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Shastov A, Mikhailov A, Kliushin N, Malkova T. Limb salvage and functional recovery in infected nonunion of the distal tibia treated with the Ilizarov techniques. J Clin Orthop Trauma 2023; 44:102255. [PMID: 37817763 PMCID: PMC10561033 DOI: 10.1016/j.jcot.2023.102255] [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] [Received: 02/06/2023] [Revised: 06/30/2023] [Accepted: 09/21/2023] [Indexed: 10/12/2023] Open
Abstract
Introduction Treatment of infected nonunion of the distal juxta-articular tibia is a challenge due to a short distal fragment, deformity, thin soft-tissue envelope, and active infection. There is still no consensus on the approach that is able to maximally salvage the limb and ankle function. Material and methods Infected juxta-articular nonunion of the distal tibia was managed with two Ilizarov techniques, monofocal compression (MC) used in 12 patients and bifocal compression-distraction (BCD) in 6 patients. The choice of the technique depended on the size of the postresection defect, ≥3 cm or ≤3 cm, respectively. The tactics of functional approach were careful debridement, insertion of wires in the distal fragment so that they do not penetrate the ankle joint, stable fixation, and temporary bridging of the ankle and forefoot. MSCT was used along with regular radiography to assess the union and regeneration. Ankle functions were evaluated with AOFAS ankle-hindfoot score system. Results Bone consolidation, infection arrest and ankle function improvement were achieved in all patients. External fixation continued 221.7 ± 15.1 days for MC and 235 ± 25.8 days for BCD. Complications were wound divergence, wire-tract infection, premature consolidation of the fibula, and hypoplastic regeneration in one case. The mean functional AOFAS score after treatment was 90.7 ± 2.5 points in MC and 89.7 ± 1.3 in BCD patients. Residual limb discrepancy after MC ranged 0-4 cm. Bone shortening was compensated in BCD patients. Conclusion Limb-salvage and functional approach to the treatment of infected nonunion of the juxta-articular distal tibia with the Ilizarov techniques achieves good outcomes. It provides bone infection arrest, consolidation, defect compensation and significantly improves the ankle joint function.
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Affiliation(s)
- A.L. Shastov
- Orthopaedic Surgeon, Bone and Joint Infection Clinic Department # 3, National Ilizarov Medical Research Centre for Traumatology and Orthopaedics, 6 M. Ulianova street, Kurgan, Russia
| | - A.G. Mikhailov
- Orthopaedic Surgeon, Head of Bone Infection Clinical Department # 3, National Ilizarov Medical Research Centre for Traumatology and Orthopaedics, 6 M. Ulianova street, Kurgan, Russia
| | - N.M. Kliushin
- Orthopaedic Surgeon, Bone and Joint Infection Clinic, National Ilizarov Medical Research Centre for Traumatology and Orthopaedics, 6 M. Ulianova street, Kurgan, Russia
| | - T.A. Malkova
- Expert of the Department for Analysis of Medical Information, National Ilizarov Medical Research Centre for Traumatology and Orthopaedics, 6 M. Ulianova street, Kurgan, Russia
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Hartmann R, Grubhofer F, Waibel FWA, Götschi T, Viehöfer AF, Wirth SH. Treatment of hindfoot and ankle infections with Ilizarov external fixator or spacer, followed by secondary arthrodesis. J Orthop Res 2021; 39:2151-2158. [PMID: 33280159 DOI: 10.1002/jor.24938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/27/2020] [Accepted: 12/01/2020] [Indexed: 02/04/2023]
Abstract
An established treatment strategy in surgical site infection after hindfoot and ankle surgery is a two-stage procedure with debridement and placement of a cement spacer, followed by antibiotic treatment and secondary arthrodesis. However, there is little evidence to favor this treatment over a one-stage procedure with debridement, followed by primary arthrodesis with an Ilizarov external fixator and antibiotic treatment. We compared the infection control and clinical and radiological outcome of a two-stage and a one-stage procedure. In this study, 7 patients with a two-stage revision and 11 patients with a one-stage revision between 2005 and 2015 were included. The primary outcome was infection control (absence of the Musculoskeletal Infection Society PJI criteria) 2 years after the ankle or hindfoot arthrodesis. Secondary outcome measures were the AOFAS hindfoot score and radiological consolidation rate. Infection control was 85% (6 out of 7 patients) in the two-stage group and 81% (9 out of 11 patients) in the one-stage group (p = 1.0). One patient (14%) of the two-stage and two patients (18%) in the one-stage group needed below-knee amputation. In the two-stage group, the mean postoperative AOFAS score was 74.8 (SD: ±11.3) versus 71.7 (SD: ±17.8) in the one-stage group. Radiological consolidation could be achieved in 71% in the spacer group (n = 5) and in 72% in the Ilizarov external fixator group (n = 9). Infection control, AOFAS score, and radiologic consolidation of hindfoot and ankle arthrodesis were comparable in both groups of patients with complicated postsurgical hindfoot or ankle infections.
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Affiliation(s)
- Rebecca Hartmann
- Department of Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Florian Grubhofer
- Department of Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Felix W A Waibel
- Department of Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Tobias Götschi
- Department of Orthopaedic Surgery, Institute for Biomechanics, ETH Zurich, Balgrist Campus, University of Zurich, Zurich, Switzerland
| | - Arnd F Viehöfer
- Department of Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Stephan H Wirth
- Department of Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
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Mulazzi M, Campodoni E, Bassi G, Montesi M, Panseri S, Bonvicini F, Gentilomi GA, Tampieri A, Sandri M. Medicated Hydroxyapatite/Collagen Hybrid Scaffolds for Bone Regeneration and Local Antimicrobial Therapy to Prevent Bone Infections. Pharmaceutics 2021; 13:pharmaceutics13071090. [PMID: 34371782 PMCID: PMC8309148 DOI: 10.3390/pharmaceutics13071090] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/29/2021] [Accepted: 07/12/2021] [Indexed: 12/15/2022] Open
Abstract
Microbial infections occurring during bone surgical treatment, the cause of osteomyelitis and implant failures, are still an open challenge in orthopedics. Conventional therapies are often ineffective and associated with serious side effects due to the amount of drugs administered by systemic routes. In this study, a medicated osteoinductive and bioresorbable bone graft was designed and investigated for its ability to control antibiotic drug release in situ. This represents an ideal solution for the eradication or prevention of infection, while simultaneously repairing bone defects. Vancomycin hydrochloride and gentamicin sulfate, here considered for testing, were loaded into a previously developed and largely investigated hybrid bone-mimetic scaffold made of collagen fibers biomineralized with magnesium doped-hydroxyapatite (MgHA/Coll), which in the last ten years has widely demonstrated its effective potential in bone tissue regeneration. Here, we have explored whether it can be used as a controlled local delivery system for antibiotic drugs. An easy loading method was selected in order to be reproducible, quickly, in the operating room. The maintenance of the antibacterial efficiency of the released drugs and the biosafety of medicated scaffolds were assessed with microbiological and in vitro tests, which demonstrated that the MgHA/Coll scaffolds were safe and effective as a local delivery system for an extended duration therapy—promising results for the prevention of bone defect-related infections in orthopedic surgeries.
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Affiliation(s)
- Manuela Mulazzi
- Institute of Science and Technology for Ceramics, National Research Council of Italy, ISTEC-CNR, 48018 Faenza, Italy; (M.M.); (G.B.); (M.M.); (S.P.); (A.T.)
| | - Elisabetta Campodoni
- Institute of Science and Technology for Ceramics, National Research Council of Italy, ISTEC-CNR, 48018 Faenza, Italy; (M.M.); (G.B.); (M.M.); (S.P.); (A.T.)
- Correspondence: (E.C.); (M.S.); Tel.: +39-0546-699761 (E.C. & M.S.)
| | - Giada Bassi
- Institute of Science and Technology for Ceramics, National Research Council of Italy, ISTEC-CNR, 48018 Faenza, Italy; (M.M.); (G.B.); (M.M.); (S.P.); (A.T.)
| | - Monica Montesi
- Institute of Science and Technology for Ceramics, National Research Council of Italy, ISTEC-CNR, 48018 Faenza, Italy; (M.M.); (G.B.); (M.M.); (S.P.); (A.T.)
| | - Silvia Panseri
- Institute of Science and Technology for Ceramics, National Research Council of Italy, ISTEC-CNR, 48018 Faenza, Italy; (M.M.); (G.B.); (M.M.); (S.P.); (A.T.)
| | - Francesca Bonvicini
- Department of Pharmacy and Biotechnology, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy; (F.B.); (G.A.G.)
| | - Giovanna Angela Gentilomi
- Department of Pharmacy and Biotechnology, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy; (F.B.); (G.A.G.)
- Operative Unit of Microbiology, IRCCS St. Orsola Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Anna Tampieri
- Institute of Science and Technology for Ceramics, National Research Council of Italy, ISTEC-CNR, 48018 Faenza, Italy; (M.M.); (G.B.); (M.M.); (S.P.); (A.T.)
| | - Monica Sandri
- Institute of Science and Technology for Ceramics, National Research Council of Italy, ISTEC-CNR, 48018 Faenza, Italy; (M.M.); (G.B.); (M.M.); (S.P.); (A.T.)
- Correspondence: (E.C.); (M.S.); Tel.: +39-0546-699761 (E.C. & M.S.)
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Multidisciplinary management of the bone and joint infection complicating treatment of an open fracture of the lower limb. ANN CHIR PLAST ESTH 2020; 65:380-393. [PMID: 32800464 DOI: 10.1016/j.anplas.2020.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/21/2020] [Indexed: 11/24/2022]
Abstract
Bone and joint infections (BJI) of the lower limb can cause functional sequelae and in some cases have an impact on patient's life prognostic. One of the main objectives of multidisciplinary consultation team meetings (MTM) in the treatment of bone and joint infections is to provide an appropriate medical-surgical care, pooling skills of different organ specialists: infectious disease physicians, microbiologists, orthopedic surgeons and plastic surgeons. Treatment is based on aggressive debridement, bone stabilization, adequate antibiotic therapy, long-term coverage of the loss of skin substance and close clinical monitoring. The authors present their multidisciplinary diagnostic and therapeutic approaches to BJI complicating an open fracture at a referent center in the management of complex bone and joint infections.
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Extensive eggshell-like debridement technique plus antibiotic-loaded calcium sulphate for one-stage treatment of chronic calcaneal osteomyelitis. Foot Ankle Surg 2020; 26:644-649. [PMID: 31521521 DOI: 10.1016/j.fas.2019.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 07/17/2019] [Accepted: 08/12/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Management of chronic calcaneal osteomyelitis is challenging. At present, there is still no widely accepted, simple, and effective surgical method to eradicate the infection and prevent osteomyelitis recurrence. The objective of this study was to assess the outcomes of one-stage treatment of chronic calcaneal osteomyelitis with a shape-preserving debridement technique combined with antibiotic-loaded calcium sulphate. METHODS Between 2012 and 2018, 33 patients (33 limbs) with chronic calcaneal osteomyelitis were treated with a novel debridement technique, named "eggshell-like debridement", plus antibiotic-impregnated calcium sulphate. The infection remission rate, recurrence rate, and amputation rate were analyzed. The American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot score was used to assess postoperative hindfoot function. RESULTS 26 patients (81.8%) achieved infection remission without recurrence. In the patients with osteomyelitis remission, pain, limitation of movement, sinus tracts, and typical redness and swelling were generally eliminated. Most of the patients could tolerate full weight-bearing without pain. The average AOFAS ankle and hindfoot score was 88 points (range, 67-100 points), implying the foot function was mostly restored. 6 patients (18.2%) had osteomyelitis recurrence but no amputation was required to elimilate the infection. CONCLUSIONS Eggshell-like debridement combined with antibiotic-loaded calcium sulphate is an effective method for one-stage management of chronic calcaneal osteomyelitis. With the application of this technique, secondary autogenous bone or muscle flap grafts are unnecessary. The surgical procedure can be simplified whlie the hindfoot function is well preserved.
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Kaziz H, Amine Triki M, Chermiti W, Mouelhi T, Naouar N, Laziz Ben Ayeche M. Acute osteomyelitis of the distal fibula in children: Treatment options and long-term follow-up. Arch Pediatr 2020; 27:342-347. [PMID: 32736914 DOI: 10.1016/j.arcped.2020.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/31/2020] [Accepted: 06/23/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Acute osteomyelitis of the distal fibula is a rare disease in children and is characterized by special features compared with other sites. The objective of this study was to report the functional outcome at long-term follow-up. METHODS We reviewed retrospectively, between January 2000 and December 2010, all cases of acute osteomyelitis of the distal fibula. Epidemiological and bacteriological data as well as therapy and outcome factors were analyzed. At the last follow-up, functional outcome was studied based on ankle motion, growth disturbance, and radiological sequelae. RESULTS Seven cases of acute osteomyelitis of the distal fibula were found. The mean age was patients was 7.71 years and the sex ratio was 2.5. The portal of entry of the pathogen was a skin injury in 57% of cases. Staphylococcusaureus was identified in 71% of cases. The mean duration of antibiotic therapy was 33.2 days. At a mean of 12.85 years of follow-up, no growth disturbance was found. The mean plantar and dorsal flexion was 41° and 27.7°, respectively. The mean postoperative American Orthopedics Foot and Ankle score (AOFAS) was 96.71 points. CONCLUSION Acute osteomyelitis of the distal fibula in children is scarce and rarely reported in the literature. It occurs more often in boys at an average age of 7 years. Local symptoms are usually more obvious than general symptoms. Surgical debridement of the subperiosteal abscess without bone trepanation seems to lead to a satisfactory outcome. LEVEL OF EVIDENCE Level IV - case series. IRB: Sahloul Hospital Human Research Ethics Committee.
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Affiliation(s)
- H Kaziz
- Orthopaedics department, Hospital Sousse, Sahloul University, city 4000 9, Sousse, Tunisia.
| | - M Amine Triki
- Orthopaedics department, Hospital Sousse, Sahloul University, city 4000 9, Sousse, Tunisia
| | - W Chermiti
- Orthopaedics department, Hospital Sousse, Sahloul University, city 4000 9, Sousse, Tunisia
| | - T Mouelhi
- Orthopaedics department, Hospital Sousse, Sahloul University, city 4000 9, Sousse, Tunisia
| | - N Naouar
- Orthopaedics department, Hospital Sousse, Sahloul University, city 4000 9, Sousse, Tunisia
| | - M Laziz Ben Ayeche
- Orthopaedics department, Hospital Sousse, Sahloul University, city 4000 9, Sousse, Tunisia
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Krissian S, Samargandi R, Druon J, Rosset P, Le Nail LR. Poor prognosis for infectious complications of surgery for ankle and hindfoot fracture and dislocation. A 34-case series. Orthop Traumatol Surg Res 2019; 105:1119-1124. [PMID: 31375389 DOI: 10.1016/j.otsr.2019.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 05/21/2019] [Accepted: 06/11/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Ankle and hindfoot fractures are associated with high rates of complications, and of infection in particular, for which rates of 1% to 48% are reported. HYPOTHESIS Treatment of bone and joint infection (BJI) secondary to surgery for ankle or hindfoot fracture is at high risk of failure. We analyzed results of treatment of BJI in this context. MATERIAL AND METHODS 33 patients (34 cases) were treated for ankle or hindfoot BJI between 2010 and 2015. Cure was defined by absence of fistula and of local or general inflammatory signs and by normal C-reactive protein level, at a minimum 2 years' follow-up. Fusion without infection was counted as success; recurrent infection and amputation were counted as failure. Mean age at trauma was 52 years (range, 16-85 years). Median time to diagnosis of BJI was 44 days (range, 2-830 days). RESULTS Mean follow-up was 20 months (range, 3-59 months). Twenty-two patients were cured (65%). Seven cases required joint fusion (21%). The failure rate was 15%, including 5 transtibial amputations. Skin cover flap was required for 15 patients (44%), at a median 33 days (range, 0-167 days). DISCUSSION Despite its retrospective design and small numbers, the present study confirmed the poor prognosis of BJI following surgery for ankle and/or hindfoot fracture. Patients need to be informed of this. TYPE OF STUDY AND LEVEL OF EVIDENCE IV, retrospective observational.
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Affiliation(s)
- Stéphanie Krissian
- Services d'orthopédie et traumatologie 1 et 2, faculté de médecine, université de Tours, CHU de Trousseau, avenue de la République, 37170 Chambray-les-Tours, France.
| | - Ramy Samargandi
- Services d'orthopédie et traumatologie 1 et 2, faculté de médecine, université de Tours, CHU de Trousseau, avenue de la République, 37170 Chambray-les-Tours, France
| | - Jérôme Druon
- Services d'orthopédie et traumatologie 1 et 2, faculté de médecine, université de Tours, CHU de Trousseau, avenue de la République, 37170 Chambray-les-Tours, France
| | - Philippe Rosset
- Services d'orthopédie et traumatologie 1 et 2, faculté de médecine, université de Tours, CHU de Trousseau, avenue de la République, 37170 Chambray-les-Tours, France
| | - Louis Romé Le Nail
- Services d'orthopédie et traumatologie 1 et 2, faculté de médecine, université de Tours, CHU de Trousseau, avenue de la République, 37170 Chambray-les-Tours, France
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Pedowitz D, Stull J. What Is the Optimal Antibiotic (Type, Dose and Route of Administration) Treatment for Infections After Foot/Ankle Fracture or Fusion Procedures? Foot Ankle Int 2019; 40:70S-71S. [PMID: 31322960 DOI: 10.1177/1071100719861644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
RECOMMENDATION The optimal antibiotic treatment after foot/ankle fractures or fusion should be determined based on the result of culture. In the absence of culture results, administered antibiotics should include coverage against common pathogens such as Staphylococcus aureus. LEVEL OF EVIDENCE Strong. DELEGATE VOTE Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus).
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Affiliation(s)
- David Pedowitz
- 1 Rothman Orthopaedics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Justin Stull
- 2 Thomas Jefferson University Hospital, The Rothman Orthopaedic Institute, Bensalem, PA, USA
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Pérez-Prieto D, Portillo ME, González-Lucena G, Ginés-Cespedosa A. Foot and ankle infections: Debridement, early fixation and rifampicin provide earlier recovery of function and quality of life. Foot Ankle Surg 2019; 25:13-18. [PMID: 29409262 DOI: 10.1016/j.fas.2017.07.644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 06/28/2017] [Accepted: 07/21/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Infection after foot and ankle fractures is a major concern for orthopedic surgeons. It is widely believed that final osteosynthesis should be delayed until the infection is cured. However, there is no literature that supports this practice. In addition, the delay impairs patient function and quality of life (QoL). METHODS In the present study, four cases of ankle infection treated with aggressive debridement, early fixation and antibiofilm antibiotics are described. It is thought that, like other implant related infections, ankle infections can be rapidly treated with the definitive fixation and by curing the infection to make for a fast recovery of QoL and function. RESULTS The infections were caused by MSSA and Pseudomonas aeruginosa in case 1, MSSA in case 2 and MRSA as well as K. pneumonia in case 3. Case 4 was a culture negative infection. They were susceptible to antibiofilm antibiotics (the gram-negative bacilli susceptible to ciprofloxacin and the gram-positive cocci susceptible to rifampicin). Cases 1, 3 and 4 were treated with a tibio-talo-calcaneal arthrodesis and case 2 was treated with a de-rotational fibular osteotomy and a medial closing wedge supramalleolar osteotomy. All cases improved at a median time of 4 weeks in terms of quality of life (SF-36) and function (AOFAS). At 2-years follow-up, no recurrence of infection was observed in any of the cases. All the cases achieved fusion or osteotomy healing at final follow-up. CONCLUSIONS Early fixation after debridement combined with antibiofilm antibiotics can be performed in foot and ankle inflections to provide early recovery of QoL and function in patients.
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Affiliation(s)
- Daniel Pérez-Prieto
- Orthopedic Department, Hospital del Mar - Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - María E Portillo
- Microbiology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Gemma González-Lucena
- Orthopedic Department, Hospital del Mar - Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alberto Ginés-Cespedosa
- Orthopedic Department, Hospital del Mar - Universitat Autònoma de Barcelona, Barcelona, Spain
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Bezstarosti H, Van Lieshout EMM, Voskamp LW, Kortram K, Obremskey W, McNally MA, Metsemakers WJ, Verhofstad MHJ. Insights into treatment and outcome of fracture-related infection: a systematic literature review. Arch Orthop Trauma Surg 2019; 139:61-72. [PMID: 30343322 PMCID: PMC6342870 DOI: 10.1007/s00402-018-3048-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Standardized guidelines for treatment of fracture-related infection (FRI) are lacking. Worldwide many treatment protocols are used with variable success rates. Awareness on the need of standardized, evidence-based guidelines has increased in recent years. This systematic literature review gives an overview of available diagnostic criteria, classifications, treatment protocols, and related outcome measurements for surgically treated FRI patients. METHODS A comprehensive search was performed in all scientific literature since 1990. Studies in English that described surgical patient series for treatment of FRI were included. Data were collected on diagnostic criteria for FRI, classifications used, surgical treatments, follow-up protocols, and overall outcome. A systematic review was performed according to the PRISMA statement. Proportions and weighted means were calculated. RESULTS The search yielded 2051 studies. Ninety-three studies were suitable for inclusion, describing 3701 patients (3711 fractures) with complex FRI. The population consisted predominantly of male patients (77%), with the tibia being the most commonly affected bone (64%), and a mean of three previous operations per patient. Forty-three (46%) studies described FRI at one specific location. Only one study (1%) used a standardized definition for infection. A total of nine different classifications were used to guide treatment protocols, of which Cierny and Mader was used most often (36%). Eighteen (19%) studies used a one-stage, 50 (54%) a two-stage, and seven (8%) a three-stage surgical treatment protocol. Ten studies (11%) used mixed protocols. Antibiotic protocols varied widely between studies. A multidisciplinary approach was mentioned in only 12 (13%) studies. CONCLUSIONS This extensive literature review shows a lack of standardized guidelines with respect to diagnosis and treatment of FRI, which mimics the situation for prosthetic joint infection identified many years ago. Internationally accepted guidelines are urgently required to improve the quality of care for patients suffering from this significant complication.
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Affiliation(s)
- H. Bezstarosti
- 000000040459992Xgrid.5645.2Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - E. M. M. Van Lieshout
- 000000040459992Xgrid.5645.2Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - L. W. Voskamp
- 000000040459992Xgrid.5645.2Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - K. Kortram
- 000000040459992Xgrid.5645.2Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - W. Obremskey
- 0000 0001 2264 7217grid.152326.1Vanderbilt University, Nashville, USA
| | - M. A. McNally
- 0000 0001 0440 1440grid.410556.3Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK
| | - W J. Metsemakers
- 0000 0004 0626 3338grid.410569.fDepartment of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium
| | - M. H. J. Verhofstad
- 000000040459992Xgrid.5645.2Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
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Nandi SK, Shivaram A, Bose S, Bandyopadhyay A. Silver nanoparticle deposited implants to treat osteomyelitis. J Biomed Mater Res B Appl Biomater 2018; 106:1073-1083. [PMID: 28508595 PMCID: PMC5685947 DOI: 10.1002/jbm.b.33910] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 04/18/2017] [Accepted: 04/22/2017] [Indexed: 01/11/2023]
Abstract
In this study, electrolytically deposited strongly adherent silver nanoparticles on stainless-steel (SS) implants were used for in situ osteomyelitis treatment. Samples were heat treated to enhance adhesion of silver on 316 L SS. Ex vivo studies were performed to measure silver-release profiles from the 316 L SS screws inserted in equine cadaver bones. No change in the release profiles of silver ions were observed in vitro between the implanted screws and the control. In vivo studies were performed using osteomyelitic rabbit model with 3 mm diameter silver-deposited 316 L SS pins at two different doses of silver: high and low. Infection control ability of the pins for treating osteomyelitis in a rabbit model was measured using bacteriologic, radiographic, histological, and scanning electron microscopic studies. Silver-coated pins, especially high dose, offered a promising result to treat infection in animal osteomyelitis model without any toxicity to major organs. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1073-1083, 2018.
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Affiliation(s)
- Samit Kumar Nandi
- Department of Veterinary Surgery and Radiology, West Bengal University of Animal and Fishery Sciences, Kolkata, 700037, India
| | - Anish Shivaram
- W. M. Keck Biomedical Materials Research Laboratory, School of Mechanical and Materials Engineering, Washington State University, Pullman, Washington, 99164-2920, USA
| | - Susmita Bose
- W. M. Keck Biomedical Materials Research Laboratory, School of Mechanical and Materials Engineering, Washington State University, Pullman, Washington, 99164-2920, USA
| | - Amit Bandyopadhyay
- W. M. Keck Biomedical Materials Research Laboratory, School of Mechanical and Materials Engineering, Washington State University, Pullman, Washington, 99164-2920, USA
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Jorge LS, Chueire AG, Fucuta PS, Machado MN, Oliveira MGL, Nakazone MA, Salles MJ. Predisposing factors for recurrence of chronic posttraumatic osteomyelitis: a retrospective observational cohort study from a tertiary referral center in Brazil. Patient Saf Surg 2017; 11:17. [PMID: 28588645 PMCID: PMC5457537 DOI: 10.1186/s13037-017-0133-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/24/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The incidence of posttraumatic osteomyelitis (PTO) is increasing despite new treatment strategies. Assessment of patients' outcomes following PTO is challenging due to multiple variables. The study goals are to determine the frequency of recurrence following PTO treatment and identify factors predisposing patients to treatment failure. METHODS Between August 01, 2007 to August 30, 2012, a single-center retrospective cohort study was performed among 193 patients diagnosed with PTO following orthopedic surgery for fracture care. Bone and soft tissues were collected for cultures and PTO was defined according to CDC/NHSN criteria. Patient, injury, surgery-associated variables, and microbiological records were reviewed for risk factors associated to recurrence of PTO. Univariate and multivariable analyses using logistic regression were performed, with p <0.05 considered significant. RESULTS Thirty-eight patients (20%) of 192 diagnosed and treated for PTO failed their treatment. Factors associated with recurrence were age between 61 and 80 years [hazard ratio (HR) = 6.086, 95% confidence interval (CI) = 2.459;15.061, p = <0.001], age above 80 years [HR = 9.975 (95% CI = 3.591;27.714), p = <0.001], intraoperative blood transfusion [HR = 2.239 (95% CI = 1.138;4.406), p = 0.020], and positive culture for Pseudomonas aeruginosa [HR = 2.700 (95% CI = 1.370;5.319), p = 0.004]. CONCLUSIONS Risk factors associated with recurrence of PTO are difficult to measure. The present study revealed that elderly patients, intraoperative blood transfusions, and infection due to P. aeruginosa were independently associated with recurrence of PTO. These factors should warn clinicians of a higher failure rate following treatment of PTO. Trial registration: ISRCTN71648577. Registered 18 May 2017. Retrospectively registered.
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Affiliation(s)
- Luciana Souza Jorge
- Hospital de Base, Infection Control Unit, São José do Rio Preto Medical School, São Paulo, Brazil
| | - Alceu G Chueire
- Orthopedics and Traumatology Unit, São José do Rio Preto Medical School, São Paulo, Brazil
| | - Patricia Silva Fucuta
- Orthopedics and Traumatology Unit, São José do Rio Preto Medical School, São Paulo, Brazil
| | - Mauricio N Machado
- Orthopedics and Traumatology Unit, São José do Rio Preto Medical School, São Paulo, Brazil
| | | | - Marcelo A Nakazone
- Orthopedics and Traumatology Unit, São José do Rio Preto Medical School, São Paulo, Brazil
| | - Mauro José Salles
- Division of Infectious Diseases, Department of Internal Medicine, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil.,Hospital da Irmandade da Santa Casa de Misericórdia de São Paulo, Rua Dr Cesáreo Mota Jr 112, CEP: 01221-020 São Paulo, SP Brazil
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Jonard B, Dean E. Posttraumatic Reconstruction of the Foot and Ankle in the Face of Active Infection. Orthop Clin North Am 2017; 48:249-258. [PMID: 28336047 DOI: 10.1016/j.ocl.2016.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Posttraumatic infection of the foot and ankle is a challenging issue for orthopedic surgeons. Making the diagnosis often requires combining laboratory and radiologic testing, patient examination, and history. Patient comorbidities should be identified and optimized whenever possible. Treatment must combine effective antibiotic therapy with thorough debridement of the infected zone. Reconstruction often requires a 2-staged approach using antibiotic spacers and temporary external fixation, with the goal of obtaining a functional, pain-free limb that is free of infection.
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Affiliation(s)
- Brandon Jonard
- Summa Health System, Department of Orthopedic Surgery, 444 North Main Street, Akron, OH 44309, USA
| | - Erin Dean
- Summa Health System, Department of Orthopedic Surgery, 444 North Main Street, Akron, OH 44309, USA; Crystal Clinic Orthopedic Center, 1310 Corporate Drive, Hudson, OH 44236, USA.
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Fernandes JS, Martins M, Neves NM, Fernandes MHV, Reis RL, Pires RA. Intrinsic Antibacterial Borosilicate Glasses for Bone Tissue Engineering Applications. ACS Biomater Sci Eng 2016; 2:1143-1150. [DOI: 10.1021/acsbiomaterials.6b00162] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- João S. Fernandes
- 3B’s
Research Group - Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark-Parque de Ciência
e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco GMR, Portugal
- ICVS/3B’s
- PT Government Associate Laboratory, Braga/Guimarães, 4710-057 Portugal
| | - Margarida Martins
- 3B’s
Research Group - Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark-Parque de Ciência
e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco GMR, Portugal
- ICVS/3B’s
- PT Government Associate Laboratory, Braga/Guimarães, 4710-057 Portugal
| | - Nuno M. Neves
- 3B’s
Research Group - Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark-Parque de Ciência
e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco GMR, Portugal
- ICVS/3B’s
- PT Government Associate Laboratory, Braga/Guimarães, 4710-057 Portugal
| | - Maria H. V. Fernandes
- Materials
and Ceramic Engineering Department, CICECO − Aveiro Institute
of Materials, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Rui L. Reis
- 3B’s
Research Group - Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark-Parque de Ciência
e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco GMR, Portugal
- ICVS/3B’s
- PT Government Associate Laboratory, Braga/Guimarães, 4710-057 Portugal
| | - Ricardo A. Pires
- 3B’s
Research Group - Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark-Parque de Ciência
e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco GMR, Portugal
- ICVS/3B’s
- PT Government Associate Laboratory, Braga/Guimarães, 4710-057 Portugal
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Lê Thua TH, Boeckx WD, Zirak C, De Mey A. Free intra-osseous muscle transfer for treatment of chronic osteomyelitis. J Plast Surg Hand Surg 2015; 49:306-310. [PMID: 26059054 DOI: 10.3109/2000656x.2015.1049952] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Chronic osteomyelitis is still a big reconstructive challenge. Even with standard care, therapeutic failures and recurrences are common. Multiple techniques of tissue transfer have increased the success rate. This study recommends free muscle transfers into the intramedullary bone cavities for treatment of chronic osteomyelitis. PATIENTS AND METHODS The review included 29 patients that were treated for chronic osteomyelitis. Osteomyelitis was located at the femur in four patients, the tibia in 22 patients, and the foot in three patients. Dead bone and scar tissue were replaced with durable free muscle flap with special attention to fill the dead space. RESULTS The average age of these patients was 48.5 years old (range = 23-70 years old). The average duration of osteomyelitis was 8.2 years (range = 1-45 years). Gracilis was applied in 20 cases (69%), latissimus dorsi was used in five cases (17.2%), and rectus abdominis was performed in four cases (13.8%). There was one flap failure, one partial superficial flap necrosis, two arterial thrombosis, and one venous thrombosis. All the remaining 28 muscle flaps survived. From 1-10 years follow-up, there was one recurrence of the osteomyelitis in the distal end of the intra-medullary cavity of a femur after reconstructing using the gracilis flap. CONCLUSION The present study demonstrated that free intramedullary muscle transfers are effective in providing a high rate of success in the treatment of chronic osteomyelitis. The secondary filling of the intramedullary cavity after extensive removal of all infected bony sequesters has proven to give a long-term arrest of chronic osteomyelitis.
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Affiliation(s)
- Trung-Hau Lê Thua
- a 1 Department of Plastic, Reconstructive & Hand Surgery, Hue Central Hospital , Hue City, Vietnam
| | - Willy D Boeckx
- b 2 Department of Plastic Surgery, Brugmann University Hospital, Free University of Brussels, Brussels , Belgium
| | - Christophe Zirak
- b 2 Department of Plastic Surgery, Brugmann University Hospital, Free University of Brussels, Brussels , Belgium
| | - Albert De Mey
- b 2 Department of Plastic Surgery, Brugmann University Hospital, Free University of Brussels, Brussels , Belgium
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Loder BG, Dunn KW. Functional reconstruction of a calcaneal deficit due to osteomyelitis with femoral head allograft and tendon rebalance. Foot (Edinb) 2014; 24:149-52. [PMID: 24835572 DOI: 10.1016/j.foot.2014.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 03/31/2014] [Indexed: 02/04/2023]
Abstract
Calcaneal osteomyelitis is one of the most devastating complications encountered with the surgical treatment of calcaneal fractures. Previous treatments have focused on infection ablation, followed by either bracing or amputation. Few reports have focused on a staged procedure and ultimate functional reconstruction of the calcaneus. The case presented utilized a flexor hallucis longus tendon transfer with reattachment of the Achilles tendon, and implantation of a femoral head allograft. At 24 month follow-up, the patient was able to return to all pre-injury activities, without bracing or assistance.
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Affiliation(s)
- Brian G Loder
- Residency Director, Henry Ford Macomb Hospital, Clinton Township, MI, United States
| | - Karl W Dunn
- Henry Ford Macomb Hospital, Clinton Township, MI, United States.
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Abstract
Operative foot and ankle osteomyelitis is challenging for orthopedic surgeons because of the area’s unique anatomy, high trauma incidence, local and systemic disease effects, and often limited space. Standard treatment includes aggressive operative debridement with local and systemic antibiotic administration to control infection. Dead space management is critical yet technically demanding. The authors report a modified antibiotic cement bead therapy technique in which antibiotic sticks, minnows, and mushroom-shaped plugs are used to strike a balance between the stability of the load-bearing unit and radical removal of infection to preserve a functional foot. Three cases are presented.
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Yang C, Geng S, Fu C, Sun J, Bi Z. A minimally invasive modified reverse sural adipofascial flap for treating posttraumatic distal tibial and calcaneal osteomyelitis. INT J LOW EXTR WOUND 2013; 12:279-85. [PMID: 24275754 DOI: 10.1177/1534734613511637] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Our aim was to report a modified reverse sural adipofascial flap for treating posttraumatic distal tibial or calcaneal osteomyelitis. We retrospectively reviewed the records of 15 patients with posttraumatic distal tibial or calcaneal osteomyelitis treated with modified reverse sural adipofascial flaps between 2005 and 2010. The flap was raised through 2 short incisions in the posterior aspect of the lower leg. The raw surface of the flap was covered with a full-thickness skin graft. Donor sites were closed primarily. Lower Extremity Functional Scale (LEFS) scores and 2-point discrimination (TPD) were recorded preoperatively and postoperatively. There were 12 males and 3 females, with an average age of 39 years (range = 18-55 years). Twelve lesions were in the distal tibia and 3 in the calcaneus. The flap ranged in size from 11 × 5 cm to 16 × 7 cm. All flaps survived, and skin grafts healed without complications. Recipient sites had an anatomic contour, and all patients were able to ambulate without the assistance of special shoes or orthoses. No infections recurred, and no ulcers of the grafted skin occurred with the regular wearing of shoes. The follow-up duration was 18.7 ± 6.8 months (range = 12-36 months). The mean LEFS score increased from 22.4 ± 8.3 preoperatively to 53.0 ± 11.2 postoperatively (P = .001). TPD markedly recovered at 24 months postoperatively. The modified reverse sural adipofascial flap provides good outcomes in treating distal tibial and calcaneal osteomyelitis with minimal donor site morbidity.
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Affiliation(s)
- Chenglin Yang
- 1The First Affiliated Hospital of Harbin Medical University, Harbin, China
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Abstract
Osteomyelitis is an inflammatory bone disorder caused by infection, leading to necrosis and destruction of bone. It can affect all ages, involve any bone, become a chronic disease and cause persistent morbidity. Treatment of osteomyelitis is challenging particularly when complex multiresistant bacterial biofilm has already been established. Bacteria in biofilm persist in a low metabolic phase, causing persistent infection due to increased resistance to antibiotics. Staphylococcus aureus and Staphylococcus epidermidis are the most common causative organism responsible for more than 50% of osteomyelitis cases. Osteomyelitis treatment implies the administration of high doses of antibiotics (AB) by means of endovenous and oral routes and should take a period of at least 6 weeks. Local drug delivery systems, using non-biodegradable (polymethylmethacrylate) or biodegradable and osteoactive materials such as calcium orthophosphates bone cements, have been shown to be promising alternatives for the treatment of osteomyelitis. These systems allow the local delivery of AB in situ with bactericidal concentrations for long periods of time and without the toxicity associated with other means of administration. This review examines the most recent literature evidence on the causes, pathogeneses and pharmacological treatment of osteomyelitis. The study methodology consisted of a literature review in Google Scholar, Science Direct, Pubmed, Springer link, B-on. Papers from 1979 till present were reviewed and evaluated.
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21
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Liu L, Zou L, Cao X, Cai J. Two different flaps for reconstruction of gunshot wounds to the foot and ankle in a child. J Pediatr Surg 2012; 47:E13-7. [PMID: 22974629 DOI: 10.1016/j.jpedsurg.2012.03.084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 03/27/2012] [Accepted: 03/28/2012] [Indexed: 10/27/2022]
Abstract
An 8-year-old boy was shot in his right foot and ankle, which resulted in soft tissue lesions of the medial malleolus and lateral calcaneus, fracture of the medial malleolus, and partial loss of the calcaneus. We designed a distally based sural flap and a posterior tibial perforator flap for reconstruction of soft tissue defects at the lateral aspect of the calcaneus and the medial malleolus, respectively. Both flaps survived successfully, and the boy had a normal gait during follow-up.
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Affiliation(s)
- Lifeng Liu
- Orthopedic Department, the General Hospital of Jinan Military Command, Jinan 250031, China.
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22
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Ramanujam CL, Zgonis T. Versatility of intrinsic muscle flaps for the diabetic Charcot foot. Clin Podiatr Med Surg 2012; 29:323-6, ix. [PMID: 22424492 DOI: 10.1016/j.cpm.2012.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Bone, joint, and/or tendon exposure following surgical debridement of diabetic foot infections requires careful consideration when choosing appropriate closure methods. The unique architecture of the foot, coupled with the functional demands of mobilization, makes soft tissue reconstruction for plantar defects especially challenging. Muscle flaps incorporate the muscle, associated nerve, and vascular pedicles during transposition. This article covers their unique properties for soft tissue coverage in the diabetic Charcot foot.
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Affiliation(s)
- Crystal L Ramanujam
- Division of Podiatric Medicine and Surgery, Department of Orthopaedic Surgery, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive-MSC 7776, San Antonio, TX 78229, USA
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Aiyenuro O, Shariff S. Acute staphylococcal hind foot osteomyelitis in a healthy adult: A case report. Foot Ankle Surg 2012; 18:e12-5. [PMID: 22326012 DOI: 10.1016/j.fas.2011.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2011] [Revised: 09/19/2011] [Accepted: 10/06/2011] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Acute osteomyelitis of the hind foot is uncommon in a normal immunocompetent adult. CASE PRESENTATION We present a previously healthy 52 year old caucasian male who developed painful swelling of his ankle/hindfoot following closed soft tissue football injury. He had no antecedent systemic symptoms. Magnetic resonance imaging and bone scan imaging, followed by surgical decompression and bone biopsy confirmed a diagnosis of Staphylococcus aureus hind foot osteomyelitis. He underwent triple fusion after debridement and had suppressive antibiotics. His pain and swelling resolved at 6 weeks postoperation and CT confirmed fusion at 6 months. His inflammatory markers normalised over the course of 7 months. After 18 months, he remained asymptomatic without any evidence of recurrence. CONCLUSION This case represents an unusual and important variation of presentation of acute osteomyelitis in a healthy adult. It can be easily overlooked when a normal patient presents with pain and functional impairment after a closed soft tissue trauma, but a high index of suspicion is paramount because virulent organisms can infect immunologically normal patients.
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Affiliation(s)
- Olusegun Aiyenuro
- Department of Orthopaedics, Medway Foundation NHS Trust, Gillingham, Kent, United Kingdom.
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Wang HF, Gao YS, Yuan T, Yu XW, Zhang CQ. Chronic calcaneal osteomyelitis associated with soft-tissue defect could be successfully treated with platelet-rich plasma: a case report. Int Wound J 2012; 10:105-9. [PMID: 22364433 DOI: 10.1111/j.1742-481x.2012.00951.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Chronic osteomyelitis associated with soft-tissue defect following surgical management is a severe complication for orthopaedic surgeons. Traditionally, the treatment protocol for the notorious complication involved thorough debridement, bone grafting, long-term antibiotic use and flap surgery. Alternatively, platelet-rich plasma (PRP), a high concentration of platelets collected via centrifugation, has been successfully used as an adjuvant treatment for bone and soft-tissue infection in medical practices. PRP has numerous significant advantages, including stypsis, inflammation remission and reducing the amount of infected fluid. It increases bone and soft-tissue healing and allows fewer opportunities for transplant rejection. Through many years of studies showing the advantages of PRP, it has become preferred organic product for the clinical treatment of infections, especially for chronic osteomyelitis associated with soft-tissue defect. To promote the clinical use of this simple and efficacious technique in trauma, we report the case of a patient with chronic calcaneal osteomyelitis associated with soft-tissue defect that healed uneventfully with PRP.
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Affiliation(s)
- Hsin-Fu Wang
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
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25
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Mouzopoulos G, Kanakaris NK, Kontakis G, Obakponovwe O, Townsend R, Giannoudis PV. Management of bone infections in adults: the surgeon's and microbiologist's perspectives. Injury 2011; 42 Suppl 5:S18-23. [PMID: 22196905 DOI: 10.1016/s0020-1383(11)70128-0] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Bone infection in adults is a potentially devastating complication following trauma or surgery. The clinician should diagnose osteomyelitis based on certain clinical manifestations and on laboratory and imaging findings. For pathogen identification, the treating surgeon should take appropriate tissue samples. Close collaboration with microbiologists is of paramount importance to dictate the appropriate duration and type of antibiotics to be administered. Treatment of acute osteomyelitis requires surgical debridement and prolonged course of antibiotics. Debate exists regarding the maintenance or the removal of any internal fixation device. Treatment of chronic osteomyelitis is more complicated. For its eradication the treatment course is often prolonged and frustrating. Based on the current literature an algorithm of treatment for both acute and chronic bone infections is recommended.
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Affiliation(s)
- G Mouzopoulos
- Academic Department of Trauma and Orthopaedics, Leeds Teaching Hospitals NHS Trust, UK
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Affiliation(s)
- P V Giannoudis
- Academic Department of Trauma & Orthopaedic surgery, School of Medicine University of Leeds, UK.
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Ramanujam CL, Zgonis T. Primary arthrodesis and sural artery flap coverage for subtalar joint osteomyelitis in a diabetic patient. Clin Podiatr Med Surg 2011; 28:421-7, ix. [PMID: 21669347 DOI: 10.1016/j.cpm.2011.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Diabetic chronic wounds with joint sepsis and osteomyelitis of the hindfoot can be difficult pathologic entities to treat. Limb salvage approaches are based on careful preoperative evaluation, surgical technique, and postoperative care. This article reviews the overall management of subtalar joint osteomyelitis with a case report showing primary arthrodesis with external fixation and soft tissue coverage with a reverse sural artery neurofasciocutaneous flap.
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Affiliation(s)
- Crystal L Ramanujam
- Division of Podiatric Medicine and Surgery, Department of Orthopaedic Surgery, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive-MSC 7776, San Antonio, TX 78229, USA
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Ramanujam CL, Facaros Z, Zgonis T. External fixation for surgical off-loading of diabetic soft tissue reconstruction. Clin Podiatr Med Surg 2011; 28:211-6. [PMID: 21276528 DOI: 10.1016/j.cpm.2010.10.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Early and aggressive treatment of diabetic foot wounds is imperative for the reduction of amputation risk. Whereas sound local wound care is important for successful management; chronic wounds often reach a stagnant point in healing because of diabetic vasculopathy, immunopathy, or neuropathy. The type, size, shape, and location of wound may not always allow primary closure or grafting. In patients with adequate perfusion and in the absence of infection, local advancement flaps are suitable for durable closure. A review and case report demonstrating the use of these flaps with external fixation as an adjunctive therapy for surgical off-loading is presented.
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Affiliation(s)
- Crystal L Ramanujam
- Division of Podiatric Medicine and Surgery, Department of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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