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Okumura T, Komura S, Hirakawa A, Hirose H, Akiyama H. Two-stage reconstruction using a vancomycin-impregnated cement spacer for finger osteomyelitis with bone and joint destruction. HAND SURGERY & REHABILITATION 2024; 43:101602. [PMID: 37783387 DOI: 10.1016/j.hansur.2023.09.369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/15/2023] [Accepted: 09/17/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVES Septic arthritis and osteomyelitis are serious infections. Several treatment methods for the small joints and bones of the hands have been reported. We hypothesized that antibiotic-impregnated cement spacers could be useful for purulent finger osteomyelitis with bone and joint destruction. PATIENTS AND METHODS Seven patients with finger osteomyelitis with bone and joint destruction were treated using vancomycin (VCM)-impregnated cement spacers. During the first surgery, a cement spacer was placed in the space created after debridement, maintaining finger length. Intraoperative specimens were tested for bacterial growth. Systemic antibiotic treatment was administered. A second surgery was performed 6-8 weeks after the first. After spacer removal, reconstruction surgeries were performed: arthrodesis using the Masquelet technique (n = 5), vascularized bone grafting (n = 1), and silicone implant arthroplasty (n = 1). We assessed the pathogenic bacteria, duration of antibiotic treatment, infection control, time to bone union, pain on visual analogue scale (VAS) (0 - 100), total active motion (TAM) of the affected fingers, and grip strength. RESULTS The pathogenic bacteria were methicillin-sensitive Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, and unknown in 3, 3, and 1 patients, respectively. Mean duration of antibiotic treatment was 6.4 weeks. In all patients, infection resolved without recurrence. One patient underwent joint arthroplasty; otherwise, bone union was achieved in 6 patients. Mean VAS score for pain was 0.9. Mean TAM was 147° for the index and middle fingers and 50° for the thumb. Mean grip strength was 86.4% of that of the unaffected side. CONCLUSION VCM-impregnated cement spacers could be useful for finger osteomyelitis, facilitating effective infection control and the maintenance of finger length, even in severe conditions.
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Affiliation(s)
- Takaomi Okumura
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Shingo Komura
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan.
| | - Akihiro Hirakawa
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hitoshi Hirose
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
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Zairi M, Mohseni AA, Msakni A, Jaber C, Mensia K, Saied W, Bouchoucha S, Boussetta R, Nessib MN. Acute hematogenous osteomyelitis in children: Management of pandiaphysitis with extensive bone destruction: A case series of thirteen child. Ann Med Surg (Lond) 2022; 82:104578. [PMID: 36268342 PMCID: PMC9577533 DOI: 10.1016/j.amsu.2022.104578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/29/2022] [Accepted: 09/04/2022] [Indexed: 11/29/2022] Open
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Brush PL, Toci GR, Semenza NC, Fletcher D, Beredjiklian P, Aita D. Masquelet Technique and Arthrodesis for Digit Salvage of the Finger in Traumatic Bone Loss and Osteomyelitis: A Case Report. Cureus 2022; 14:e26773. [PMID: 35967169 PMCID: PMC9366054 DOI: 10.7759/cureus.26773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2022] [Indexed: 11/22/2022] Open
Abstract
Use of the Masquelet technique in the hand is uncommon, particularly for cases complicated by osteomyelitis. This case report describes a patient who was advised to proceed with digital amputation following the traumatic segmental bone loss with a non-salvageable distal interphalangeal joint surface complicated by osteomyelitis but refused amputation and requested alternative treatment. We suggested and performed the Masquelet procedure and arthrodesis to salvage the digit. The first stage consisted of surgical debridement and placement of an antibiotic cement spacer, and the second stage included the replacement of the antibiotic cement spacer with an iliac crest autograft and arthrodesis eight weeks after the primary procedure. The Masquelet technique led to the resolution of osteomyelitis, successful osseous union, finger ray salvage, and distal interphalangeal joint arthrodesis.
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Harch SAJ, Lim YJ, Mooney L, Ryan LJ, Warner MS. Prevotella intermedia: a rare cause of native knee joint septic arthritis and osteomyelitis in an immunocompetent patient. Intern Med J 2022; 52:891-892. [PMID: 35538015 DOI: 10.1111/imj.15784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/10/2021] [Accepted: 04/10/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Susan A J Harch
- Department of Infectious Diseases, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Yi J Lim
- University of Adelaide, Adelaide, South Australia, Australia
| | - Luke Mooney
- Department of Orthopaedics and Trauma, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Liam J Ryan
- Department of Orthopaedics and Trauma, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Morgyn S Warner
- Department of Infectious Diseases, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia.,University of Adelaide, Adelaide, South Australia, Australia.,Department of Microbiology and Infectious Diseases, SA Pathology, Adelaide, South Australia, Australia
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Chughtai M, Scollan JP, Emara AK, Brej B, Steckler A, Churchill JL, Ferre A, Saluan P, Styron JF. The "Fight Bite" Saline Joint Loading Test: Effectiveness in Detecting Simulated Traumatic Metacarpophalangeal Arthrotomies. Hand (N Y) 2022:15589447211068184. [PMID: 34991409 DOI: 10.1177/15589447211068184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The saline load test is routinely used to recognize other joints' traumatic arthrotomies; however, there are currently no studies evaluating the novelty of this test for metacarpophalangeal joints (MCPJs). This study aimed to investigate the effectiveness and sensitivity of saline load testing in identifying the traumatic arthrotomies of the MCPJs using human cadavers. Methods: This was a cadaveric study of 16 hands (79 MCPJs). Traumatic arthrotomies were created using 11-blade stab-incisions, followed by blunt probing into the joint on the radial or ulnar side of the flexed MCPJs. A 3-mL syringe was used to inject intra-articular methylene-blue-dyed saline from the contralateral side. The volume at saline extravasation was recorded. Test sensitivity and factors influencing extravasation volume were assessed. Results: The mean (range) volume injected to identify arthrotomy of all MCPJs was 0.18 mL (0.1-0.4 mL). The mean volume to identify MCPJ arthrotomy of the thumb, index, long, ring, and small fingers was 0.16 mL (0.1-0.3 mL), 0.19 mL (0.1-0.3 mL), 0.21 mL (0.1-0.4 mL), 0.17 mL (0.1-0.3 mL), and 0.16 mL (0.1-0.3 mL), respectively. Cadaver age, laterality, and joint range of motion were not significantly associated with the injected volume at extravasation(P > .05, each). Injection volumes of 0.3 and 0.32 mL were required to detect arthrotomies at 95% and 99% sensitivities across all MCPJs. None of the MCPJs required > 0.4 mL to detect arthrotomy. Conclusions: Saline joint loading volumes to detect traumatic arthrotomy were similar for all MCPJs. Injection volumes of 0.32 mL is suggested for 99% sensitivity. Our findings provide the first report, to our knowledge, on intra-articular injection volumes expected to detect an arthrotomy of MCPJ. This is critical for further validation using in vivo clinical studies.
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Affiliation(s)
| | | | | | - Ben Brej
- Cleveland Clinic Foundation, OH, USA
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Gessmann J, Rosteius T, Baecker H, Sivalingam K, Peter E, Schildhauer TA, Köller M. Is the bioactivity of induced membranes time dependent? Eur J Trauma Emerg Surg 2021; 48:3051-3061. [PMID: 34873632 PMCID: PMC9360131 DOI: 10.1007/s00068-021-01844-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/21/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE The induced membrane technique (IMT) is a two-stage surgical procedure for reconstruction of bone defects. Bone grafting (second stage of IMT) is recommend after 4-8 weeks assuming the highest bioactivity of IMs. However, larger studies concerning the biology and maturation of IMs and a potential time dependency of the bioactivity are missing. Therefore, aim of this study was the time-dependent structural and cellular characterization of cement spacer IMs concomitantly to an analysis of membrane bioactivity. METHODS IMs from 60 patients (35-82 years) were obtained at different maturation stages (1-16 weeks). IMs were studied by histology and co-culture with mesenchymal stem cells (MSC). IM lysates were analyzed by ELISA and protein microarray. RESULTS Increasing vascularization and fibrosis were found in membranes older than 4 and 7 weeks, respectively. MSC grew out from all membranes and all membranes enhanced proliferation of cultured MSC. Osteocalcin and osteopontin (in membrane lysates or induced in MSC by membrane tissue) were found over all time points without significant differences. In contrast to alkaline phosphatase activity, increasing levels of osteoprotegerin were found in membranes. CONCLUSION The histological structure of IMs changes during growth and maturation, however, biologically active MSC and factors related to osteogenesis are found over all time points with minor changes. Thus, membranes older than 8 weeks exert regenerative capacities comparable to the younger ones. The postulated narrow time frame of 4-8 weeks until bone grafting can be questioned and surgeons may choose timing for the second operation more independently and based on other clinical factors.
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Affiliation(s)
- Jan Gessmann
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Thomas Rosteius
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
| | - Hinnerk Baecker
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Kavitha Sivalingam
- Department of Surgical Research, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Elvira Peter
- Department of Surgical Research, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Thomas Armin Schildhauer
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Manfred Köller
- Department of Surgical Research, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
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Abstract
Although most hand infections can be eradicated by appropriate management with return to normal function, complications are frequently encountered. Common complications include stiffness, osteomyelitis, and large soft tissue defects that require complex wound management. Risk factors for hand infections include an immunocompromised host state, as is the case in patients with diabetes mellitus or human immunodeficiency virus/AIDS, as well as those on immunosuppressive medications for autoimmune disorders or following organ transplantation. Patients at risk for complications secondary to hand infections should be monitored closely during the treatment process so that complications may be identified and treated early.
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Staged arthrodesis using the Masquelet technique for osteomyelitis of the finger with articular destruction: a report of two cases. Arch Orthop Trauma Surg 2019; 139:1025-1031. [PMID: 31093754 DOI: 10.1007/s00402-019-03197-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Indexed: 02/09/2023]
Abstract
Osteitis of the fingers is a serious infection that needs early diagnosis and appropriate surgical debridement and antibiotic treatment of the infected bone. If the effects of treatments are insufficient, long-term antibiotic treatment and repeated operations could be required. In worst cases, some patients may have to undergo amputation. Recently, the usefulness of the Masquelet technique in extensive traumatic bone defects has been reported. We herein describe two cases of immunocompromised patients with purulent osteitis involving joint destruction of the finger treated by two-stage arthrodesis using the Masquelet technique. They obtained good infection control and better function of the finger than before the operation. Moreover, there was no recurrence of the infection. The Masquelet technique could be an alternative technique for osteitis with high risk of amputation.
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