Outcomes after infected humeral shaft nonunion surgery.

Objectives: This study looks to report overall union rate after surgical treatment of infected humeral shaft nonunions. Design: Retrospective. Setting: Eight Level 1 trauma centers. Patients/Participants: Twenty-six patients with infected humeral shaft nonunions and ≥180-day follow-up. A nonunion was considered infected in the presence of a draining sinus or positive intraoperative cultures. Intervention: Surgical treatment of infected humeral nonunion. Main Outcome Measurements: The primary outcome was union rate, and subanalysis was performed comparing planned single stage versus staged surgery. Secondary outcomes included overall postoperative complications. Results: The mean follow-up time was 20.7 months; median age was 39.5 years. The initial fixation construct in most patients was plate and screws (81%). After revision surgery, only 50% (n = 13) of these went on to union. Preplanned staged treatment does not appear to be associated with successful union. Postoperative complications were high including persistent nonunion and infection. Tobacco use, diabetes, BMI, and bone grafting did not affect union. Conclusions: This study supports our hypothesis that infected humeral nonunions are challenging to treat and are at high risk for recalcitrant nonunion (50%). Further research is warranted to determine whether staged treatment is associated with a higher rate of union. Level of Evidence: III.