Recalcitrant Humeral Non-union Following Unusual Hematogenous E. coli Osteomyelitis

We discuss a case of 27 years old female, presented 10 years ago with E. Coli osteomyelitis with subsequent pathological fracture. The patient has numerous medical conditions such as thalassemia, sickle cell disease, Factor V deficiency, Familial Mediterranean Fever, multiple Deep Vein Thrombosis events. Initially she was treated with IV AB, followed by multiple debridement surgeries, local implantation of PMMA with antibiotics. Multiple reconstruction attempts were taken including plate osteosynthesis, vascularized fibular graft, massive autologic bone grafting, Taylor Spatial Frame. However, each and every surgery ended up with re-fracture eventually. During the course of surgical treatments wrist drop occurred as a result of radial nerve palsy. At some point above elbow amputation was considered.

Parathyroid hormone treatment for a year was introduced prior the next surgery and continued for a year after the double plating combined with autologous bone grafting and radial nerve release. Now, two years after that surgery the fixation is stable and the arm painless.

Recently, tendon transfer to address wrist drop was performed.