Managing Complications After Humerus Fracture Surgery: What You Need to Know

Surgical management of humeral fracture debridement?

Previously, I had a sports accident that resulted in a humeral fracture.
After examination at the hospital, it was discovered to be a pathological fracture.
The doctor recommended surgery to remove the damaged area and to use a plate for fixation with artificial bone.
Initially, I thought I could wait for over a year for the plate to be removed after healing, but unexpectedly, two months post-surgery, the wound suddenly opened up.
After undergoing debridement at the hospital, the wound has not healed for a long time (continuously exuding serous fluid).
During a follow-up visit, the doctor suggested a deep debridement and removal of the outer layer of artificial bone, along with the application of antibiotic bone cement.
However, I read online that bone cement is considered a foreign material, does not promote growth, and that the area filled with bone cement will not regenerate bone.
I would like to ask, since I am still young, is it okay for bone cement to remain in my body long-term without removal? Is there a chance to remove the bone cement later? Will the bone grow back after its removal? Or are there any better alternatives?

San, 30~39 year old female. Ask Date: 2018/10/31

Dr. Li Yongheng reply Orthopedics

1.
Pathological fractures in young individuals are uncommon, so it is essential to rule out the possibility of malignant bone tumors first.

2.
If a wound suddenly opens and continues to exude tissue fluid, it could indicate an infection or a rejection of the artificial bone.
Therefore, bacterial cultures and blood tests (ESR, CRP, WBC) should be performed for confirmation.

3.
If an infection is confirmed, debridement may be necessary, along with the application of antibiotic bone cement.
The antibiotic beads can also be removed during the subsequent plate removal surgery.

4.
The success rate is higher when combined with hyperbaric oxygen therapy.

Reply Date: 2018/10/31

More Info

Managing complications after a humerus fracture surgery can be quite complex, especially when dealing with pathological fractures and the subsequent surgical interventions. It sounds like you have been through a challenging journey with your injury, and I will address your concerns regarding the use of bone cement, healing, and potential future interventions.

Firstly, it is essential to understand that a pathological fracture indicates an underlying condition that weakens the bone, making it more susceptible to fractures. Surgical intervention, such as the removal of damaged bone and the use of artificial bone or plates for stabilization, is often necessary. However, complications can arise, as you've experienced with the wound dehiscence (the opening of the surgical wound) and persistent drainage.

The use of bone cement (polymethylmethacrylate, or PMMA) is common in orthopedic surgeries, particularly for stabilizing fractures or filling voids left by resected bone. While it is true that bone cement is considered a foreign material and does not promote bone growth in the same way that living bone does, it can provide structural support and help maintain alignment during the healing process. The concern about leaving bone cement in the body long-term is valid; however, many patients live with bone cement without significant issues. The cement itself is generally biocompatible, meaning it does not typically cause adverse reactions in the body.

Regarding your specific questions:
1. Long-term presence of bone cement: It is generally safe for bone cement to remain in the body long-term, especially if it is not causing any complications. However, if you experience persistent pain, infection, or other issues related to the cement, your healthcare provider may recommend its removal.

2. Possibility of removal: Bone cement can be removed, but the procedure can be complex and may require additional surgery. The decision to remove it should be based on your symptoms and the advice of your orthopedic surgeon.

3. Bone regrowth after removal: If the bone cement is removed, the potential for bone regrowth depends on the condition of the surrounding bone and the underlying pathology that caused the initial fracture. In some cases, the bone may regenerate, especially if the underlying issue is addressed.

4. Alternative approaches: If you are concerned about the use of bone cement, discuss with your orthopedic surgeon the possibility of other options. In some cases, bone grafting (using your bone or donor bone) may be a viable alternative to cement, as it can promote natural bone healing and growth.

5. Managing complications: It is crucial to follow your surgeon's recommendations for wound care and rehabilitation. If you notice any signs of infection (increased redness, swelling, warmth, or discharge), contact your healthcare provider immediately. Regular follow-up appointments are essential to monitor healing and address any complications early.

In conclusion, while the use of bone cement is a common practice in orthopedic surgery, it is essential to weigh the benefits against potential long-term implications. Open communication with your healthcare provider will help you navigate your recovery and make informed decisions about your treatment options. Always prioritize your health and well-being, and do not hesitate to seek a second opinion if you feel uncertain about your current treatment plan.

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