Hybrid Osteosynthesis for Septic Humeral Shaft Nonunion in a Patient with Obesity: A Case Report.
- 1Department of Orthopedic Surgery and Traumatology, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, MEX.
- 2Department of Orthopedic Surgery and Traumatology, Centro Médico ABC, Mexico City, MEX.
- 3Department of Orthopedic Surgery and Traumatology, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, MEX.
Abstract
Septic humeral shaft nonunion represents a complex reconstructive challenge in orthopedic surgery, particularly in patients with obesity, in whom increased lever arms and greater mechanical loading of the upper extremity substantially compromise fixation stability. Recurrent failure of isolated fixation constructs, including intramedullary nails or compression plates, necessitates hybrid strategies that combine enhanced biomechanical stability with effective eradication of microbial infection. This article presents the case of a middle-aged man with obesity and a history of a left humeral shaft fracture initially treated with intramedullary nailing in December 2020 who developed persistent nonunion. Following revision surgery with dynamic compression plating, fixation failure occurred secondary to implant fatigue. A second revision procedure was performed through a posterior approach, including nerve neurolysis, extensive debridement, and hybrid fixation using a 240 x 8 mm Targon™ H intramedullary nail (B. Braun, Melsungen, Germany) combined with a narrow 4.5-mm dynamic compression plate (DCP; DePuy Synthes, Warsaw, IN, USA). Cancellous bone chip grafting was also performed. Intraoperative cultures yielded Staphylococcus epidermidis, establishing the diagnosis of septic nonunion, and targeted oral clindamycin therapy was initiated. Despite transient postoperative radial neuropraxia, which resolved with pregabalin treatment and structured physical rehabilitation, the patient achieved complete osseous union, eradication of infection, and an Upper Extremity Functional Scale (UEFS) score of 69/80, corresponding to 86% of maximal functional capacity. In conclusion, hybrid fixation combining an intramedullary nail with a narrow 4.5-mm DCP, together with pathogen-directed antimicrobial therapy, provides excellent axial and rotational stability and represents an effective salvage strategy for septic humeral shaft nonunion in patients with increased biomechanical demands.
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BibTeX
@article{chiquiniramirez2026hybrid,
title = {{Hybrid Osteosynthesis for Septic Humeral Shaft Nonunion in a Patient with Obesity: A Case Report.}},
author = {Paolo Chiquini-Ramírez and Nancy Lorena Villamues-Moreno and Jorge Ponce-de-Léon-Dominguez and Leonardo Moreno-Degante and Bernardo Pettet-Ruiz and Ernesto Torres-Casado and Héctor Mauricio Reyes-García and Nelva Garduza-Leyva},
journal = {Cureus},
year = {2026},
month = nov,
doi = {10.7759/cureus.119283},
url = {https://europepmc.org/article/MED/42999717},
note = {CC BY},
}
RIS
TY - JOUR
TI - Hybrid Osteosynthesis for Septic Humeral Shaft Nonunion in a Patient with Obesity: A Case Report.
AU - Paolo Chiquini-Ramírez
AU - Nancy Lorena Villamues-Moreno
AU - Jorge Ponce-de-Léon-Dominguez
AU - Leonardo Moreno-Degante
AU - Bernardo Pettet-Ruiz
AU - Ernesto Torres-Casado
AU - Héctor Mauricio Reyes-García
AU - Nelva Garduza-Leyva
PY - 2026
DA - 2026/11/07
JO - Cureus
DO - 10.7759/cureus.119283
UR - https://europepmc.org/article/MED/42999717
AB - Septic humeral shaft nonunion represents a complex reconstructive challenge in orthopedic surgery, particularly in patients with obesity, in whom increased lever arms and greater mechanical loading of the upper extremity substantially compromise fixation stability. Recurrent failure of isolated fixation constructs, including intramedullary nails or compression plates, necessitates hybrid strategies that combine enhanced biomechanical stability with effective eradication of microbial infection. This article presents the case of a middle-aged man with obesity and a history of a left humeral shaft fracture initially treated with intramedullary nailing in December 2020 who developed persistent nonunion. Following revision surgery with dynamic compression plating, fixation failure occurred secondary to implant fatigue. A second revision procedure was performed through a posterior approach, including nerve neurolysis, extensive debridement, and hybrid fixation using a 240 x 8 mm Targon™ H intramedullary nail (B. Braun, Melsungen, Germany) combined with a narrow 4.5-mm dynamic compression plate (DCP; DePuy Synthes, Warsaw, IN, USA). Cancellous bone chip grafting was also performed. Intraoperative cultures yielded Staphylococcus epidermidis, establishing the diagnosis of septic nonunion, and targeted oral clindamycin therapy was initiated. Despite transient postoperative radial neuropraxia, which resolved with pregabalin treatment and structured physical rehabilitation, the patient achieved complete osseous union, eradication of infection, and an Upper Extremity Functional Scale (UEFS) score of 69/80, corresponding to 86% of maximal functional capacity. In conclusion, hybrid fixation combining an intramedullary nail with a narrow 4.5-mm DCP, together with pathogen-directed antimicrobial therapy, provides excellent axial and rotational stability and represents an effective salvage strategy for septic humeral shaft nonunion in patients with increased biomechanical demands.
SN - 2168-8184
ER -