A Case Report of Post-traumatic Osteomyelitis with Gap Non-union of Humerus with Segmental Bone Defect and Scarred Skin Treated with Open Reduction Internal Fixation with Osteomyocutaneous Fibula

Abstract

Introduction: Non-union of closed humerus fractures is estimated to be about 5.5% and this figure is even higher in open fractures. In cases of non-union of the humerus with segmental bone defect, if a conventional treatment has failed, free fibular transfer is often considered for satisfactory bone union. In some cases, where there is severe scarring due to multiple previous surgeries. In such cases, skin cover may not be adequate and tight closures often lead to necrosis and failure excision. Segmental bone defects of the upper limb that is >6 cm with soft-tissue coverage defects have limited options for reconstruction. Osteomyocutaneous fibula may provide to be a valuable option in such cases. Case Report: This is a report a case of a 27-year-old male presented with a history of road traffic accident with Gustilo-Anderson Grade 3 B open fracture of humerus midshaft. He developed humerus osteomyelitis, for which he underwent surgical debridement. He presented to us with gap non-union with segmental bone loss. The overlying skin was scarred and had significant limb shortening. Treatment options for such a case are reconstruction or amputation. Challenges for reconstruction were to deal with the segmental bone loss and the soft-tissue defect following scar excision. We tackled both these challenges with an osteomyocutaneous fibula flap. At 1-year follow-up, the humerus showed union and flap uptake was good. Conclusion: Osteomyocutaneous fibula flap is a valuable treatment options in such complicated cases allowing for both bone union and soft-tissue coverage with a single surgical procedure.