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Management of medullary osteomyelitis of the humerus.

Osteomyelitis is a severe infection of bone and is particularly challenging to treat when involving long bones. Osteomyelitis of the humerus is an uncommon but difficult problem, and the guidelines of treatment have been drawn from the literature on the treatment of tibial and femoral osteomyelitis. We present our technique for treating adult hematogenous medullary osteomyelitis of the humerus. Steps include the following: (1) a deltopectoral approach to the humerus, (2) formation of a cortical window in the proximal humerus, (3) biopsy and reaming of the intramedullary canal from proximal to distal under fluoroscopy, (4) lavage of the intramedullary canal, (5) placement of antibiotic-impregnated antibiotic beads on a stainless steel wire into the canal, and (6) long-term antibiotics and laboratory monitoring of white blood cell count and erythrocyte sedimentation rates levels. Preliminary clinical results with at least 12 months' follow-up have resulted in excellent results without complications. We recommend this technique for the treatment of osteomyelitis of the humerus, for it affords a reliable and familiar approach to the treatment of a difficult infection of the humerus.