PMC9826561_01
Radiograph of the left humerus showing massive soft-tissue swelling, areas of destruction of the humeral head with patchy osteolysis, and sclerosis. A large bone defect is visible with cement spacer block and beads in situ.
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F1
The proximal segment showed patchy sclerotic and lytic patches with areas of resorbed deformed head (Fig. 1).
Post-operative day 5 image showing a debrided wound with nail in situ. There is granulation tissue visible with some amount of necrotic tissue in the center.
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F2
After preliminary fixation with intramedullary Rush nail (3.5 mm), wound was kept open and packed adequately (Fig. 2).
Postoperative day 15 photograph showing a healing wound. The soft-tissue defect has been well covered by the granulation tissue.
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F3
After the intravenous therapy, the patient was started on oral Ciprofloxacin 500 mg BD regimen for another 6 weeks. As the wound condition improved, counts dropped further to 6000, ESR normalized (Fig. 3).
Lateral radiograph after second surgery. Calcium sulfate beads with bone graft are well placed with nail in situ. The arm was protected in a splint.
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F4
Post-operative X-ray showed well-placed beads along the length of nail in the defect (Fig. 4, 5).
Anteroposterior radiograph after second surgery. Calcium sulfate beads with bone graft are well placed with nail in situ. The arm was protected in a splint.
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F5
Post-operative X-ray showed well-placed beads along the length of nail in the defect (Fig. 4, 5).
Radiograph at 12 weeks after second surgery. Calcium sulfate is well absorbed with evidence of new bone formation.
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F6
A follow-up radiograph at 12 weeks postoperatively showed complete absorption of the calcium sulfate beads and new bone formation along the site of defect (Fig. 6).
Radiograph at 8 months after second surgery. The bone is well healed with evidence of developing medullary cavity.
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F7
The nail was removed after 20 weeks and at 32 weeks that the bone showed excellent healing (Fig. 7).