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Yu S, Lee S. Recurrent skin opening induced by chronic sternal osteomyelitis caused by a bite wound in a cat: A case report. Vet Med Sci 2024; 10:e1425. [PMID: 38563757 PMCID: PMC10986631 DOI: 10.1002/vms3.1425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 02/07/2024] [Accepted: 03/10/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Chronic sternal osteomyelitis is a rare condition in felines, with limited reported cases to date. OBJECTIVES We report the case of a 2-year-old castrated male, domestic shorthair cat, weighing 4.68 kg, that presented with skin openings every 3-4 months, despite skin debridement and reconstruction. METHODS A subcutaneous dead space larger than the skin defect was detected. Haematological analysis revealed elevated levels of inflammatory markers. Thoracic radiography revealed sternal deformation and suspected osteomyelitis. Computed tomography revealed a fistula extending from the third to the fourth sternebrae. RESULTS Bone and soft tissue debridement and abscess flushing were performed along with long-term antibiotic therapy. The cat remained recurrence-free throughout an 18-month post-surgery follow-up period. CONCLUSION To the best of our knowledge, this is the first report of chronic osteomyelitis occurring in a cat's sternebrae and represents the first successful case of its treatment. This case showcases the potential for improved treatment outcomes in similar cases. Understanding and successful treatment of such cases can pave the way for better management of feline osteomyelitis.
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Affiliation(s)
- Seung‐yeon Yu
- Department of Veterinary SurgeryCollege of Veterinary MedicineChungbuk National UniversityCheongjuRepublic of Korea
| | - Sungin Lee
- Department of Veterinary SurgeryCollege of Veterinary MedicineChungbuk National UniversityCheongjuRepublic of Korea
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Gupta SK, Esposito ER, Phillips R, Schwab PE, Leary EV, Hoernschemeyer DG. Effect of Antibiotic Prophylaxis on Infection Rates in Pediatric Supracondylar Humerus Fractures Treated with Closed Reduction and Percutaneous Pinning: A Prospective Double-Blinded Randomized Controlled Trial. J Am Acad Orthop Surg 2024; 32:410-416. [PMID: 38422496 DOI: 10.5435/jaaos-d-23-00795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/16/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Supracondylar humerus fractures (SCHFs) are the most common elbow fracture in the pediatric population. In the case of displaced fractures, closed reduction and percutaneous Kirschner wire pinning (CRPP) is commonly performed. Infection rates are between 0 and 7%; however, retrospective studies have shown no benefit of preoperative antibiotics. There continues to be notable variability in antibiotic usage based on surgeon preference and local institutional policy. We conducted a double-blinded, randomized controlled trial to evaluate whether antibiotic prophylaxis reduces the risk of infection in pediatric SCHF patients treated with CRPP. METHODS Pediatric patients with displaced SCHF who presented to a pediatric hospital were enrolled and randomized into two groups. Group I received one dose of prophylactic antibiotics (25 mg/kg cefazolin IV up to 1g or clindamycin 10 mg/kg up to 600 mg/kg IV in the case of cefazolin allergy). Group II received placebo (10-mL prefilled syringe of normal saline). All patients underwent CRPP and casting followed by pin removal 3 to 6 weeks after the initial procedure. The presence of pin-site infection, erythema, drainage, septic arthritis, and osteomyelitis was recorded. RESULTS One hundred sixty patients were enrolled in the study. Eighty-two patients were randomized to receive antibiotics, and 78 patients were randomized to placebo. No difference was seen in the rate of infection between the treatment groups (1.2% in the antibiotic group versus 1.3% in the placebo group; P = 1.00). Presence of purulent drainage (0.0% versus 1.3%; P = 0.49), septic arthritis (0.0% versus 0.0%; P = 1.00), and osteomyelitis (1.2% versus 0.0%; P = 1.00) was similar in both groups. No difference in the need for additional antibiotics (1.2% versus 1.3%; P = 1.00) or additional surgery (1.2% versus 0.0%; P = 1.00) was found between groups. DISCUSSION The use of antibiotic prophylaxis did not affect the risk of infection in pediatric patients who underwent CRPP for displaced SCHF. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov: NCT03261830. LEVEL OF EVIDENCE Therapeutic Level I.
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Affiliation(s)
- Sumit K Gupta
- From the Department of Orthopaedic Surgery, University of Missouri, Columbia, MO
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Ganta A, Merrell LA, Adams J, Konda SR, Egol KA. Retention of Antibiotic Cement Delivery Implants in Orthopedic Infection Associated With United Fractures Does Not Increase Recurrence Risk. J Orthop Trauma 2024; 38:190-195. [PMID: 38206770 DOI: 10.1097/bot.0000000000002771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 01/13/2024]
Abstract
OBJECTIVES To evaluate whether retention of antibiotic cement delivery devices after resolution of orthopaedic infection is associated with recurrence. METHODS DESIGN Retrospective cohort. SETTING Academic medical center. PATIENT SELECTION CRITERIA Patients with a fracture definitively treated with internal fixation that went on to unite and develop a confirmed fracture-related infection or osteomyelitis after a remote fracture surgery and had implantation of antibiotic-impregnated cement for infection management. OUTCOME MEASURES AND COMPARISONS Patients were divided into whom the antibiotic implants were retained (Retained Cohort) and whom the antibiotic implants were removed (Removed Cohort). Outcome measures included clinical infection resolution, infection recurrence, time to resolution of infection signs, symptoms and laboratory values, reoperation and readmission rates, and need for soft tissue coverage (local flap vs. free tissue transfer) because of recurrence. RESULTS Of 98 patients treated for fracture-related infection in united fractures or osteomyelitis after a remote fracture surgery, 39 (39.8%) underwent implantation of antibiotic-impregnated cement delivery devices: 21 (21.4%) beads, 7 (7.1%) rods, and 11 (11.2%) blocks. Twenty patients (51.3%) comprised the Retained Cohort and 19 patients (48.7%) comprised the Removed Cohort. There were few differences in demographics ([American Society of Anesthesiology Score, P = 0.026] and [diabetes, P = 0.047]), infection location, and pathogenic profiles. The cohorts demonstrated no difference in eventual resolution of infection (100% in the Retained Cohort, 95% in the Removed Cohort, P = 0.487) and experienced similar time to clinical infection resolution, based on signs, symptoms, and laboratory values ( P = 0.360). There was no difference in incidence of subsequent infection recurrence after clinical infection resolution (1 recurrence Retained vs. 2 recurrences Removed, P = 0.605) for those considered "cured." Compared with the Retained Cohort, the Removed Cohort underwent more reoperations (0.40 vs. 1.84 reoperations, P < 0.001) and admissions after implantation ( P < 0.001). CONCLUSIONS Retention of antibiotic-impregnated cement delivery devices in patients with orthopaedic infection after fractured bones that have healed was not associated with infection recurrence. Additional surgical intervention with the sole purpose of removing antibiotic delivery devices may not be warranted. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Abhishek Ganta
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY; and
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Queens, NY
| | - Lauren A Merrell
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY; and
| | - Jack Adams
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY; and
| | - Sanjit R Konda
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY; and
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Queens, NY
| | - Kenneth A Egol
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY; and
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Queens, NY
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Vermoet NCW, Weijs WLJ, van Bilsen MWT, Honings J. Pharyngo-cervicospinal fistula with destructive osteomyelitis after laryngopharyngectomy and radiotherapy, managed successfully with a vascularized fibula free flap. Int J Oral Maxillofac Surg 2024; 53:282-285. [PMID: 37813806 DOI: 10.1016/j.ijom.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 09/12/2023] [Accepted: 09/25/2023] [Indexed: 10/11/2023]
Abstract
Total laryngectomy is an operation mainly employed in recurrent laryngeal and hypopharyngeal carcinoma after previous radiotherapy. The most feared complication after this procedure is a pharyngocutaneous fistula. An extremely rare complication is the development of osteomyelitis of the cervical spine, which is associated with high rates of neurological impairment and epidural empyema, often requiring surgical treatment. This report describes the case of a patient with neck and shoulder pain and progressive motor weakness of the left deltoid and biceps muscle, caused by a pharyngo-cervicospinal fistula with spinal empyema. This condition resulted in destructive osteomyelitis of the cervical spine. A successful reconstruction of the cervical spine and neopharynx was performed using a free vascularized fibula bone and skin graft in a complex area because of previous treatments. It appears that no similar case has been described previously.
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Affiliation(s)
- N C W Vermoet
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands.
| | - W L J Weijs
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - M W T van Bilsen
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - J Honings
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
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Black GG, Vaeth AM, Kochheiser M, Chen Y, Truong AY, Reif T, Rozbruch SR, Henry MW, Otterburn DM. Infection After Lower-Limb Osseointegration: A Single-Center Retrospective Evaluation of Pathogens, Management, and Outcomes. Ann Plast Surg 2024; 92:S96-S100. [PMID: 38556655 DOI: 10.1097/sap.0000000000003856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
PURPOSE Osseointegration (OI) is a novel alternative to traditional socket-suspended prostheses for lower-limb amputees, eliminating the socket-skin interface and allowing for weight bearing directly on the skeletal system. However, the stoma through which the implant attaches to the external prosthesis creates an ingress route for bacteria, and infection rates as high as 66% have been reported. The aims of this study are to classify infection management and long-term outcomes in this patient population to maximize implant salvage. METHODS An institutional review board-approved retrospective analysis was performed on all patients who underwent lower-limb OI at our institution between 2017 and 2022. Demographic, operative, and outcome data were collected for all patients. Patients were stratified by the presence and severity of infection. Chi-square and t tests were performed on categorical and continuous data, respectively, using an alpha of 0.05. RESULTS One hundred two patients met our study criteria; 62 had transfemoral OI and 40 had transtibial OI. Patients were followed for 23.8 months on average (range, 3.5-63.7). Osteomyelitis was more likely than soft tissue infection to be polymicrobial in nature (71% vs 23%, P < 0.05). Infections at the stoma were mostly (96%) managed with oral antibiotics alone, whereas deeper soft tissue infections also required intravenous antibiotics (75%) or operative washout (19%). Osteomyelitis was managed with intravenous antibiotics and required operative attention; 5 (71%) underwent washout and 2 (29%) underwent explantation. Both implants were replaced an average of 3.5 months after explantation. There was no correlation between history of soft tissue infection and development of osteomyelitis (P > 0.05). The overall implant salvage rate after infection was 96%. CONCLUSIONS This study describes our institution's experience managing infection after OI and soft tissue reconstruction. Although infections do occur, they are easily treatable and rarely require operative intervention. Explantation due to infection is rare and can be followed up with reimplantation, reaffirming that OI is a safe and effective treatment modality.
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Affiliation(s)
- Grant G Black
- From the Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine
| | - Anna M Vaeth
- From the Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine
| | - Makayla Kochheiser
- From the Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine
| | - Yunchan Chen
- From the Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine
| | - Albert Y Truong
- From the Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine
| | - Taylor Reif
- Limb Lengthening and Complex Reconstruction Service
| | | | - Michael W Henry
- Division of Infectious Diseases, Hospital for Special Surgery, New York, NY
| | - David M Otterburn
- From the Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine
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Lo ES, Kwok HM, Pan NY. Imaging spectrum and complications of otogenic infections: insights into delayed diagnosis. Br J Radiol 2024; 97:726-733. [PMID: 38335140 PMCID: PMC11027324 DOI: 10.1093/bjr/tqae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/09/2024] [Accepted: 01/12/2024] [Indexed: 02/12/2024] Open
Abstract
Skull base osteomyelitis (SBO) is a late manifestation of complicated otogenic infections that presents a diagnostic challenge. Delayed or missed diagnoses lead to high morbidity and mortality and can be attributed to non-specific symptoms, subtle early radiologic findings, radiologic mimicry of nasopharyngeal carcinoma (NPC), and under-recognition from clinician and radiologists. This pictorial review aims to emphasize on early imaging recognition and distinction between SBO and NPC.
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Affiliation(s)
- Eugene Sean Lo
- Diagnostic Radiology Department, Princess Margaret Hospital, Kowloon, 2-10 Princess Margaret Hospital Road, Hong Kong
| | - Hoi Ming Kwok
- Diagnostic Radiology Department, Princess Margaret Hospital, Kowloon, 2-10 Princess Margaret Hospital Road, Hong Kong
| | - Nin Yuan Pan
- Diagnostic Radiology Department, Princess Margaret Hospital, Kowloon, 2-10 Princess Margaret Hospital Road, Hong Kong
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Aragón-Sánchez J, Víquez-Molina G, López-Valverde ME. Controversial Issues Regarding Positive Bone Margins in Surgery for Diabetic Foot Osteomyelitis: A Pilot Study. INT J LOW EXTR WOUND 2024; 23:109-115. [PMID: 34488462 DOI: 10.1177/15347346211041267] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Obtaining clean margins in patients who undergo surgical treatment for diabetic foot osteomyelitis (DFO) is recommended. We hypothesize that the rate of recurrence of the infection is not associated with positive margins, even when using a short-term duration of postoperative antibiotic treatment. We conducted a retrospective pilot study of patients who underwent surgery for DFO confirmed by histopathological analysis of the resected bone from August 1, 2020, to December 1, 2020. Bone samples were taken from the proximal margins to be studied by microbiology and histopathology. Twenty-five (89.3%) patients underwent conservative surgery, and 3 (10.7%) patients underwent a minor amputation. After surgery, the antibiotics were stopped in 19 (67.9%) patients and continued in 9 (32.1%) patients for a median period of 4 days. The microbiology of the bone margins was positive in 20 (71.4%) cases, but the histopathology of the bone margins was positive in just 7 (25%) cases. Recurrence of the infection was detected in 3 (10.7%) patients. Seventeen (68%) patients with microbiological-positive margins did not have a recurrence of infection, while 3 (100%) patients had a recurrence of infection (P = .53). Six (24%) patients among those with histopathological-positive margins did not have a recurrence of infection, and1 (33.3%) patient had a recurrence of infection (P = 1). The recurrence of infection was low and always detected in soft tissues, including the cases with a histopathological-positive bone margin. Postoperative antibiotics were administered for a short period of time and not based on the analysis of bone margins.
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Vittrup S, Jensen LK, Hartmann KT, Aalbaek B, Hanberg P, Slater J, Hvistendahl MA, Stilling M, Jørgensen NP, Bue M. Rifampicin does not reduce moxifloxacin concentrations at the site of infection and may not improve treatment outcome of a one-stage exchange surgery protocol of implant-associated osteomyelitis lesions in a porcine model. APMIS 2024; 132:198-209. [PMID: 38153297 DOI: 10.1111/apm.13371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 11/23/2023] [Indexed: 12/29/2023]
Abstract
We aimed to evaluate moxifloxacin steady-state concentrations in infected bone and soft tissue and to explore the additive microbiological and pathological treatment effect of rifampicin to standard moxifloxacin treatment of implant-associated osteomyelitis (IAO). 16 pigs were included. On Day 0, IAO was induced in the proximal tibia using a susceptible Staphylococcus aureus strain. On Day 7, the pigs underwent one-stage exchange surgery of the IAO lesions and were randomized to receive seven days of intravenous antibiotic treatment of either rifampicin combined with moxifloxacin or moxifloxacin monotherapy. On Day 14, microdialysis was applied for continuous sampling (8 h) of moxifloxacin concentrations. Microbiological, macroscopical pathology, and histopathological analyses were performed postmortem. Steady-state moxifloxacin area under the concentration-time curve was lower in the combination therapy group in plasma (total) and subcutaneous tissue compartments (infected and noninfected) (p < 0.04), while no differences were found in bone compartments. No additional treatment effect of rifampicin to moxifloxacin treatment was found (p = 0.57). Conclusive, additive rifampicin treatment does not reduce moxifloxacin concentrations at the infection site. Rifampicin treatment may not be necessary in a one-stage exchange treatment of IAO. However, our sample size and treatment period may have been too small and short to reveal true clinical differences.
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Affiliation(s)
- Sofus Vittrup
- Aarhus Denmark Microdialysis Research (ADMIRE), Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Louise Kruse Jensen
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Katrine Top Hartmann
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Bent Aalbaek
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Pelle Hanberg
- Aarhus Denmark Microdialysis Research (ADMIRE), Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Josefine Slater
- Aarhus Denmark Microdialysis Research (ADMIRE), Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Magnus Andreas Hvistendahl
- Aarhus Denmark Microdialysis Research (ADMIRE), Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Maiken Stilling
- Aarhus Denmark Microdialysis Research (ADMIRE), Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Mats Bue
- Aarhus Denmark Microdialysis Research (ADMIRE), Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
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Zhang WF, Xu J, Zhang JQ, Han F, Tong L, Zhang H, Guan H. [Perioperative management of wounds associated with secondary sternal osteomyelitis and/or mediastinitis after sternotomy and its clinical effects]. Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi 2024; 40:151-158. [PMID: 38418176 DOI: 10.3760/cma.j.cn501225-20231028-00141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
Objective: To investigate the perioperative management of wounds associated with secondary sternal osteomyelitis and/or mediastinitis after sternotomy, and to evaluate its clinical effects. Methods: This study was a retrospective observational study. From January 2017 to December 2022, 36 patients with wounds associated with secondary sternal osteomyelitis and/or mediastinitis after sternotomy who were conformed to the inclusion criteria were admitted to the Burn Center of PLA of the First Affiliated Hospital of Air Force Medical University, including 23 males and 13 females, aged 25 to 81 years. Preparation for surgery was made. For patients with suspected retrosternal mediastinal abscess cavity, all cancellous bone of the unhealed sternum was bitten off to fully expose the retrosternal mediastinum, remove the source of infection and granulation tissue, and to fill the sternum defect with flipped unilateral pectoralis major muscle. For patients who had no retrosternal mediastinal infection but had fresh granulation tissue in unhealed sternal wounds, the necrotic tissue and a small amount of necrotic sternum were palliatively removed, and bilateral pectoralis major muscles were advanced and abutted to cover the sternal defect. After the skin in the donor area was closed by tension-relieving suture, continuous vacuum sealing drainage was performed, and continuous even infusion and lavage were added 24 hours later. The thorax was fixed with an armor-like chest strap, the patients were guided to breathe abdominally, with both upper limbs fixed to the lateral chest wall using a surgical restraint strap. The bacterial culture results of wound exudation specimens on admission were recorded. The wound condition observed during operation, debridement method, muscle flap covering method, intraoperative bleeding volume, days of postoperative infusion and lavage, lavage solution volume and changes on each day, and postoperative complications and wound healing time were recorded. After discharge, the wound healing quality, thorax shape, and mobility functions of thorax and both upper limbs were evaluated during follow-up. The stability and closure of sternum were observed by computed tomography (CT) reexamination. Results: On admission, among 36 patients, 33 cases were positive and 3 cases were negative in bacterial culture results of wound exudation specimens. Intraoperative observation showed that 26 patients had no retrosternal mediastinal infection but had fresh granulation tissue in unhealed sternal wounds, palliative debridement was performed and bilateral pectoralis major muscles were advanced and abutted to cover the defect. In 10 patients with suspected retrosternal mediastinal abscess cavity, the local sternum was completely removed by bite and the defect was covered using flipped unilateral pectoralis major muscle. During the operation, one patient experienced an innominate vein rupture and bleeding of approximately 3 000 mL during mediastinal exploration, and the remaining patients experienced bleeding of 100-1 000 mL. Postoperative infusion and lavage were performed for 4-7 days, with a lavage solution volume of 3 500-4 500 mL/d. The lavage solution gradually changed from dark red to light red and finally clear. Except for 1 patient who had suture rupture caused by lifting the patient under the armpit during nursing on the 3rd day after surgery, the wounds of the other patients healed smoothly after surgery, and the wound healing time of all patients was 7-21 days. Follow-up for 3 to 9 months after discharge showed that the patient who had suture rupture caused by armpit lifting died due to multiple organ failure. In 1 patient, the armor-like chest strap was removed 2 weeks after surgery, and the shoulder joint movement was not restricted, resulting in local rupture of the suture, which healed after dressing change. The wounds of the remaining patients healed well, and they resumed their daily life. The local skin of patient's pectoralis major muscle defect was slightly sunken and lower than that of the contralateral thorax in the patients undergoing treatment of pectoralis major muscle inversion, while no obvious thoracic deformity was observed in patients undergoing treatment with pectoralis major muscle propulsion and abutment. The chest and upper limb movement in all patients were slightly limited or normal. CT reexamination results of 10 patients showed that the sternum was stable, the local sternum was closed or covered completely with no lacuna or defects. Conclusions: Once the wound associated with secondary sternal osteomyelitis and/or mediastinitis after sternotomy is formed, individualized and precise debridement should be performed as soon as possible, different transfer ways of pectoralis major muscle flap should be chosen to cover the defect, and postoperative continuous infusion and lavage together with strict thorax and shoulder joint restraint and immobilization should be performed. This treatment strategy can ensure good wound healing without affecting the shape and function of the donor area.
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Affiliation(s)
- W F Zhang
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital, Air Force Medical University, Xi'an 710032, China
| | - J Xu
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital, Air Force Medical University, Xi'an 710032, China
| | - J Q Zhang
- Department of Burns and Plastic Surgery, Affiliated Hospital of Jining Medical College, Jining 272100, China
| | - F Han
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital, Air Force Medical University, Xi'an 710032, China
| | - L Tong
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital, Air Force Medical University, Xi'an 710032, China
| | - H Zhang
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital, Air Force Medical University, Xi'an 710032, China
| | - H Guan
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital, Air Force Medical University, Xi'an 710032, China
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Ogrodnik PJ, Thomas PBM, Collingwood A. Tibial fractures treated with mono-lateral fixation: Principles of design and application. Proc Inst Mech Eng H 2024; 238:187-197. [PMID: 38314816 DOI: 10.1177/09544119231215998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
This paper presents the outcome of a data review of patients treated with the IOS external fixation system at the Royal Stoke University Hospital: a fixation designed to meet four requirements for external fixation proposed in this paper. Demographic data and outcome were collected and assessed. From 69 initial patients, 64 patients (55 males and 9 females) had an average age of 35.9 years. The mean time to union was 127 days. There were no incidences of malunion, or refracture post fixation removal attributable to the treatment method. In addition, in this cohort, there was no incidence of pin tract infection resulting in osteomyelitis. Of all the factors assessed the only factor to have any significant effect on healing was smoking: an average delay of 31 days. An examination of RUST (radiographic union score tibia) and modified RUST scores illustrated a potential false negative of up to 80%. Hence, this study cannot support the use of either scoring system to diagnose fracture healing. IOS external fixation was shown to be an effective method for the treatment of unstable tibial fractures. The reduction at fixation removal was shown to be very good. There was no incidence of osteomyelitis. It is, therefore, suggested that appropriately used external fixation is a viable alternative to intramedullary nailing if designed and surgically applied using four design principles outlined in this paper. Furthermore, it is proposed that external fixation be designed and applied to meet these four principles.
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Affiliation(s)
- Peter Jan Ogrodnik
- Orthopaedics and Biomechanics Research Group, Keele University, Stoke-on-Trent, UK
- Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Peter Brian MacFarlane Thomas
- Orthopaedics and Biomechanics Research Group, Keele University, Stoke-on-Trent, UK
- Royal Stoke University Hospital, Stoke-on-Trent, UK
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Yammine K. Surgical Options for Diabetic Toe Ulcers and Osteomyelitis Technical Tips and a Decision-Making Algorithm. Foot Ankle Spec 2024; 17:22S-29S. [PMID: 37819011 DOI: 10.1177/19386400231201516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Diabetic foot ulcers (DFUs) reflect a pivotal event that could lead to serious complications such as amputation and death. Although conservative surgery was reported to have better outcomes when compared to nonsurgical standard of care of forefoot wounds, the surgical management of diabetic toe ulcers (DTUs) is hardly researched. METHODS The aim of this study is to describe the types and techniques of surgical procedures that could be needed when managing DTU. The proposed surgical techniques were based on their outcomes following an evidence-based search of the literature. RESULTS Six major types of procedures could be used to treat DTUs; (1) interphalangeal joint resection arthroplasty, (2) phalangectomy or internal pedal amputation, (3) distal Syme amputation, (4) percutaneous toe flexor tenotomy, (5) toe fillet flap, and (6) toe amputation. Details on technical tips are described. CONCLUSION Based on the location, ulcer grade of the ulcer and the status of the surrounding soft tissue, a surgical decision-making algorithm is proposed to assist surgeons when managing such prevalent conditions.Levels of Evidence: Level V: Expert review.
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Affiliation(s)
- Kaissar Yammine
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, School of Medicine, Lebanese American University, Beirut, Lebanon
- Diabetic Foot Clinic, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
- Center for Evidence-Based Anatomy, Sport & Orthopedics Research
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12
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Shifko CR, Jenniches D, Holmberg K, Andreini D, Philp A, Altman DT, Bremmer D. Antibiotic Prophylaxis for Grade 3 Open Fractures: A Retrospective Comparison of Ceftriaxone Plus Vancomycin Versus Cefazolin Plus Gentamicin. Surg Infect (Larchmt) 2024; 25:39-45. [PMID: 38079252 DOI: 10.1089/sur.2023.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024] Open
Abstract
Background: Because of the established path of bacterial entry and contamination-associated mechanisms, grade 3 open orthopedic fractures represent a substantial infection risk. The Eastern Association for the Surgery of Trauma (EAST) guidelines recommended covering Staphylococcus aureus and adding aminoglycoside gram-negative coverage. Local institutional guidelines rely on ceftriaxone for gram negative coverage and add methicillin-resistant Staphylococcus aureus coverage with vancomycin. Patients and Methods: The electronic health records of adults admitted for a grade 3 open fracture between January 1, 2016, and October 31, 2021, were retrospectively reviewed. Patients who received cefazolin and gentamicin (CZ+GM) or ceftriaxone and vancomycin (CRO+VA) as prophylaxis were included. We recorded the rate of a composite treatment failure outcome of receipt of antibiotic agents, infection-related hospitalization, or subsequent debridement for injury-site skin and soft tissue infection or osteomyelitis. The presence of acute kidney injury (AKI) was also evaluated. Results: There were 65 patients included in the CZ+GM group and 53 patients in the CRO+VA group. Patients in the CZ+GM group were younger (mean 42.6 compared with 50.6 years; p = 0.02). Otherwise, there were no significant differences between groups' demographics, mechanism and site of injury, timeline of care, or surgical interventions. More patients in the CZ+GM arm met the composite treatment failure outcome, but it was not statistically significant (45% vs. 32%; p = 0.2). There were similar rates of treatment failure at 30 days (21% vs. 26%; p = 0.5) and for only osteomyelitis (8% vs. 9%; p = 1). Conclusions: The trend in numerically lower treatment failure rates in the CRO+VA group across outcomes provides sufficient evidence to continue the current local recommendations. Given our sample size, type 2 error may have occurred, and studies with greater power should analyze this question.
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Affiliation(s)
| | | | - Kyle Holmberg
- Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Derek Andreini
- Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Allan Philp
- Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | | | - Derek Bremmer
- Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
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13
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El Zein S, Berbari EF, Passerini M, Petri F, Maamari J, Murad MH, Sendi P, Tande AJ. Rifampin Based Therapy for Patients With Staphylococcus aureus Native Vertebral Osteomyelitis: A Systematic Review and Meta-analysis. Clin Infect Dis 2024; 78:40-47. [PMID: 37721158 DOI: 10.1093/cid/ciad560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/01/2023] [Accepted: 09/15/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Native vertebral osteomyelitis (NVO) caused by Staphylococcus aureus is associated with high risk of treatment failure and increased morbidity. The role of rifampin-based therapy for the treatment of this condition is controversial. The goal of this systematic review and meta-analysis is to explore the efficacy and safety of rifampin-based therapy for the treatment of S. aureus NVO. METHODS We searched Cochrane, Embase, Medline, Scopus, and Web of Science databases for studies published up to May 2023, focusing on adults with NVO treated with or without rifampin-containing regimens. A random-effects model meta-analysis estimated relative risks and risk difference with 95% confidence intervals (CI). RESULTS Thirteen studies (2 randomized controlled trials and 11 comparative cohort studies), comprising 244 patients with S. aureus NVO who received rifampin and 435 who did not, were analyzed. Meta-analysis showed that rifampin-based regimens were associated with lower risk of clinical failure (risk difference, -14%; 95% CI, -19% to -8%; P < .001; I2 = 0%; relative risk, 0.58; 95% CI, .37-.92, P = .02, I2 = 21%). Only 1 study reported on adverse events. All studies had a high or uncertain risk of bias, and the certainty of evidence was rated as very low. CONCLUSIONS Adjunctive rifampin therapy might be associated with lower risk of S. aureus NVO treatment failure; however, the low certainty of evidence precludes drawing definitive conclusions that would alter clinical practice. A randomized trial is necessary to corroborate these findings.
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Affiliation(s)
- Said El Zein
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Elie F Berbari
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Matteo Passerini
- Department of Infectious Disease, ASST FBF SACCO Fatebenefratelli, Milano, Lombardia, Italy
| | - Francesco Petri
- Department of Infectious Disease, ASST FBF SACCO Fatebenefratelli, Milano, Lombardia, Italy
| | - Julian Maamari
- St. Elizabeth's Medical Center, A Boston University Teaching Hospital, Brighton, Massachusetts, USA
| | - M Hassan Murad
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Parham Sendi
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Aaron J Tande
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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14
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Bermejo Olano MDM, Campelo Gutierrez C, Hervas Gómez R, Alfayate García JM, Sánchez Ríos JP, Moreno Núñez L. [Risk factors associated with osteomyelitis due to Corynebacterium striatum in patients with diabetic foot]. Med Clin (Barc) 2024; 162:15-18. [PMID: 37981483 DOI: 10.1016/j.medcli.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 09/23/2023] [Accepted: 09/27/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVE Corynebacterium striatum (CS) is an emerging micro-organism in diabetic foot infection for which there are currently few studies. The objective was to analyze the risk factors (RF) related to CS osteomyelitis in patients with diabetic foot. METHODS A case-control study was conducted in the Diabetic Foot Unit between 2015 and 2021. Forty-four patients with osteomyelitis due to CS (cases) and 44 patients with osteomyelitis due a different micro-organism (controls) were included. RESULTS Peripheral artery disease (OR: 2.8, p = 0.037), atrial fibrillation (OR: 3.7, p = 0.034), ischemic diabetic foot (OR: 3.3, p = 0.020) and previous prolonged antibiotic therapy more than 14 days (OR: 3.4, p = 0.012) were identified as RF for osteomyelitis due to CS. When performing the multivariate analysis antibiotic therapy >14 days was independent RF (OR: 3.46; p = 0.017). CONCLUSIONS Previous antibiotic therapy received more than 14 days is an independent and statistically significant RF for CS osteomyelitis in patients with diabetic foot.
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Affiliation(s)
| | | | - Rafael Hervas Gómez
- Unidad de Infecciosas, Hospital Universitario Fundación Alcorcón, Madrid, España
| | | | | | - Leonor Moreno Núñez
- Unidad de Infecciosas, Hospital Universitario Fundación Alcorcón, Madrid, España.
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15
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Lu GN, Jafari A. Commentary on: "Frontal Osteomyelitis and Sinusitis Complication After Type III Frontal Bone Cranioplasty for Facial Feminization" by Brown et al. Facial Plast Surg Aesthet Med 2024; 26:83-84. [PMID: 38100313 DOI: 10.1089/fpsam.2023.0237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
We present a complementary report of a 38-year-old XY intersex female with frontal mucopyocele developing 5 years after frontal setback for gender-affirming surgery to supplement recent report by Brown et al: Frontal Osteomyelitis and Sinusitis Complication After Type III Frontal Bone Cranioplasty for Facial Feminization by Brown et al.
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Affiliation(s)
- G Nina Lu
- Department of Otolaryngology, Division of Facial Plastic and Reconstructive Surgery, University of Washington, Seattle, Washington, USA
| | - Aria Jafari
- Department of Otolaryngology, Division of Rhinology and Endoscopic Skull Base Surgery, University of Washington, Seattle, Washington, USA
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16
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Brown AE, Shrout MA, Howard BE. Frontal Osteomyelitis and Sinusitis Complication After Type III Frontal Bone Cranioplasty for Facial Feminization. Facial Plast Surg Aesthet Med 2024; 26:79-82. [PMID: 38100319 DOI: 10.1089/fpsam.2022.0397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
Background: Forehead contouring can be a component of facial feminization surgery (FFS). Its complications have been rarely reported on and are often described as "hypothetical." Methods: A case report of complications from forehead contouring resulting in frontal osteomyelitis and sinusitis. Results: A female patient presented with frontal osteomyelitis, sinusitis, and forehead contour deformity after a type III forehead contouring surgery. She had failed prior treatment including oral antibiotics, IV antibiotics, revision sinus surgery, and revision nasal surgery. For definitive treatment, she underwent an anterior table resection, sinus obliteration with bony contouring, and pericranial flap. Conclusions: Forehead contouring represents a recent significant advancement in FFS and gender-affirming therapy. Descriptions of complications and their management are important when novel therapies such as FFS are introduced. This case demonstrates complications from type III forehead contouring including osteomyelitis, frontal sinusitis, and forehead deformity.
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Affiliation(s)
- Adam E Brown
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, USA
| | - Max A Shrout
- Division of Plastic and Reconstructive Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Brittany E Howard
- Division of Facial Plastic Surgery, Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
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17
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Shuhardi SA, Said MSM, Kew TY, Ramli R. Recurrent Temporal Infections: The Link to Systemic Lupus Erythematosus. Am J Case Rep 2023; 24:e942163. [PMID: 38155491 PMCID: PMC10763645 DOI: 10.12659/ajcr.942163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/28/2023] [Accepted: 11/09/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is an autoimmune disease with diverse manifestations. The involvement of the musculoskeletal system is very common, and infection is one of the manifestations, which can involve any part of the body. We report a case of a middle-aged woman with recurrent episodes of infection of her left temple. CASE REPORT A 51-year old woman was referred to our clinic following failures to eradicate infection on her left temple for 9 months. Examination revealed facial asymmetry, with diffuse non-tender swelling involving her left temple area, which extended to her cheek. Computed tomography and magnetic resonance imaging (MRI) showed a periosteal reaction of the zygomatic bone. Left temporalis muscle thickening and residual osteomyelitis of the zygomatic bone were also shown by MRI. In view of the unresolved infection with incision and drainage and antibiotics, further blood investigations led to the discovery of SLE. The antinuclear antibody and anti-double-stranded DNA were positive. In addition, low nephelometry markers, C3 (26.7 mg/dL) and C4 (8.24 mg/dL), were observed. This patient was treated with 200 mg of oral hydrochloroquine once daily and 5 mg of oral prednisolone once daily. After 6 months of treatment, the infection subsided, and the structures involved showed remarkable healing. The patient is still taking the same dose and frequency of both drugs at the present time. CONCLUSIONS Temporalis pyomyositis and osteomyelitis of the zygomatic bone could be manifestation of SLE disease; however, the involvement of infection cannot be ruled out.
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Affiliation(s)
- Syafiqah Aina Shuhardi
- Department of Oral and Maxillofacial Surgery, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Mohd Shahrir Mohamed Said
- Department of Medicine, Faculty of Medicine, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Thean Yean Kew
- Department of Radiology, Faculty of Medicine, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Roszalina Ramli
- Department of Oral and Maxillofacial Surgery, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Bhatt AA, Vibhute P, Wu XC, Escott EJ, Chung C, Rhyner PA. Cervical Osteomyelitis and Diskitis as a Complication of Neopharyngeal Breakdown: A Multisite Case Series Review. AJNR Am J Neuroradiol 2023; 44:1418-1420. [PMID: 37945524 PMCID: PMC10714855 DOI: 10.3174/ajnr.a8042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/27/2023] [Indexed: 11/12/2023]
Abstract
Laryngectomy and pharyngectomy are surgical options for advanced laryngeal or pharyngeal squamous cell carcinoma. Cervical osteomyelitis-diskitis, occurring when there is dehiscence of the posterior neopharyngeal wall, is an uncommon complication of laryngopharyngectomy. This case series describes imaging findings of pharyngoesophageal wall breakdown with subsequent cervical spine infection and demonstrates that most of these patients had undergone prior esophageal or neopharyngeal dilations for benign posttreatment stricture. Neck pain, fever, or serologic evidence of infection should prompt careful evaluation for osteomyelitis-diskitis and assessment for neopharyngeal breakdown and sinus tract formation, especially in the postdilation setting.
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Affiliation(s)
- Alok A Bhatt
- From the Department of Radiology (A.A.B., P.V., P.A.R.), Mayo Clinic, Jacksonville, Florida
| | - Prasanna Vibhute
- From the Department of Radiology (A.A.B., P.V., P.A.R.), Mayo Clinic, Jacksonville, Florida
| | - Xin Cynthia Wu
- Department of Radiology (X.C.W.), University of California, San Francisco, San Francisco, California
| | - Edward J Escott
- Department of Radiology (E.J.E.), University of Kentucky, Lexington, Kentucky
| | - Charlotte Chung
- Department of Radiology (C.C.), New York University Langone Health, New York, New York
| | - Patricia A Rhyner
- From the Department of Radiology (A.A.B., P.V., P.A.R.), Mayo Clinic, Jacksonville, Florida
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Dechaene V, Gallet C, Soueges S, Liu L, Delabar V, Adélaïde L, Jarraud S, Dauwalder O, Jouanneau E, Wan M, Jacquesson T, Guyotat J, Conrad A, Triffault-Fillit C, Ferry T, Valour F. Diagnostic, clinical management, and outcome of bone flap-related osteomyelitis after cranioplasty. Int J Infect Dis 2023; 137:48-54. [PMID: 37839505 DOI: 10.1016/j.ijid.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/29/2023] [Accepted: 10/09/2023] [Indexed: 10/17/2023] Open
Abstract
OBJECTIVES We aimed to describe diagnostic, management, and outcome of bone flap-related osteomyelitis after cranioplasty. METHODS Patients followed up in our tertiary care hospital for bone flap-related osteomyelitis after cranioplasty were included in a retrospective cohort (2008-2021). Determinants of treatment failure were assessed using logistic regression and Kaplan-Meier curves analysis. RESULTS The 144 included patients (81 [56.3%] males; median age 53.4 [interquartile range [IQR], 42.6-62.5] years) mostly presented wound abnormalities (n = 115, 79.9%). All infections were documented, the main pathogens being Staphylococcus aureus (n = 64, 44.4%), Cutibacterium acnes (n = 57, 39.6%), gram-negative bacilli (n = 40, 27.8%) and/or non-aureus staphylococci (n = 34, 23.6%). Surgery was performed in 140 (97.2%) cases, for bone flap removal (n = 102, 72.9%) or debridement with flap retention (n = 31, 22.1%), along with 12.7 (IQR, 8.0-14.0) weeks of antimicrobial therapy. After a follow-up of 117.1 (IQR, 62.5-235.5) weeks, 37 (26.1%) failures were observed: 16 (43.2%) infection persistence, three (8.1%) relapses, 22 (59.5%) superinfections and/or two (1.7%) infection-related deaths. Excluding superinfections, determinants of the 19 (13.4%) specific failures were an index craniectomy for brain tumor (odds ratio = 4.038, P = 0.033) and curettage of bone edges (odds ratio = 0.342, P = 0.048). CONCLUSION Post-craniectomy bone flap osteomyelitis are difficult-to-treat infection, necessitating prolonged antimicrobial therapy with appropriate surgical debridement, and advocating for multidisciplinary management in dedicated reference centers.
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Affiliation(s)
- Victor Dechaene
- Department of Infectious Diseases, Reference Center for the Management of Complex Bone and Joint Infections (CRIOAc, Lyon), Hospices Civils de Lyon, Lyon, France
| | - Clémentine Gallet
- Department of Neurosurgery D, Tumoral and Vascular Malformation Surgery Unit, Hospices Civils de Lyon, Lyon, France
| | - Sarah Soueges
- Department of Infectious Diseases, Reference Center for the Management of Complex Bone and Joint Infections (CRIOAc, Lyon), Hospices Civils de Lyon, Lyon, France
| | - Lannie Liu
- Department of Neurosurgery B, Skull Base Surgery Unit, Hospices Civils de Lyon, Lyon, France
| | - Violaine Delabar
- Department of Neurosurgery B, Skull Base Surgery Unit, Hospices Civils de Lyon, Lyon, France
| | - Léopold Adélaïde
- Department of Infectious Diseases, Lucien Husset Hospital, Vienne, France
| | - Sophie Jarraud
- 24/24 Microbiology Plateforme, Infectious Agent Institute, Centre de Biologie et Pathologie Nord, Hospices Civils de Lyon, Lyon, France; CIRI - Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France
| | - Olivier Dauwalder
- 24/24 Microbiology Plateforme, Infectious Agent Institute, Centre de Biologie et Pathologie Nord, Hospices Civils de Lyon, Lyon, France; CIRI - Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France
| | - Emmanuel Jouanneau
- Department of Neurosurgery B, Skull Base Surgery Unit, Hospices Civils de Lyon, Lyon, France
| | - Marie Wan
- Department of Infectious Diseases, Reference Center for the Management of Complex Bone and Joint Infections (CRIOAc, Lyon), Hospices Civils de Lyon, Lyon, France
| | - Timothée Jacquesson
- Department of Neurosurgery B, Skull Base Surgery Unit, Hospices Civils de Lyon, Lyon, France; Department of Anatomy, University of Lyon 1, Lyon, France; CREATIS Laboratory, CNRS UMR5220, Inserm U1044, INSA-Lyon, University of Lyon 1, Lyon, France
| | - Jacques Guyotat
- Department of Neurosurgery D, Tumoral and Vascular Malformation Surgery Unit, Hospices Civils de Lyon, Lyon, France
| | - Anne Conrad
- Department of Infectious Diseases, Reference Center for the Management of Complex Bone and Joint Infections (CRIOAc, Lyon), Hospices Civils de Lyon, Lyon, France; CIRI - Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France
| | - Claire Triffault-Fillit
- Department of Infectious Diseases, Reference Center for the Management of Complex Bone and Joint Infections (CRIOAc, Lyon), Hospices Civils de Lyon, Lyon, France
| | - Tristan Ferry
- Department of Infectious Diseases, Reference Center for the Management of Complex Bone and Joint Infections (CRIOAc, Lyon), Hospices Civils de Lyon, Lyon, France; CIRI - Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France
| | - Florent Valour
- Department of Infectious Diseases, Reference Center for the Management of Complex Bone and Joint Infections (CRIOAc, Lyon), Hospices Civils de Lyon, Lyon, France; CIRI - Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France.
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Boonen M, Ginckels L, Tuerlinckx G, Lammens J. Papineau-irrigation technique: an alternative treatment of fracture-related infectious soft tissue defects. Acta Orthop Belg 2023; 89:651-658. [PMID: 38205756 DOI: 10.52628/89.4.12193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
The original Papineau technique described satisfactory results in treating infection-related pseudarthrosis and chronic osteomyelitis with chronic draining wounds. We described our experience in treating these soft tissue defects using the Papineau-irrigation technique. We retrospectively reviewed the records of patients that were treated with the Papineau-irrigation technique at UZ Leuven, Belgium, between January 2006 and January 2023. All surgical procedures were performed by one senior orthopedic surgeon. There were no exclusion criteria. There was successful healing of the soft tissue defect in 27 out of 32 patients with serial drip irrigation. Additional debridement was often necessary. The Papineau-irrigation technique may provide a useful alternative for treating fracture-related soft tissue defects. In addition, this technique is safe and feasible. Further comparative studies are necessary to validate its efficacy.
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Kitov B, Davarski A, Angelova P, Kitova T, Kehayov I. 'Vertebral osteomyelitis after spine instrumentation surgery: risk factors and management' by E. Benavent et al., J Hosp Infect 2023;140:102-9. J Hosp Infect 2023; 142:142-143. [PMID: 37690485 DOI: 10.1016/j.jhin.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/06/2023] [Indexed: 09/12/2023]
Affiliation(s)
- B Kitov
- Clinic of Neurosurgery, Saint Georgi University Hospital, Plovdiv, Bulgaria
| | - A Davarski
- Department of Neurosurgery, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - P Angelova
- Department of Neurosurgery, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria.
| | - T Kitova
- Department of Anatomy, Histology and Embryology, Medical Faculty, Medical University of Plovdiv, Bulgaria
| | - I Kehayov
- Department of Neurosurgery, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
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Ota M, Urita A, Shibayama H, Iwasaki N. Glenohumeral joint preservation using continuous intramedullary perfusion of high-concentration antibiotics in a patient with septic shoulder arthritis and proximal humerus osteomyelitis: A case report. J Orthop Sci 2023; 28:1548-1551. [PMID: 34716064 DOI: 10.1016/j.jos.2021.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/12/2021] [Accepted: 09/16/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Mitsutoshi Ota
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan; Department of Orthopaedic Surgery, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Atsushi Urita
- Department of Orthopaedic Surgery, Dokkyo Medical University, Mibu, Japan.
| | - Hiroki Shibayama
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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23
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Dehne LM, Foertsch MJ, Droege CA, Makley AT, Mosher DR, Philpott CD, Sagi HC, Mueller EW, Droege ME. Antibiotic Duration Following Abdominal Gunshot Injuries With Associated Pelvis or Spine Involvement: A 20-Year Single-Center Experience. J Surg Res 2023; 291:97-104. [PMID: 37354706 DOI: 10.1016/j.jss.2023.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 05/04/2023] [Accepted: 05/15/2023] [Indexed: 06/26/2023]
Abstract
INTRODUCTION Optimal antimicrobial prophylaxis duration following gunshot wounds (GSW) to the abdomen with an associated orthopedic fracture is unknown. This study evaluated the safety and efficacy of short versus long courses of prophylactic antibiotics following penetrating hollow viscus injury with communicating orthopedic fracture. METHODS This retrospective study included adult patients admitted to the trauma service over a 20-y period who sustained an abdominal GSW with hollow viscus injury and communicating spine or pelvic fractures. Patients were stratified into cohorts based on prophylactic antibiotic duration: short course (SC, ≤48 h) and long course (>48 h). The primary outcome was the incidence of osteomyelitis and meningitis up to 1-y postinjury. Secondary outcomes included hospital length of stay and the incidence of multidrug-resistant organisms and Clostridioides difficile infections. Risk factors for osteomyelitis and meningitis were determined. RESULTS A total of 125 patients were included with 45 (36%) in the SC group. Median prophylactic antibiotic durations were SC, 1 (interquartile range [IQR], 1-2) versus long course, 7 (IQR, 5-7) d (P < 0.001). There was no difference in osteomyelitis and meningitis incidence (2 [4.4%] versus 4 [5%], P = 0.77). Median hospital length of stay (7 [IQR, 6-11] versus 9 [IQR, 6-15] d, P = 0.072) and incidence of multidrug-resistant organisms (6 [13.3%] versus 13 [16.3%], P = 0.86) and Clostridioides difficile infections (0 [0%] versus 1 [1.3%], P = 0.77) were similar between groups. There were no independent risk factors identified for osteomyelitis or meningitis. CONCLUSIONS A shorter course of antibiotic prophylaxis ≤48 h may be adequate following abdominal GSW that traverses a hollow viscus and results in pelvic fracture or spinal column injury.
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Affiliation(s)
- Lauren Michelle Dehne
- Department of Pharmacy Services, UC Health - University of Cincinnati Medical Center, Cincinnati, Ohio; University of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, Ohio.
| | - Madeline Jane Foertsch
- Department of Pharmacy Services, UC Health - University of Cincinnati Medical Center, Cincinnati, Ohio; University of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, Ohio
| | - Christopher Allen Droege
- Department of Pharmacy Services, UC Health - University of Cincinnati Medical Center, Cincinnati, Ohio; University of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, Ohio
| | - Amy Teres Makley
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Carolyn Dosen Philpott
- Department of Pharmacy Services, UC Health - University of Cincinnati Medical Center, Cincinnati, Ohio; University of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, Ohio
| | - Henry Claude Sagi
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Eric William Mueller
- Department of Pharmacy Services, UC Health - University of Cincinnati Medical Center, Cincinnati, Ohio; University of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, Ohio
| | - Molly Elizabeth Droege
- Department of Pharmacy Services, UC Health - University of Cincinnati Medical Center, Cincinnati, Ohio; University of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, Ohio
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Husseini JS, Huang AJ. Discitis-osteomyelitis: optimizing results of percutaneous sampling. Skeletal Radiol 2023; 52:1815-1823. [PMID: 35976405 DOI: 10.1007/s00256-022-04151-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 02/02/2023]
Abstract
Vertebral discitis-osteomyelitis is an infection of the spine that involves the intervertebral disc and the adjacent vertebral body but may also extend into the paraspinal and epidural soft tissues. If blood cultures and other culture data fail to identify a causative microorganism, percutaneous sampling is indicated to help guide targeted antimicrobial therapy. Despite limited supporting evidence, withholding antimicrobial therapy for up to 2 weeks is recommended to maximize microbiological yield, although literature supporting this recommendation is limited. During the procedure, technical factors that may improve yield include targeting of paraspinal fluid collections or soft tissue abnormalities for sampling, acquiring multiple core samples if possible, and use of larger gauge needles when available. Repeat sampling may be indicated if initial percutaneous biopsy is negative but should be performed no sooner than 72 h after the initial percutaneous biopsy to ensure adequate time for culture results to return.
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Affiliation(s)
- Jad S Husseini
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA.
| | - Ambrose J Huang
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA
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Markovinović L, Knezović I, Šokota A, Škrbina S, Batoš AT, Geber G, Penezić A. Retropharyngeal Abscess with Clival Osteomyelitis Caused by Streptococcus intermedius and Staphylococcus aureus in a 6-Year-old Boy. Pediatr Infect Dis J 2023; 42:e390-e391. [PMID: 37310912 DOI: 10.1097/inf.0000000000003998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Leo Markovinović
- Department of Pediatric Infectious Diseases, University Hospital for Infectious Diseases "Dr. Fran Mihaljević," Zagreb, Croatia
| | - Ivica Knezović
- Department of Pediatric Infectious Diseases, University Hospital for Infectious Diseases "Dr. Fran Mihaljević," Zagreb, Croatia
| | - Ante Šokota
- Department of Pediatric Infectious Diseases, University Hospital for Infectious Diseases "Dr. Fran Mihaljević," Zagreb, Croatia
| | - Sanda Škrbina
- Department of Pediatric Infectious Diseases, University Hospital for Infectious Diseases "Dr. Fran Mihaljević," Zagreb, Croatia
| | | | - Goran Geber
- Sestre milosrdnice University Hospital Center, Clinic of Otorhinolaryngology and Head and Neck Surgery, Zagreb, Croatia
| | - Ana Penezić
- Sestre milosrdnice University Hospital Center, Clinic of Otorhinolaryngology and Head and Neck Surgery, Zagreb, Croatia
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Sharma P, Baghel A. Outcome of intramedullary nail coated with antibiotic-impregnated cement in chronic osteomyelitis. Ann Afr Med 2023; 22:434-439. [PMID: 38358142 PMCID: PMC10775937 DOI: 10.4103/aam.aam_185_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 02/16/2024] Open
Abstract
Introduction Chronic osteomyelitis (Chr OM) may result as a sequel of acute hematogenous infection or following open fractures or orthopedic surgeries. Among various osteoarticular infections, Chr OM is one of the most challenging in terms of treatment. In the present study, we evaluate the outcome of antibiotic cement-coated nails in the treatment of chronic pyogenic osteomyelitis and also discuss the future innovations in field of antibiotic-compatible biomaterials for coating the implants. Materials and Methods Twelve cases of Chr OM (5 hematogenous and 7 exogenous following trauma or surgery) were operated by intramedullary nail coated with antibiotic-impregnated bone cement from September 2018 to January 2021. All the cases had bacteriological confirmation of infection by deep curettage and its subsequent culture sensitivity. K nail was used in 10 cases and elastic stable intramedullary nails were used in 2 cases. Results Out of 12 cases, 8 were male and 4 were female. The average duration of follow-up was 13 months. Infection was controlled in all the cases (two cases required repeat antibiotic-coated nailing), and there was no incidence of relapse in any case. The control of infection was assessed by clinical assessment and laboratory parameters. Conclusion Antibiotic cement-coated nails are an effective method in local control of infection in Chr OM without any systemic side effect.
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Affiliation(s)
- Pulak Sharma
- Department of Orthopaedics, Apex Trauma Center, SGPGI, Lucknow, Uttar Pradesh, India
| | - Anurag Baghel
- Department of Orthopaedics, Apex Trauma Center, SGPGI, Lucknow, Uttar Pradesh, India
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Jaroenarpornwatana A, Koonalinthip N, Chawaltanpipat S, Janchai S. Is the duration of diabetic foot ulcers an independent risk factor for developing diabetic foot osteomyelitis? Foot (Edinb) 2023; 56:102000. [PMID: 36905796 DOI: 10.1016/j.foot.2023.102000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 02/16/2023] [Accepted: 03/05/2023] [Indexed: 03/13/2023]
Abstract
OBJECTIVE This study aimed to determine whether the prolonged duration of diabetic foot ulcers was associated with an increased incidence of diabetic foot osteomyelitis. STUDY DESIGN A retrospective cohort study METHODS: The medical records of all patients who participated in the diabetic foot clinic between January 2015 and December 2020 were reviewed. Patients with new diabetic foot ulcers were monitored for diabetic foot osteomyelitis. The collected data included the patient's profile, comorbidities and complications, the ulcer profile (area, depth, location, duration, number of ulcers, inflammation, and history of the previous ulcer), and outcome. Univariate and multivariate Poisson regression analyses were used to assess risk variables for diabetic foot osteomyelitis. RESULTS Eight hundred and fifty-five patients were enrolled; 78 developed diabetic foot ulcers (cumulative incidence 9% over 6 years, average annual incidence 1.5%) and among these diabetic foot ulcers, 24 developed diabetic foot osteomyelitis (cumulative incidence 30% over 6 years, average annual incidence of 5%, incidence rate 0.1/person-year). Statistically significant risk factors for the development of diabetic foot osteomyelitis were ulcers that were deep to the bone (adjusted risk ratio 2.50, p = 0.04) and inflamed wounds (adjusted risk ratio 6.20, p = 0.02). The duration of diabetic foot ulcers was not associated with diabetic foot osteomyelitis (adjusted risk ratio 1.00, p = 0.98). CONCLUSION The duration was not an associated risk factor for diabetic foot osteomyelitis, while bone-deep ulcers and inflamed ulcers were found to be significant risk factors for the development of diabetic foot osteomyelitis.
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Affiliation(s)
- Araya Jaroenarpornwatana
- Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, The Thai Red Cross society, Bangkok, Thailand; Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nantawan Koonalinthip
- Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, The Thai Red Cross society, Bangkok, Thailand; Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | - Siriporn Chawaltanpipat
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Siriporn Janchai
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Moosa SR, Allan AH, Younes AN, Bakri FG, Younes NA. Percutaneous Partial Bone Excision in the Management of Diabetic Toe Osteomyelitis. Foot Ankle Int 2023; 44:836-844. [PMID: 37329229 DOI: 10.1177/10711007231178530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND Diabetic foot osteomyelitis affecting the toes is associated with several complications including amputation. Management is variable and include medical therapy alone or coupled with surgery. Removal of infected tissues is a common therapeutic option. However, limited source data are available. This study determines the outcome and complications of percutaneous partial bone excision (PPBE) of infected bone among diabetic patients with toe osteomyelitis. METHODS This is an uncontrolled experimental prospective study in diabetic patients who underwent PPBE of infected pieces of bone for toe osteomyelitis in the outpatient setting at a single foot clinic. All participants were followed up until the occurrence of wound healing or amputation. RESULTS Forty-seven patients (mean ± SD age was 62.8 ± 11.6 years) participated. Forty-four patients (93.6%) had complete healing and 3 (6.4%) required toe amputation. The mean (±SD) wound healing time was 11 (±4.6) (range, 7-22) weeks. Diabetes mellitus type 1 and younger age were significantly associated with increased risk for amputation. CONCLUSION PPBE of infected toes in diabetic patients can be performed successfully and safely in the outpatient clinic. It can also improve healing and avoids inpatient stay. LEVEL OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
- Sameh R Moosa
- National Center of Diabetes, Endocrinology and Genetics, Specialized Foot Clinics, Amman, Jordan
| | - Ali H Allan
- National Center of Diabetes, Endocrinology and Genetics, Specialized Foot Clinics, Amman, Jordan
| | - Amr N Younes
- Jordan University of Science and Technology, Irbid, Jordan
| | - Faris G Bakri
- National Center of Diabetes, Endocrinology and Genetics, Specialized Foot Clinics, Amman, Jordan
- Department of Medicine, University of Jordan, Amman, Jordan
- Infectious Diseases and Vaccine Center, University of Jordan, Amman, Jordan
| | - Nidal A Younes
- National Center of Diabetes, Endocrinology and Genetics, Specialized Foot Clinics, Amman, Jordan
- Department of General Surgery, University of Jordan, Amman, Jordan
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29
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McDonald ACE, Julian J, Voss LM, Boyle MJ, Crawford HA. An Update on Pediatric Acute Hematogenous Osteomyelitis in New Zealand - A Decade on. J Pediatr Orthop 2023; 43:e614-e618. [PMID: 37253712 DOI: 10.1097/bpo.0000000000002443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION New Zealand (NZ) has high rates of pediatric acute hematogenous osteomyelitis (AHO) with males and children of Pasifika and Māori ethnicity overrepresented. AIMS To update the incidence of Pediatric AHO over 10 years, identifying trends in presentation, organisms, treatment, and outcomes. METHODS A 10-year retrospective review of children aged 6 weeks to 15 years admitted with Pediatric AHO across two centers from 2008 to 2017. Demographic data, features of presentation, investigations, management, and complications were collected. Incidence was calculated from census data. Data were compared with our osteomyelitis database from the previous decade. (1). RESULTS 796 cases were identified. The incidence was 18 per 100,000 per annum. The average age was 7.7 years. Pasifika and Māori children are overrepresented (57%). 370 children (51%) came from low socioeconomic areas. Methicillin-sensitive Staphylococcus aureus was the most common pathogen (87%). Methicillin-resistant Staphylococcus aureus (MRSA) rates are low (4.4%). Forty-four (5.5%) children were admitted to the Pediatric Intensive Care Unit (PICU) with 9% mortality. The mean duration of antibiotics was 40 days. 325 children (41%) had surgery. Chronic infection has increased from 1.7% to 5.7%. CONCLUSIONS NZ has high rates of AHO, however, the incidence has decreased from the previous decade. Males, those in low socioeconomic areas, Pasifika and Māori have high disease burden. The use of MRI as a diagnostic modality has increased. Future studies should focus on improving treatment via prospective analysis and reporting long-term morbidity to improve outcomes for children with severe disease and reduce rates of chronic infection.
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Affiliation(s)
- Anna C E McDonald
- Starship Childrens Hospital, Auckland District Health Board; Department of Paediatrics, The University of Auckland Faculty of Medical and Health Sciences
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30
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Lack WD. Commentary on: Risk Factors and Characteristics of Recalcitrant Osteomyelitis Following Initial Surgical and Antibiotic Treatment. J Orthop Trauma 2023; 37:423. [PMID: 37348039 DOI: 10.1097/bot.0000000000002652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Affiliation(s)
- William D Lack
- University of Washington Department of Orthopaedics and Sports Medicine, Seattle, WA
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31
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Ren Y, Liu L, Sun D, Zhang Z, Li M, Lan X, Ni J, Yan MM, Huang W, Liu ZM, Peng AQ, Zhang Y, Jiang N, Song K, Huang Z, Bi Q, Zhang J, Yang Q, Yang J, Liu Y, Fu W, Tian X, Wang Y, Zhong W, Song X, Abudurexiti A, Xia Z, Jiang Q, Shi H, Liu X, Wang G, Hu Y, Zhang Y, Yin G, Fan J, Feng S, Zhou X, Li Z, He W, Weeks J, Schwarz EM, Kates SL, Huang L, Chai Y, Bin Yu MD, Xie Z, Deng Z, Xie C. Epidemiological updates of post-traumatic related limb osteomyelitis in china: a 10 years multicentre cohort study. Int J Surg 2023; 109:2721-2731. [PMID: 37247014 PMCID: PMC10498838 DOI: 10.1097/js9.0000000000000502] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/09/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Post-traumatic related limb osteomyelitis (PTRLO) is a complex bone infection. Currently, there are no available microbial data on a national scale that can guide appropriate antibiotic selection, and explore the dynamic changes in dominant pathogens over time. This study aimed to conduct a comprehensive epidemiological analysis of PTRLO in China. METHODS The study was approved by the Institutional Research Board (IRB), and 3526 PTRLO patients were identified from 212 394 traumatic limb fracture patients at 21 hospitals between 1 January 2008 and 31 December 2017. A retrospective analysis was conducted to investigate the epidemiology of PTRLO, including changes in infection rate (IR), pathogens, infection risk factors and antibiotic resistance and sensitivity. RESULTS The IR of PTRLO increased gradually from 0.93 to 2.16% (Z=14.392, P <0.001). Monomicrobial infection (82.6%) was significantly higher than polymicrobial infection (17.4%) ( P <0.001). The IR of Gram-positive (GP) and Gram-negative (GN) pathogens showed a significant increase from the lowest 0.41% to the highest 1.15% (GP) or 1.62% (GN), respectively. However, the longitudinal trend of GP vs. GN's composition did not show any significance (Z=±1.1918, P >0.05). The most prevalent GP strains were Methicillin-sensitive Staphylococcus aureus (MSSA) (17.03%), Methicillin-resistant Staphylococcus aureus (MRSA) (10.46%), E. faecalis (5.19%) and S. epidermidis (4.87%). In contrast, the dominant strains GN strains were Pseudomonas Aeruginosa (10.92%), E. cloacae (10.34%), E. coli (9.47%), Acinetobacter Baumannii (7.92%) and Klebsiella Pneumoniae (3.33%). In general, the high-risk factors for polymicrobial infection include opened-fracture (odds ratio, 2.223), hypoproteinemia (odds ratio, 2.328), and multiple fractures (odds ratio, 1.465). It is important to note that the antibiotics resistance and sensitivity analysis of the pathogens may be influenced by complications or comorbidities. CONCLUSIONS This study provides the latest data of PTRLO in China and offers trustworthy guidelines for clinical practice. (China Clinical Trials.gov number, ChiCTR1800017597).
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Affiliation(s)
- YouLiang Ren
- Department of Orthopaedics, Second Affiliated Hospital of Chongqing Medical University
- Department of Orthopaedics, Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY
| | - Lei Liu
- Department of Orthopaedics, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen
- Department of Orthopaedics, West China Hospital, Sichuan University
| | - Dong Sun
- Department of Orthopaedics, First Affiliated Hospital of Army Medical University
| | - ZhengDong Zhang
- Department of Orthopaedics, West China Hospital, Sichuan University
- Department of Orthopedics, The First Affiliated Hospital of Chengdu Medical College, Chengdu
| | - Meng Li
- Department of Orthopaedics, Gansu Provincial Hospital
- Department of Orthopaedics, Lanzhou General Hospital of People’s Liberation Army, Lanzhou
| | - Xu Lan
- Department of Orthopaedics, Gansu Provincial Hospital
- Department of Orthopaedics, Lanzhou General Hospital of People’s Liberation Army, Lanzhou
| | - JiangDong Ni
- Department of Orthopaedics Surgery, Second Xiangya Hospital, Central South University, Changsha
| | - Ming-Ming Yan
- Department of Orthopaedics Surgery, Second Xiangya Hospital, Central South University, Changsha
| | - Wei Huang
- Department of Orthopaedics, First Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Zi-Ming Liu
- Department of Orthopaedics, First Affiliated Hospital of Chongqing Medical University, Chongqing
- Institute of Sports Medicine Beijing Key Laboratory of Sports Injuries Peking University Third Hospital
| | - AQin Peng
- Department of Orthopaedics, Third Hospital of Hebei Medical University, Shijiazhuang
| | - YanLong Zhang
- Department of Orthopaedics, Third Hospital of Hebei Medical University, Shijiazhuang
| | - Nan Jiang
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou
| | - KeGuan Song
- Third Department of Orthopaedics, First Affiliated Hospital of Harbin Medical University, Harbin
| | - ZhiPeng Huang
- Third Department of Orthopaedics, First Affiliated Hospital of Harbin Medical University, Harbin
| | - Qing Bi
- Department of Orthopaedics, Zhejiang Provincial People's Hospital of Hangzhou Medical College, Hangzhou
| | - Jun Zhang
- Department of Orthopaedics, Zhejiang Provincial People's Hospital of Hangzhou Medical College, Hangzhou
| | - Qun Yang
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian
| | - Jun Yang
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian
| | - Yi Liu
- Department of Orthopaedics, Affiliated Hospital of Zunyi Medical University, Zunyi
| | - Wei Fu
- Department of Orthopaedics, Affiliated Hospital of Zunyi Medical University, Zunyi
- Department of Orthopaedics, Guizhou Provincial People’s Hospital
| | | | - YuanZheng Wang
- Department of Orthopaedics, Guizhou Provincial People’s Hospital
| | - WanRun Zhong
- Department of Orthopaedics Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine
| | - XingHua Song
- Department of Orthopaedics, First Hospital of Xinjiang Medical University, Ürümqi
- Department of Spine and Joint, The Affiliated Shunde Hospital of Jinan University, Foshan
| | | | - ZhiLin Xia
- Department of Orthopaedics, Second Hospital of Beijing Municipal Corps Chinese People's Armed Police
| | - Qing Jiang
- Department of Orthopaedics, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School
| | - HongFei Shi
- Department of Orthopaedics, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School
| | - XiMing Liu
- Department of Orthopaedics, Wuhan General Hospital of People's Liberation Army, Wuhan
| | - GuoDong Wang
- Department of Orthopaedics, Wuhan General Hospital of People's Liberation Army, Wuhan
| | - YunSheng Hu
- Department of Orthopaedics, Tangdu Hospital, Fourth Military Medical University, Xi'an
| | - YunFei Zhang
- Department of Orthopaedics, Tangdu Hospital, Fourth Military Medical University, Xi'an
| | - GuoYong Yin
- Department of Orthopaedics, First Affiliated Hospital of Nanjing Medical University, Nanjing
| | - Jin Fan
- Department of Orthopaedics, First Affiliated Hospital of Nanjing Medical University, Nanjing
| | - ShiQing Feng
- Department of Orthopaedics, Tianjin Medical University General Hospital, Heping, China
| | - XianHu Zhou
- Department of Orthopaedics, Tianjin Medical University General Hospital, Heping, China
| | - ZhengDao Li
- Department of Orthopaedics, First People’s Hospital of Xuzhou, Affiliated Hospital of China University of Mining and Technology
| | - WenBin He
- Department of Trauma Orthopaedics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai
| | - Jason Weeks
- Department of Orthopaedics, Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY
| | - Edward M Schwarz
- Department of Orthopaedics, Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY
| | - Stephen L Kates
- Department of Orthopedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Lei Huang
- Department of Orthopaedics, Peking University Jishuitan Hospital, Beijing
| | - YiMin Chai
- Department of Orthopaedics Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine
| | - MD Bin Yu
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou
| | - Zhao Xie
- Department of Orthopaedics, First Affiliated Hospital of Army Medical University
| | - ZhongLiang Deng
- Department of Orthopaedics, Second Affiliated Hospital of Chongqing Medical University
| | - Chao Xie
- Department of Orthopaedics, Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY
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Petrovic M, Landsberger HG, Peng KA. Complex Case of Skull Base Osteomyelitis Secondary to Chronic Otitis Media. Ear Nose Throat J 2023; 102:31S-34S. [PMID: 37515329 DOI: 10.1177/01455613231189219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023] Open
Abstract
We present a case of a 58-year-old male with type II diabetes managed with metformin and insulin, who presented to the clinic with left chronic otitis media, persistent drainage, a stenotic meatus, and a prior history of 3 canal wall-down mastoidectomies and antibiotic therapy. A revision tympanoplasty with mastoidectomy was performed, and during the postoperative period, the patient had persistent pain and otorrhea, which were managed with opioids and several courses of antibiotic therapy. After symptoms persisted, imaging and culture ultimately led to the diagnosis of fungal skull base osteomyelitis, which was eventually treated successfully. While these complications are rare, their likelihood is increased with treatment delay and in the immunocompromised patient. Close management of immunocompromised patients, including diabetic patients, is vital in identifying complications early to aid in timely diagnosis and treatment to lead to the best possible outcome.
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Affiliation(s)
- Masa Petrovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Institute for Cardiovascular Diseases "Dedinje", Belgrade, Serbia
| | - Hannah G Landsberger
- Department of Surgery, Long Island Jewish Medical Center, Northwell Health, New Hyde Park, NY, USA
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Yfanti Z, Tetradis S, Nikitakis NG, Alexiou KE, Makris N, Angelopoulos C, Tsiklakis K. Radiologic findings of osteonecrosis, osteoradionecrosis, osteomyelitis and jaw metastatic disease with cone beam CT. Eur J Radiol 2023; 165:110916. [PMID: 37300936 DOI: 10.1016/j.ejrad.2023.110916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/17/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE The purpose of this study was to assess CBCT scans of patients with medication related osteonecrosis of the jaws (MRONJ), osteoradionecrosis (ORN), osteomyelitis (OM) and jaw metastatic disease (JM), evaluate the presence and extent of radiologic findings, identify radiologic parameters that may distinguish the four entities and last, introduce a new modified radiographic index (CRIm), in order to contribute to the diagnosis of these conditions. METHODS Τwo major databases were retrospectively searched for fully documented and diagnosed CBCT scans of MRONJ, ORN, OM and JM from 2006 to 2019. 335 CBCT scans met the inclusion criteria and were assessed under standardized viewing conditions blindly by 2 observers. The CRIm index proposed in this study evaluates: lytic changes, sclerosis, periosteal bone formation, sequestration, non-healing extraction sockets and other findings which included: sinus implication, inferior alveolar canal implication and jaw fracture. Lytic changes, sclerosis, periosteal bone formation, sequestration and non-healing extraction sockets were scored as: absent (0), localized/single (1) and extensive/multiple (2). Each one of other findings were scored individually as: absent (0) and present (1). For statistical analysis t-test, Pearson's r correlation coefficient, one-way ANOVA and Bonferonni were performed. RESULTS Extensive lytic changes were the most common finding, especially for ORN, where it occurred in all CBCT scans (100%). The mean value of the CRIm index differs significantly between CBCT scans with MRONJ and JM, as well as between those with OM and JM (Bonferroni p < 0.001). CONCLUSIONS The new modified Composite Radiographic Index introduced in this study, appears to have improved an objective approach to the previously used Composite Radiographic Index by means of cumulative radiologic features. Τhe predominance of certain radiologic features in one or more of these entities may lead the diagnostician towards the correct diagnosis.
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Affiliation(s)
- Zafeiroula Yfanti
- Department of Oral Diagnosis and Radiology, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece.
| | - Sotirios Tetradis
- Section of Oral Maxillofacial Radiology, UCLA School of Dentistry, Los Angeles, CA, USA.
| | - Nikolaos G Nikitakis
- Department of Oral Medicine & Pathology and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece.
| | - Konstantina Eleni Alexiou
- Department of Oral Diagnosis and Radiology, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece.
| | - Nikolaos Makris
- Department of Oral Diagnosis and Radiology, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece.
| | - Christos Angelopoulos
- Department of Oral Diagnosis and Radiology, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece.
| | - Kostas Tsiklakis
- Department of Oral Diagnosis and Radiology, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece.
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Ranade AS, Gandhi S. Fungal Osteomyelitis of the Proximal Tibial Epiphysis and Septic Arthritis Secondary to an Open Wound: A Case Report. JBJS Case Connect 2023; 13:01709767-202309000-00055. [PMID: 37590557 DOI: 10.2106/jbjs.cc.23.00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
CASE A 9-year-old boy presented with a painful, swollen knee. He had a wound on the knee 2 months ago after a fall in contaminated water. At another hospital, this was treated with debridement twice, and the patient received several antibiotics. Imaging showed septic arthritis and epiphyseal osteomyelitis involving the proximal medial tibia. Surgical debridement and joint washout were performed. Fungal cultures grew Scedosporium boydii. Antifungal treatment with voriconazole was given. At a 5-year follow-up, we noticed favorable outcomes without any complications. CONCLUSIONS Fungal osteomyelitis because of direct inoculation should be considered a rare differential diagnosis while treating epiphyseal osteomyelitis.
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Affiliation(s)
- Ashish S Ranade
- Blooming Buds Centre for Pediatric Orthopaedics, Deenanath Mangeshkar Hospital, Pune, India
| | - Shreyans Gandhi
- Department of Orthopaedics, Deenanath Mangeshkar Hospital, Pune, India
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35
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Ishibashi S, Kodama A, Maruyama N, Tanaka T, Hayashi Y, Shinomiya R, Okada S, Adachi N. Bacille Calmette-Guérin Vaccine-Induced Tuberculous Elbow Osteomyelitis in an Infant: A Case Report. JBJS Case Connect 2023; 13:01709767-202309000-00046. [PMID: 37590400 DOI: 10.2106/jbjs.cc.22.00470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/10/2022] [Indexed: 08/19/2023]
Abstract
CASE We report a case of Bacillus Calmette-Guérin (BCG) vaccine-induced osteomyelitis of the distal end of the right humerus in a 1-year and 8-month-old girl. The patient was treated with debridement and a 12-month antituberculosis drug. After 3 years of follow-up, no growth disturbances or sequelae were observed. CONCLUSION BCG osteomyelitis is difficult to diagnose because of its rarity. It is important to suspect BCG osteomyelitis based on symptoms and blood tests and to perform PCR testing. Long-term follow-up after treatment is necessary to monitor for recurrence and avoid growth disturbances until epiphyseal line closure occurs.
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Affiliation(s)
- Shigeki Ishibashi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University Kasumi, Hiroshima, Japan
| | - Akira Kodama
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University Kasumi, Hiroshima, Japan
| | - Natsuki Maruyama
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical and Health Sciences, Kasumi, Hiroshima, Japan
| | - Teruyasu Tanaka
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University Kasumi, Hiroshima, Japan
| | - Yuta Hayashi
- Department of Musculoskeletal Traumatology and Reconstructive Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University Kasumi, Hiroshima, Japan
| | - Rikuo Shinomiya
- Department of Musculoskeletal Traumatology and Reconstructive Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University Kasumi, Hiroshima, Japan
| | - Satoshi Okada
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical and Health Sciences, Kasumi, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University Kasumi, Hiroshima, Japan
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36
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Díaz-Velis L, Álvarez-Echeverría F, Garrido G. [Culture and metagenomics as bacterial identification methods in patients with diabetic foot ulcers: a systematic review]. Rev Med Chil 2023; 151:206-221. [PMID: 38293856 DOI: 10.4067/s0034-98872023000200206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 03/06/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Diabetic foot osteomyelitis (DFO) is a serious complication of infected ulcers in a diabetic patient. The identification of the infecting microorganisms is generally by culture, which causes a bias. Recently, metagenomics has been used for microbial identification. AIM To systematically review the scientific literature related to DFO in the last 10 years to evaluate if culture and metagenomics are complementary. MATERIAL AND METHODS To carry out the systematic review, PRISMA and Rayyan were used for the selection of studies, using three databases, using the keywords diabetes, osteomyelitis, culture and microbiome. Articles in English or Spanish were included, containing information related to bacterial identification in DFO. Characteristics of the technique, patients and frequency of bacterial appearance were collected. RESULTS Twenty six articles were included, 19 used culture and 7 metagenomics. The patients were predominantly men (68%), with an average age of 61 years, 83% had type 2 diabetes and comorbidities, mainly vascular and neuropathy. The Families with the highest frequency of appearance using the culture technique were Enterobacteriaceae (29.3%) and Staphylococcaceae(28.3%) and with metagenomics Peptoniphilaceae (22.1%) and Staphylococcaceae (9.4%). Peptoniphilaceae were not identified in culture, although they were frequently identified by metagenomics. Methicillin- resistant Staphylococcus aureus, regularly identified by culture, was not identified using metagenomics. CONCLUSIONS Comparing results, there is a certain complementarity between microbiological culture and sequencing to identify bacteria present in DFO.
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Affiliation(s)
- Leonor Díaz-Velis
- Departamento de Ciencias Farmacéuticas, Facultad de Ciencias, Universidad Católica del del Norte, Antofagasta, Chile
| | - Fabián Álvarez-Echeverría
- Departamento de Ciencias Farmacéuticas, Facultad de Ciencias, Universidad Católica del del Norte, Antofagasta, Chile
| | - Gabino Garrido
- Departamento de Ciencias Farmacéuticas, Facultad de Ciencias, Universidad Católica del del Norte, Antofagasta, Chile
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Quintana-Ortega C, Prieto-Moreno Pfeifer A, Palomino Lozano L, Lancharro Á, Saavedra Lozano J, Villa-García ÁJ, Seoane-Reula E. Colchicine as rescue treatment in two pediatric patients with chronic recurrent multifocal osteomyelitis (CRMO). Mod Rheumatol Case Rep 2023; 7:215-218. [PMID: 35134976 DOI: 10.1093/mrcr/rxac010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/03/2021] [Accepted: 01/26/2022] [Indexed: 01/07/2023]
Abstract
Chronic recurrent multifocal osteomyelitis (CRMO) is a rare idiopathic autoinflammatory bone disease characterised by noninfective inflammation of bones. Diagnostic approach is challenging and requires exclusion of other causes such as malignancies or infections. Nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids are usually applied as first-line therapy in CRMO patients; however, some cases require more intensive therapy with second-line agents to control disease activity. We hereby describe the use of colchicine as a nonconventional second-line disease-modifying antirheumatic drug in two pediatric patients with CRMO refractory to NSAIDs and corticosteroids. Our data indicate that colchicine might prove an important area for future research as a potential therapeutic option with easy administration, low cost, and a good safety profile in CRMO patients refractory to first-line therapy.
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Affiliation(s)
| | | | | | - Ángel Lancharro
- Department of Pediatric Radiology, Gregorio Marañón University Hospital, Madrid, Spain
| | - Jesús Saavedra Lozano
- Department of Pediatric Infectious Diseases, Gregorio Marañón University Hospital, Madrid, Spain
| | - Ángel José Villa-García
- Department of Pediatric Orthopedic and Trauma Surgery, Gregorio Marañón University Hospital, Madrid, Spain
| | - Elena Seoane-Reula
- Department of Pediatric Allergy and Immunology, Primary Immunodeficiencies Unit Gregorio Marañón University General Hospital, Madrid, Spain
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38
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Khan S, Dhakad PS, Agwani KM, Saradhara DK. Malignant transformation of chronic osteomyelitis of mandible: A rare presentation. J Cancer Res Ther 2023; 19:S967-S969. [PMID: 38384092 DOI: 10.4103/jcrt.jcrt_1387_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 07/26/2022] [Indexed: 11/04/2022]
Abstract
ABSTRACT Chronic osteomyelitis is a bone disease that is characterized by inflammatory processes, including necrosis of mineralized and marrow tissues, suppuration, resorption, sclerosis, and hyperplasia. The primary cause of chronic osteomyelitis is usually microbiologic, and it results from an odontogenic infection, postextraction complication, inadequate removal of necrotic bone, early termination of antibiotic therapy, inappropriate selection of antibiotics, diagnostic failure, trauma, inadequate treatment for a fracture, or irradiation to the mandible. The incidence of malignant transformation of chronic osteomyelitis in the head and neck region is very low and rare in developed countries. This is the first case report on the malignant transformation of chronic osteomyelitis of the mandible which discusses its etiopathogenesis and radiographic imaging.
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Affiliation(s)
- Saba Khan
- Department of Oral Medicine and Radiology, Darshan Dental College and Hospital, Loyara, Udaipur, Rajasthan, India
- Department of Oral Medicine and Radiology, Sankalchand Patel University, Visnagar, Gujarat, India
| | - Pooja S Dhakad
- Department of Oral Medicine and Radiology, Darshan Dental College and Hospital, Loyara, Udaipur, Rajasthan, India
| | - Khalid M Agwani
- Department of Oral Maxillofacial Surgery, Darshan Dental College and Hospital, Loyara, Udaipur, Rajasthan, India
- Department of Oral and Maxillofacial Surgery, Sankalchand Patel University, Visnagar, Gujarat, India
| | - Dhyey K Saradhara
- Department of Oral and Maxillofacial Surgery, Darshan Dental College and Hospital, Loyara, Udaipur, Rajasthan, India
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39
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Chkadua TZ, Oltarzhevskaya ND, Cholokava TD, Baisova LM, Sogachev GV, Egiazaryan AK. [Post-Covid osteomyelitis of the facial bones]. Stomatologiia (Mosk) 2023; 102:68-72. [PMID: 38096398 DOI: 10.17116/stomat202310206268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The pandemic of coronavirus infection existed from 2019 to 2023. The World Health Organization (WHO) has announced on May 5, 2023 that the pandemic had ended. However, it does not cease to have an adverse effect on the health of the world population. Necrotic lesions of the bones of the facial skeleton are now a characteristic sign of a severe coronavirus infection. We conducted a review of scientific publications that reflected the relationship between coronavirus and necrotic processes of the skull bones, methods of treatment, prevention and the latest developments in this direction. The purpose of this article is to review existing studies on Post-Covid osteomyelitis of facial bones, its impact, features of the clinical picture of this disease, analysis of methods and means of treatment of this group of patients. Analysis of literature data has shown that the search for an ideal dressing material continues, especially the developments of native developers stand emphasized. The advantages of modern materials over traditional ones have become unquestionable, but further research in this direction is required.
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Affiliation(s)
- T Z Chkadua
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | | | - T D Cholokava
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - L M Baisova
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - G V Sogachev
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - A K Egiazaryan
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
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40
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Momo OM, Otake S, Minamikawa S, Ohkusu K, Nakagishi Y. Painless subcutaneous abscess caused by bacillus Calmette-Guérin osteomyelitis. Pediatr Int 2023; 65:e15381. [PMID: 36208007 DOI: 10.1111/ped.15381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Osamu Matsumura Momo
- Department of General Pediatrics, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan
| | - Shogo Otake
- Division of Infectious Disease, Department of Pediatrics, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan
| | - Shogo Minamikawa
- Department of General Pediatrics, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan
| | - Kiyofumi Ohkusu
- Department of Microbiology, Tokyo Medical University, Tokyo, Japan
| | - Yasuo Nakagishi
- Department of General Pediatrics, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan
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41
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Sheridan GA, Falk DP, Fragomen AT, Rozbruch SR. Calcium sulfate in the management of osteomyelitis: A systematic review and meta-analysis of comparative studies. Medicine (Baltimore) 2022; 101:e31364. [PMID: 36397437 PMCID: PMC9666130 DOI: 10.1097/md.0000000000031364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Calcium sulfate (CS) is used extensively as an antibiotic carrier in the treatment of chronic osteomyelitis, largely due to its biodegradable nature. The aim of this systematic review and meta-analysis is to analyze the comprehensive performance of CS in the literature when compared to other biomaterials or treatments for osteomyelitis. We assess the ability of CS to eradicate infection and achieve other key clinical outcomes. METHODS All studies comparing the use of CS to any other surgical technique for the surgical management of osteomyelitis were eligible for analysis. The indication for surgery in each case was chronic osteomyelitis. The minimum dataset required included details regarding infection eradication rates, union rates (in cases of nonunion), all-cause revision surgery and wound leakage. The primary outcome variables of concern were infection eradication and all-cause revision surgery. Secondary outcome variables included union and wound leakage. A random effects meta-analysis was performed. RESULTS Five studies were deemed eligible for inclusion. The CS group had a significantly higher rate of infection eradication (P = .013) and a significantly lower rate of revision for all causes (P < .001) when compared to the comparative group. In total, the CS group had 30 cases of wound leakage compared to 8 in the comparative group (P = .064). CONCLUSION CS demonstrates superior rates of infection eradication and all-cause revision when compared with alternative treatment methods for chronic osteomyelitis. While the current study reports on differing but nonsignificant rates of wound leakage between CS and other treatments, future studies are required to accurately investigate this clinically important complication.
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Affiliation(s)
- Gerard A. Sheridan
- Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY, USA
- * Correspondence: Gerard A. Sheridan, Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY, USA (e-mail: )
| | - David P. Falk
- Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY, USA
| | - Austin T. Fragomen
- Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY, USA
| | - S. Robert Rozbruch
- Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY, USA
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42
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Truong DH, Fontaine JL, Malone M, Wukich DK, Davis KE, Lavery LA. A Comparison of Pathogens in Skin and Soft-Tissue Infections and Pedal Osteomyelitis in Puncture Wound Injuries Affecting the Foot. J Am Podiatr Med Assoc 2022; 112:20-206. [PMID: 33141882 DOI: 10.7547/20-206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/03/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND To compare pathogens involved in skin and soft-tissue infections (SSTIs) and pedal osteomyelitis (OM) in patients with and without diabetes with puncture wounds to the foot. METHODS We evaluated 113 consecutive patients between June 1, 2011, and March 31, 2019, with foot infection (SSTIs and OM) from a puncture injury sustained to the foot. Eighty-three patients had diabetes and 30 did not. We evaluated the bacterial pathogens in patients with SSTIs and pedal OM. RESULTS Polymicrobial infections were more common in patients with diabetes mellitus (83.1% versus 53.3%; P = .001). The most common pathogen for SSTIs and OM in patients with diabetes was Staphylococcus aureus (SSTIs, 50.7%; OM, 32.3%), whereas in patients without diabetes it was Pseudomonas (25%) for SSTIs. Anaerobes (9.4%) and fungal infection (3.1%) were uncommon. Pseudomonas aeruginosa was identified in only 5.8% of people with diabetes. CONCLUSIONS The most common bacterial pathogen in both SSTIs and pedal OM was S aureus in patients with diabetes. Pseudomonas species was the most common pathogen in people without diabetes with SSTIs.
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Affiliation(s)
- David H Truong
- *Surgical Service, Podiatry Section, Veterans Affairs North Texas Health Care System, Dallas, TX
- †Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Javier La Fontaine
- †Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
- ‡Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Matthew Malone
- §Infectious Diseases and Microbiology, School of Medicine, Western Sydney University, Sydney, Australia
- ‖South West Sydney Limb Preservation and Wound Research, Liverpool Hospital, South Western Sydney LHD, Sydney, Australia
| | - Dane K Wukich
- †Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Kathryn E Davis
- ‡Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Lawrence A Lavery
- †Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
- ‡Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
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43
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Ma WB, Yao XD. [A case of neonatal intravenous indwelling needle puncture site infection caused ulnar osteomyelitis]. Zhonghua Er Ke Za Zhi 2022; 60:1079-1080. [PMID: 36207859 DOI: 10.3760/cma.j.cn112140-20220226-00149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- W B Ma
- Department of Orthopedics, Xi'an Children's Hospital, Xi'an 710002, China
| | - X D Yao
- Department of Orthopedics, Xi'an Children's Hospital, Xi'an 710002, China
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44
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Nguyen S, Wallard P, Robineau O, Topolinski H, Beltrand E, Benkanoun A, Baranski D, Descamps D, Senneville E. Reply to Aragón-Sánchez et al. Conservative surgery and postoperative antibiotics guided by bone biopsies for diabetic foot osteomyelitis. Comments on Nguyen S, et al. Conservative surgical treatment for metatarsal osteomyelitis in diabetic foot: Experience of two French centres. Diabetes Metab Res Rev 2022; 38:e3569. [PMID: 35933615 DOI: 10.1002/dmrr.3569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Sophie Nguyen
- Infectious Diseases Department, Bethune Hospital, Bethune, France
| | - Pauline Wallard
- Infectious Diseases Department, Bethune Hospital, Bethune, France
| | - Olivier Robineau
- Infectious Diseases Department, Gustave Dron Hospital, Tourcoing, France
| | | | - Eric Beltrand
- Orthopedic Surgery Unit, Gustave Dron Hospital, Tourcoing, France
| | - Ali Benkanoun
- Orthopedic Surgery Unit, Bethune Hospital, Bethune, France
| | | | | | - Eric Senneville
- Infectious Diseases Department, Gustave Dron Hospital, Tourcoing, France
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45
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Aragón-Sánchez J, Víquez-Molina G, López-Valverde ME, Lázaro-Martínez JL. Conservative surgery and postoperative antibiotics guided by bone biopsies for diabetic foot osteomyelitis. Comments on Nguyen S, et al. conservative surgical treatment for metatarsal osteomyelitis in diabetic foot: Experience of two French centres. Diabetes Metab Res Rev 2022; 38:e3566. [PMID: 35841192 DOI: 10.1002/dmrr.3566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Javier Aragón-Sánchez
- Department of Surgery, Diabetic Foot Unit, La Paloma Hospital, Las Palmas de Gran Canaria, Spain
| | | | | | - José Luis Lázaro-Martínez
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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46
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Uppal N, Hafeez A, Ansari HMN, Xavier F, Gupta AK. Post-traumatic tuberculosis of Zygoma - An uncommon presentation. J Stomatol Oral Maxillofac Surg 2022; 123:e604-e608. [PMID: 34933135 DOI: 10.1016/j.jormas.2021.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/03/2021] [Accepted: 12/15/2021] [Indexed: 06/14/2023]
Abstract
Tubercular osteomyelitis of mid-facial bones is extremely rare because of its immense vascular supply. Due to rare incidence, myriad presentation, and lack of specific symptoms, this condition presents a challenge in diagnosis and calls for acute clinical awareness. This article presents a case report of a 31-year-old martial artist with complaints of trauma to his right malar region since one month and a gradually increasing swelling below his right eye for 3 weeks without any discharge. A diagnosis of primary Tuberculosis of right zygomatic bone was made with the help of multiple diagnostic tools. The patient was treated with four drug anti-tubercular therapy and responded with complete recovery from disease.
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Affiliation(s)
- Nakul Uppal
- Department of Dentistry, All India Institute of Medical Sciences, Raipur, India
| | - Abdul Hafeez
- Department of Dentistry, All India Institute of Medical Sciences, Raipur, India.
| | | | - Frijo Xavier
- Department of Dentistry, All India Institute of Medical Sciences, Raipur, India
| | - Ashish Kumar Gupta
- Department of Pathology, All India Institute of Medical Sciences, Raipur, India
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47
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Kanjanaphan T, Tangcheewinsirikul S. Tuberculous Osteomyelitis: An Unusual Cause of Limping. J Clin Rheumatol 2022; 28:e690-e691. [PMID: 35662231 DOI: 10.1097/rhu.0000000000001870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | - Sirikarn Tangcheewinsirikul
- Rheumatology, Department of Pediatrics, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
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Manchanda K, Rodriguez-Materon S, Raudes A, SanGiovanni TP. Osteolytic Lesion of the First Metatarsal After Catfish Spine Injury: A Case Report. JBJS Case Connect 2022; 12:01709767-202209000-00037. [PMID: 36075017 DOI: 10.2106/jbjs.cc.22.00329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CASE A 17-year-old adolescent boy complained of plantar pain at the first metatarsal 2 months after a catfish spine injury. Imaging was consistent with a retained foreign body, and surrounding osteolysis was concerning for osteomyelitis. He underwent surgical debridement and was found to have inflammation and necrosis, apparently caused by catfish spine venom. CONCLUSION Although osteolytic lesions are commonly attributed to infection or tumor, in the situation of venomous injuries, osteolysis can be a sequela of the severe local inflammatory reaction due to the toxins. Debridement is vital to remove the offending agent and the local toxins from the venom.
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Affiliation(s)
- Kshitij Manchanda
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Solangel Rodriguez-Materon
- Orthopaedic Surgery, Foot and Ankle Department, Baptist Health Orthopaedic Care, Baptist Health South Florida, Coral Gables, Florida
| | - Adrianna Raudes
- Orthopaedic Surgery, Foot and Ankle Department, Baptist Health Orthopaedic Care, Baptist Health South Florida, Coral Gables, Florida
| | - Thomas Philip SanGiovanni
- Orthopaedic Surgery, Foot and Ankle Department, Baptist Health Orthopaedic Care, Baptist Health South Florida, Coral Gables, Florida
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Yu XJ, Lin YD, Hu P, Zee CS, Ji SJ, Zhou F. Imaging findings of vertebral osteomyelitis caused by nontuberculous mycobacterial organisms: Three case reports and literature review. Medicine (Baltimore) 2022; 101:e29395. [PMID: 35713445 PMCID: PMC9276087 DOI: 10.1097/md.0000000000029395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/13/2022] [Indexed: 11/30/2022] Open
Abstract
RATIONALE Prompt diagnosis of nontuberculous Mycobacterial (NTM) vertebral osteomyelitis is challenging, yet necessary to prevent serious morbidity and mortality. Here, we report 3 cases of vertebral osteomyelitis caused by NTM with imaging findings. PATIENT CONCERNS Case 1, a 58-year-old male patient, was admitted to our hospital because of the presence of a pulmonary mass for 6 months with cough and chest pain.Case 2, a 50-year-old male patient, had fever and cough for 3 years and was diagnosed with tuberculosis. Antituberculosis treatment was ineffective, accompanied by lymph node enlargement and osteosclerotic changes involving vertebral bodies.Case 3, a 66-year-old female patient, was admitted to our hospital with a mass on the top of her head for 1 month, which ruptured in the last 2 weeks. DIAGNOSES Case 1: Sputum culture revealed Mycobacterium (M.) avium.Case 2: The final culture results of the lymph node biopsy samples were M. intracellulare.Case 3: Culture results of the sputum and pus from the abscess were M. gordon.We found sclerosing lesions in the spine in all 3 NTM patients, which were easily misdiagnosed as metastatic tumors. In 2 cases, there was bone destruction in the ilium with limbic sclerosis, and there were abscesses near the ilium and in front of the sacrum in 1 case. INTERVENTIONS Case 1 was transferred to other specialist hospital.Case 3 received surgical treatment for cranial lesions and abscess drainage.Case 2 and case 3 received targeted treatment for nontuberculous mycobacteria in our hospital. OUTCOME The condition of case 1 was unknown.Recovery of case 2 was uneventful because of prolonged illness; however, inflammation gradually improved overall.Case 3 had no recurrence following surgical treatment. LESSONS In our 3 cases of NTM vertebral osteomyelitis, bone lesions were often misdiagnosed as bony metastases because of the presence of multiple sclerotic lesions. Diagnoses were challenging and delayed. It is important to consider osteomyelitis by NTM when disseminated osteosclerosis with or without osteolytic bone lesions is present in conjunction with continuous inflammatory symptoms and signs. Moreover, an open biopsy of the lesion should be performed for a definitive diagnosis.
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Affiliation(s)
- Xiao Jing Yu
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yu Dong Lin
- Department of Urology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Peng Hu
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Chi Shing Zee
- Department of Radiology, USC University Hospital, Los Angeles, CA
| | - Shu Juan Ji
- Department of Infectious Disease, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Fei Zhou
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Kc KM, Gnawali GP, Gc R. Frontal Bone Osteomyelitis in Adult. J Nepal Health Res Counc 2022; 20:257-259. [PMID: 35945886 DOI: 10.33314/jnhrc.v20i01.3854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 06/03/2022] [Indexed: 06/15/2023]
Abstract
Frontal bone osteomyelitis is a rare clinical disease which occurs as a result of frontal sinusitis, penetrating injury on head, post-operative complication after sinus surgery and hematogenous spread from distant site. Early diagnosis, appropriate surgical debridement and antibiotic are keys to prevent from life threatening intracranial complications. We report a 63 years old male patient with osteomyelitis of outer cortex of frontal bone. The wound was thoroughly debrided after computer tomography scan showed an osteolytic lesion on outer table of fontal bone and antibiotic was continued for 2 months until inflammatory markers become normal. Keywords: Frontal bone; Intracranial complications; osteomyelitis; pott's puffy tumour.
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Affiliation(s)
| | | | - Raju Gc
- Mercy City Hospital, Butwal, Rupandehi, Nepal
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