graft as an intramedullary strut for infected non-union of the humerus.
abstract: PURPOSE. To review outcomes of 7 patients who underwent revision surgery for infected non-union of the humerus using a fibular graft as an intramedullary strut. METHODS. Records of 7 men aged 29 to 59 (mean, 40) years with humeral diaphyseal infected non-union who underwent fixation using a compression plate and a non-vascularised fibular graft as an intramedullary strut were reviewed. The mean number of previous surgeries was 2.7 (range, 2-4). Three of the patients had active draining sinuses previously. Their C-reactive protein levels were normal and tissue cultures negative. The remaining 4 patients had active draining sinuses. They first underwent implant removal and debridement. Tissue cultures confirmed infection in 3 of them. The mean duration between debridement and the index surgery was 5 (range, 3-10) months. RESULTS. The mean length of the fibulae harvested was 13 (range, 12-15) cm. All 7 non-unions healed. The mean time to healing was 5.4 (range, 4-8) months. The mean follow-up period was 15 (range, 13-24) months. All patients had weakness of the extensor hallucis longus, which improved to near normal at month 3. There was no donor-site morbidity. Three patients with active infection at presentation underwent repeat surgery. Two of them had wound washouts, and their non-unions went on to heal successfully; one underwent implant removal after union due to an active sinus. Six of the patients returned to their pre-injury activity level, and one endured a brachial plexus injury. CONCLUSION. Fixation using a compression plate and a non-vascularised fibular graft as an intramedullary strut achieved good outcome for infected non-union of the humerus despite prior multiple failed surgeries.
authors.affiliation: Department of Orthopaedics, Christian Medical College, Vellore, Tamilnadu, India.
authors.forename: G
authors.initials: G
authors.lastname: Gopisankar
authors.forename: Arockiaraj S V
authors.initials: AS
authors.lastname: Justin
authors.forename: Manasseh
authors.initials: M
authors.lastname: Nithyananth
authors.forename: Vinoo M
authors.initials: VM
authors.lastname: Cherian
authors.forename: V N
authors.initials: VN
authors.lastname: Lee
mesh_terms: D000328:Adult; D001860:Bone Plates; D003646:Debridement; D005360:Fibula / Q000637:transplantation*; D005593:Fracture Fixation, Internal; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000382:microbiology / Q000601:surgery*