Acute Osteomyelitis in Closed Fracture of Adult Humerus- Case Report and Review of Literature

Acute osteomyelitis developing in a closed fracture is extremely rare. Only twenty six such cases have been reported in literature so far with most cases being associated with immunodeficiency or polytraumaalongwith a potential source of infection though none of them involved the humeral shaft. We report a case of acute osteomyelitis of shaft of humerus in an unpredisposed 50 year old male without any apparent source of infection following closed diaphyseal humeral fracture. Acute osteomyelitis was managed with antibiotics. However it later on complicated into chronic osteomyelitis which was treated with debridement and sequestrectomy. Bony defect was addressed later when all signs of infection had disappeared with acute docking and onlay fibular grafting with plating. Union was seen at 10 weeks post op with satisfactory functional results. The pathogenesis of this complication after closed fractures is actively debated and is thought to involve proliferation of microorganisms already residing in host tissues or their translocation from microfissures in skin in the setting of low resistance due to inflammed soft tissue after trauma. Hence this complication should be considered if excessive or prolonged pain and swelling with signs of inflammation develop where no other obvious infection is apparent. Also onlay fibular grafting alongwith plating successfully addressed bony defect in our case.