Acute deep infection after surgical fixation of proximal humeral fractures

Acute deep infection after open reduction–internal fixation of proximal humeral fractures is uncommon. Currently, there are no reported series on the outcomes of patients treated for infection after surgery for proximal humeral fractures. The purpose of this study was to review the frequency, clinical presentation, bacteriology, treatment, and outcomes of patients with such fractures complicated by acute deep infection. Between 1993 and 2003, 5 patients with acute deep infection after open reduction–internal fixation of proximal humeral fractures were identified. The medical records, laboratory data, and radiographs were examined retrospectively. The mean age at the time of infection diagnosis was 50 years (range, 33-82 years), and the mean interval from proximal humeral fracture fixation to the time of infection diagnosis was 27 days (range, 14-40 days). All patients were available for final follow-up evaluation at a mean of 6.4 years (range, 32 months to 8.3 years). Of the 5 patients, 4 (80%) went on to nonunion requiring revision surgery. Coagulase-negative Staphylococcus 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 final follow-up of 6.4 years, the American Shoulder and Elbow Surgeons score averaged 53 points (range, 33-75 points) and the Simple Shoulder Test score averaged 6.2 points (range, 1-10 points). Acute deep infection after open reduction–internal fixation of proximal humeral fractures is a devastating complication. Patients should be counseled that the results of treatment of deep infection are plagued with high complication rates, poor functional outcome, and a notably high nonunion rate.