Treatment of infected humeral shaft nonunion and presumed aseptic nonunion with positive intraoperative cultures: a retrospective single-center study

The management of infected humeral shaft nonunion (HSN) remains challenging due to the lack of consensus and the potential for occult infection. The aim of this study was to evaluate a surgical strategy based on a two-stage treatment for suspected infection or a one-stage treatment for infection diagnosed retrospectively based on systematic bacteriological sampling.

We retrospectively reviewed 16 patients with a median age of 36 years who were treated for septic HSN: 9 patients underwent a two-stage procedure using the induced membrane technique, and 7 patients were treated in a single stage. Revision parameters included achieving bone union, its time frame, and a functional assessment based on joint motion and the Quick-DASH score.

At a median follow-up of 47.5 months, 12 out of 16 patients were cured with acquired bone union and no septic recurrence. The median time to bone union was 5.5 months. Smoking and previous surgeries were adverse factors for bone healing. Radiological and functional outcomes were comparable between patients treated in a single stage and those treated in two stages.

This study confirms the relevance of one-stage surgery for HSN with occult infection and the value of systematic bacteriological sampling during the revision of humeral diaphyseal osteosynthesis.