case_images: PMC9826561_01
case_images: 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.
case_images: JOCR-12-40-g001.jpg
case_images: PMC9826561_01_JOCR-12-40-g001.jpg
case_images: F1
case_images: The proximal segment showed patchy sclerotic and lytic patches with areas of resorbed deformed head (Fig. 1).
case_images: 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.
case_images: JOCR-12-40-g002.jpg
case_images: PMC9826561_01_JOCR-12-40-g002.jpg
case_images: F2
case_images: After preliminary fixation with intramedullary Rush nail (3.5 mm), wound was kept open and packed adequately (Fig. 2).
case_images: Postoperative day 15 photograph showing a healing wound. The soft-tissue defect has been well covered by the granulation tissue.
case_images: JOCR-12-40-g003.jpg
case_images: PMC9826561_01_JOCR-12-40-g003.jpg
case_images: F3
case_images: 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).
case_images: 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.
case_images: JOCR-12-40-g004.jpg
case_images: PMC9826561_01_JOCR-12-40-g004.jpg
case_images: F4
case_images: Post-operative X-ray showed well-placed beads along the length of nail in the defect (Fig. 4, 5).
case_images: 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.
case_images: JOCR-12-40-g005.jpg
case_images: PMC9826561_01_JOCR-12-40-g005.jpg
case_images: F5
case_images: Post-operative X-ray showed well-placed beads along the length of nail in the defect (Fig. 4, 5).
case_images: Radiograph at 12 weeks after second surgery. Calcium sulfate is well absorbed with evidence of new bone formation.
case_images: JOCR-12-40-g006.jpg
case_images: PMC9826561_01_JOCR-12-40-g006.jpg
case_images: F6
case_images: 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).
case_images: Radiograph at 8 months after second surgery. The bone is well healed with evidence of developing medullary cavity.
case_images: JOCR-12-40-g007.jpg
case_images: PMC9826561_01_JOCR-12-40-g007.jpg
case_images: F7
case_images: The nail was removed after 20 weeks and at 32 weeks that the bone showed excellent healing (Fig. 7).