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Unexpected Positive Cultures After Failed Proximal Humerus Osteosynthesis: Why a Two-Stage Procedure Could Be Safer
Raffaele Garofalo1, Nunzio Lassandro2, Angelo De Crescenzo2
1IRCCS Humanitas Reserch Hospital, Humanitas University, 20089 Milan, Italy.
Journal of Clinical Medicine
|May 4, 2026
Summary
Microbiological analysis of removed devices in failed proximal humerus osteosynthesis revealed bacterial presence in most cases. Subsequent treatment improved patient range of motion and reduced pain significantly.
Area of Science:
- Orthopedic Surgery
- Infectious Disease
- Microbiology
Background:
- Failed osteosynthesis of proximal humerus fractures presents treatment challenges with poor clinical outcomes.
- Evaluating microbiological positivity of removed devices is crucial for understanding treatment failures.
- Assessing clinical outcomes, including range of motion and pain reduction, is essential post-intervention.
Purpose of the Study:
- To determine the microbiological positivity of implants removed due to proximal humerus osteosynthesis failure.
- To evaluate the clinical outcomes of patients undergoing implant removal and arthrolysis for failed proximal humerus synthesis.
- To correlate microbiological findings with clinical recovery, including range of motion and pain levels.
Main Methods:
- Retrospective analysis of 15 patients with failed proximal humerus synthesis undergoing implant removal and arthrolysis.
- Microbiological cultures of removed devices processed using the MicroDTTect® system for enhanced sensitivity.
- Assessment of patient demographics, Visual Analog Scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, Constant score, and range of motion (ROM) pre- and post-operatively.
Main Results:
- Microbiological cultures were positive in 8 out of 15 patients (53.3%), with slow-growing anaerobic bacteria, particularly C. acnes (62.5%), being predominant.
- Significant improvements were observed in passive range of motion (ROM).
- Patient-reported outcomes showed marked improvement: VAS decreased from 8.4 to 2, ASES score increased from 9 to 50.2, and Constant score rose from 17 to 40.7 at follow-up.
Conclusions:
- The study suggests a high prevalence of subclinical infection in cases of failed proximal humerus osteosynthesis.
- A two-stage surgical approach is recommended for managing proximal humerus synthesis failures.
- Arthrolysis followed by physiotherapy effectively prepares the shoulder for subsequent definitive prosthesis implantation, improving functional outcomes.
