Pediatric‑onset humeral osteomyelitis managed with an anterior tibial artery–based second fibular flap and shoulder prosthesis: A rare Case Report
Keywords:
Chronic osteomyelitis, humerus, Pediatric trauma, Free fibula flap, Anterior tibial artery, NonunionAbstract
Background:
Chronic osteomyelitis of the humerus is usually a rare phenomenon in children and may lead to nonunion and failed reconstruction. This case demonstrates the long-term sequelae of such complications, resulting in extensive bone necrosis and reconstructive failure.
Case Presentation:
We report the case of a 16‑year‑old male who presented with a five‑year history of a painful, discharging sinus following a childhood humeral fracture initially treated with an external fixator. The patient then developed chronic nonunion with recurrent infection. Debridement and a free fibula flap were attempted; however, this failed. Examination and imaging showed extensive destruction of the humeral head and proximal shaft consistent with chronic osteomyelitis.
A shoulder prosthesis was placed, and a second vascularized fibular flap was used for reconstruction based on the anterior tibial artery. This provided both structural support and soft‑tissue coverage. The patient developed no recurrence and had stable limb function at follow‑up.
Conclusion:
This case highlights the challenges of chronic humeral osteomyelitis in pediatric trauma and shows a case of successful limb salvage using a second fibular flap based on the anterior tibial artery after a previous flap failure.
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Copyright (c) 2026 Kamran Khalid, Ali Akbar Subhani, Urwah Kamran, Rabia Ahmad, Ahmed Faraz, Muhammad Maaz Hassan (Author)
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