Treatment of postoperative tibial chronic osteomyelitis using bone transport techniques; an observational study

Management and Long-Term Outcomes of Post-traumatic Chronic Osteomyelitis in Long Bones: Cierny-Mader Types III and IV

Background This study describes the long-term clinical and functional outcomes of patients with post-traumatic Cierny-Mader (C-M) Type III and IV chronic osteomyelitis (CO), managed by considering individual patient differences. Methods Twenty patients who developed CO of the long bones after trauma were included in this study. Data on the demographic characteristics of the patients, clinical and radiological characteristics, and surgical methods applied were collected. The classification system defined by C-M was used for CO classification. The Short Form-36 (SF-36) quality of life scale was used to evaluate the functional outcomes and quality of life of the patients at the end of follow-up. Results The participants included 16 males and four females, with an average age of 39.3 ± 14.5 years. The mean duration of CO was 6.8 ± 7.5 years. The anatomical location of the CO was in the tibia in 15 patients, in the femur in four, and in the radius in one. The mean follow-up time after CO reconstruction was 4.5 ± 1.05 years. According to the C-M anatomical classification, there were nine patients with Type III and 11 with Type IV. According to the C-M physiological classification, there was one patient with Class A, 16 with Class B1, and three with Class B2. Different combinations of surgical procedures were performed on each patient. The average number of surgical interventions performed on the patients was 3.1 ± 1.1. Culture growth was detected in 13 patients. At the end of follow-up, the patients' SF-36 scores were lower than those in the normal population. Conclusion Due to the varied histories of CO and individual differences, it is quite challenging to plan a standard treatment procedure for CO in clinical practice. Successful treatment can be achieved with a long-term multidisciplinary approach and individualized, well-planned treatment methods.

Clinical features of chronic tibial osteomyelitis: a single-center retrospective study of 282 cases in Xinjiang, China

BACKGROUND

Chronic osteomyelitis is a highly prevalent and severe orthopaedic complication, representing a critical unresolved issue. The clinical symptoms of osteomyelitis are influenced by various factors, including geography, lifestyle, and pre-existing medical conditions.This study aims to provide theoretical basis for treatment and prevention of osteomyelitis by investigating and analyzing clinical features and pathogen distribution among 282 patients with chronic tibial osteomyelitis in xinjiang.

METHODS

A total of 282 patients with chronic tibial osteomyelitis from January 1, 2012 to January 1, 2022 in the First Affiliated Hospital of Xinjiang Medical University were retrospectively analyzed. All data were collected from electronic medical record (EMR) system including demographics, etiology, risk factors, osteomyelitis location and clinical classification.

RESULTS

Farmers, students, unemployed and retirees accounted for a relatively large proportion of the 282 patients. There were 233 males and 49 females with a gender ratio of 4.75:1. The average age was 40.21 ± 15.68 years and was mainly concentrated in 41-50 years, specifically, the mean age of females was slightly older than that of males. Education level was mostly primary and secondary school education, and illiteracy. Risk factors of chronic tibial osteomyelitis included history of smoking and drinking, history of multiple repeated surgeries, and impaired immunity. Frequent clinical symptoms were in the order of pain, local swelling, pus discharge and skin ulceration. Among all inflammatory markers, proportion of positive results were 30.85%, 59.93% and 53.90% for white blood cell (WBC), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), respectively. Positive rate of pathogenic microorganism culture was low and the three most common bacteria were Staphylococcus aureus (S. aureus), Pseudomonas aeruginosa (P. aeruginosa) and Escherichia coli (E. coli). The most frequent site of infection was middle tibia. According to Cierny-Mader osteomyelitis classification, the most common types were type IIIA, IVA and IIA.

CONCLUSION

Number of visits due to chronic osteomyelitis increased year by year, with young and middle-aged male farmers and low education level as the main groups. Smoking and drinking were two considerable risk factors that should be attached to a great importance. No significant increase was found in inflammatory markers and lower positive rate of pathogenic microorganism culture was observed. Multi-drug resistant bacteria were common and S. aureus remained the most frequent pathogen. Elevated ESR had certain diagnostic value for osteomyelitis. Type III and type IV osteomyelitis accounted for a large proportion which posed great challenges for clinical diagnosis and treatment.

Bone Volume Analysis and Associated Influencing Factors in Mandibular Distraction Osteogenesis: A Retrospective Analysis

BACKGROUND

Distraction osteogenesis is a progressively popular technique for maxillofacial bone reconstruction, but there is a notable gap in the analysis of bone volume within the distraction segment and the exploration of associated influencing factors.

PURPOSE

The purpose of this study was to quantitatively analyze the new bone volume and the distraction gap volume in the three-dimensional (3D) model and explore the influencing factors associated with the percentage of the new bone volume to the distraction gap volume.

STUDY DESIGN, SETTING, SAMPLE

This retrospective study included patients who underwent maxillofacial distraction osteogenesis treatment at the West China Hospital of Stomatology between 2014 and 2022, utilizing the mandibular distractor (Cebei, Ningbo, China). Exclusion criteria encompassed individuals with incomplete clinical or radiographical records as well as those who loss to follow-up.

PREDICTOR VARIABLE

The predictor variables were age, sex, diagnosis, consolidation period duration, distraction modality, osteotomy area, distraction gap volume, and proximal bone segment volume.

MAIN OUTCOME VARIABLE(S)

The outcome variable was osteogenic effect which defined as the percentage of the new bone volume to the distraction gap volume in the 3D model.

COVARIATES

Not applicable.

ANALYSES

T-tests were used to describe categorical variables, and Pearson correlation analysis was used to describe continuous variables. Linear regression was employed to assess the predictiveness of variables for osteogenic effect. Data are described as mean ± standard deviation; statistical significance was established at a P value < .05.

RESULTS

The study sample contained 35 patients(11 males and 24 females) with a mean age of 21.17 ± 11.82 years (range: 5 to 47 years) were included. The mean osteogenic effect of all samples was 78.89 ± 24.70%. Multiple linear regression models confirmed that the osteogenic effect was significantly influenced by the distraction gap volume (P = .003), proximal bone segment volume (P = .009), osteotomy area (P = .034), diagnosis (P = .004), and distraction modality (P = .021).

CONCLUSION AND RELEVANCE

The percentage of new bone mass to simulated volume based on 3D model measurement can serve as an effective quantitative indicator for evaluating the osteogenic effect; our study demonstrates that distraction gap volume, proximal bone segment volume, osteotomy area, diagnosis, and distraction modality can statistically significantly influence the osteogenic effect.

Debridement-Reconstruction-Docking Management System Versus Ilizarov Technique for Lower-Extremity Osteomyelitis

BACKGROUND

Osteomyelitis causes marked disability and is one of the most challenging diseases for orthopaedists to treat because of the considerable rate of infection recurrence. In this study, we proposed and assessed the debridement-reconstruction-docking (DRD) system for the treatment of lower-extremity osteomyelitis. This procedure comprises 3 surgical stages and 2 preoperative assessments; namely, pre-debridement assessment, debridement, pre-reconstruction assessment, reconstruction, and docking-site management. We evaluated the use of the DRD system compared with the Ilizarov technique, which is defined as a 1-stage debridement, osteotomy, and bone transport.

METHODS

This retrospective cohort included 289 patients who underwent either DRD or the Ilizarov technique for the treatment of lower-extremity osteomyelitis at a single institution between January 2013 and February 2021 and who met the eligibility criteria. The primary outcome was the rate of infection recurrence. Secondary outcomes included the external fixator index (EFI), refracture rate, and the Paley classification for osseous and functional results. An inverse-probability-weighted regression adjustment model was utilized to estimate the effect of the DRD system and Ilizarov technique on the treatment of lower-extremity osteomyelitis.

RESULTS

A total of 131 and 158 patients underwent DRD or the Ilizarov technique, respectively. The inverse-probability-weighted regression adjustment model suggested that DRD was associated with a significant reduction in infection recurrence (risk ratio [RR], 0.26; 95% confidence interval [CI], 0.13 to 0.50; p < 0.001) and EFI (-6.9 days/cm, 95% CI; -8.3 to -5.5; p < 0.001). Patients in the DRD group had better Paley functional results than those in the Ilizarov group (ridit score, 0.55 versus 0.45; p < 0.001). There was no significant difference between the 2 groups in the rate of refracture (RR, 0.87; 95% CI, 0.42 to 1.79; p = 0.71) and Paley osseous results (ridit score, 0.51 versus 0.49; p = 0.39).

CONCLUSIONS

In this balanced retrospective cohort of patients with lower-extremity osteomyelitis, the use of the DRD system was associated with a reduced rate of infection recurrence, a lower EFI, and better Paley functional results compared with the use of the Ilizarov technique.

LEVEL OF EVIDENCE

Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.