Long bone osteomyelitis

2002 ◽  
Vol 4 (5) ◽  
pp. 439-445 ◽  
Author(s):  
Luca Lazzarini ◽  
Fausto de Lalla ◽  
Jon T. Mader
Keyword(s):  
Long Bone ◽  
Long Bone Osteomyelitis

Can we predict outcome after treatment of long bone osteomyelitis?

2020 ◽  
Vol 102-B (11) ◽  
pp. 1587-1596
Author(s):  
Andrew J. Hotchen ◽  
Maria Dudareva ◽  
Ruth A. Corrigan ◽  
Jamie Y. Ferguson ◽  
Martin A. McNally
Keyword(s):  
Soft Tissues ◽  
Surgical Debridement ◽  
Bone Involvement ◽  
Long Bone ◽  
Time Points ◽  
Patient Reported ◽  
Host Status ◽  
One Year ◽  
Long Bone Osteomyelitis ◽  
Eq Vas

Aims This study presents patient-reported quality of life (QoL) over the first year following surgical debridement of long bone osteomyelitis. It assesses the bone involvement, antimicrobial options, coverage of soft tissues, and host status (BACH) classification as a prognostic tool and its ability to stratify cases into ‘uncomplicated’ or ‘complex’. Methods Patients with long-bone osteomyelitis were identified prospectively between June 2010 and October 2015. All patients underwent surgical debridement in a single-staged procedure at a specialist bone infection unit. Self-reported QoL was assessed prospectively using the three-level EuroQol five-dimension questionnaire (EQ-5D-3L) index score and visual analogue scale (EQ-VAS) at five postoperative time-points (baseline, 14 days, 42 days, 120 days, and 365 days). BACH classification was applied retrospectively by two clinicians blinded to outcome. Results In total, 71 patients with long-bone osteomyelitis were included. There was significant improvement from time of surgery to one year postoperatively in mean EQ-VAS (58.2 to 78.9; p < 0.001) and mean EQ-5D-3L index scores (0.284 to 0.740; p < 0.001). At one year following surgery, BACH ‘uncomplicated’ osteomyelitis was associated with better QoL compared to BACH ‘complex’ osteomyelitis (mean EQ-5D-3L 0.900 vs 0.685; p = 0.020; mean EQ-VAS 87.1 vs 73.6; p = 0.043). Patients with uncomplicated bone involvement (BACH type B1, cavitary) reported higher QoL at all time-points when compared to complex bone involvement (B2, segmental or B3, osteomyelitis involving a joint). Patients with good antimicrobial options (Ax or A1) gave higher outcome scores compared to patients with multidrug-resistant isolates (A2). The need for microvascular tissue transfer (C1 and C2) did not impact significantly on QoL. Patients without major comorbidities (uncomplicated, H1) reported higher QoL compared to those with significant disease (complex, H2). Conclusion Uncomplicated osteomyelitis, as defined by BACH, gave higher self-reported QoL when compared to complex cases. The bone involvement, antimicrobial options, and host status variables were able to stratify patients in terms of QoL. These data can be used to offer prognostic information to patients who are undergoing treatment for long bone osteomyelitis. Cite this article: Bone Joint J 2020;102-B(11):1587–1596.

Long-Bone Osteomyelitis Diagnosis and Management

1994 ◽  
Vol 29 (10) ◽  
pp. 71-86 ◽  
Author(s):  
Jon T. Mader ◽  
Jason Calhoun
Keyword(s):  
Long Bone ◽  
Diagnosis And Management ◽  
Long Bone Osteomyelitis

scholarly journals THE STUDY OF OUTCOME OF CHRONIC PYOGEN IC LONG BONE OSTEOMYELITIS TREATED BY ANTIBIOTIC IMPREGNATED BONE CEMENT BEADS AND NAILS

2015 ◽  
Vol 04 (10) ◽  
pp. 1622-1627 ◽  
Author(s):  
Soumyajit Mondal ◽  
Rajiv Roy ◽  
Tapas Kuma Ghosh ◽  
Rajeeb Banik ◽  
Gautam Bhattacharya
Keyword(s):  
Bone Cement ◽  
Long Bone ◽  
Long Bone Osteomyelitis

scholarly journals The BACH classification of long bone osteomyelitis

2019 ◽  
Vol 8 (10) ◽  
pp. 459-468 ◽  
Author(s):  
Andrew J. Hotchen ◽  
Maria Dudareva ◽  
Jamie Y. Ferguson ◽  
Parham Sendi ◽  
Martin A. McNally
Keyword(s):  
Classification Accuracy ◽  
Soft Tissues ◽  
Multidrug Resistant ◽  
Long Bone ◽  
Test Results ◽  
Clinical Imaging ◽  
The United Kingdom ◽  
Host Status ◽  
Long Bone Osteomyelitis

Objectives The aim of this study was to assess the clinical application of, and optimize the variables used in, the BACH classification of long-bone osteomyelitis. Methods A total of 30 clinicians from a variety of specialities classified 20 anonymized cases of long-bone osteomyelitis using BACH. Cases were derived from patients who presented to specialist centres in the United Kingdom between October 2016 and April 2017. Accuracy and Fleiss’ kappa (Fκ) were calculated for each variable. Bone involvement (B-variable) was assessed further by nine clinicians who classified ten additional cases of long bone osteomyelitis using a 3D clinical imaging package. Thresholds for defining multidrug-resistant (MDR) isolates were optimized using results from a further analysis of 253 long bone osteomyelitis cases. Results The B-variable had a classification accuracy of 77.0%, which improved to 95.7% when using a 3D clinical imaging package (p < 0.01). The A-variable demonstrated difficulty in the accuracy of classification for increasingly resistant isolates (A1 (non-resistant), 94.4%; A2 (MDR), 46.7%; A3 (extensively or pan-drug-resistant), 10.0%). Further analysis demonstrated that isolates with four or more resistant test results or less than 80% sensitive susceptibility test results had a 98.1% (95% confidence interval (CI) 96.6 to 99.6) and 98.8% (95% CI 98.1 to 100.0) correlation with MDR status, respectively. The coverage of the soft tissues (C-variable) and the host status (H-variable) both had a substantial agreement between users and a classification accuracy of 92.5% and 91.2%, respectively. Conclusions The BACH classification system can be applied accurately by users with a variety of clinical backgrounds. Accuracy of B-classification was improved using 3D imaging. The use of the A-variable has been optimized based on susceptibility testing results. Cite this article: A. J. Hotchen, M. Dudareva, J. Y. Ferguson, P. Sendi, M. A. McNally. The BACH classification of long bone osteomyelitis. Bone Joint Res 2019;8:459–468. DOI: 10.1302/2046-3758.810.BJR-2019-0050.R1

Can we predict outcome after treatment of long bone osteomyelitis?

2020 ◽  
pp. 1-10
Author(s):  
Andrew J. Hotchen ◽  
Maria Dudareva ◽  
Ruth A. Corrigan ◽  
Jamie Y. Ferguson ◽  
Martin A. McNally
Keyword(s):  
Soft Tissues ◽  
Surgical Debridement ◽  
Bone Involvement ◽  
Long Bone ◽  
Time Points ◽  
Patient Reported ◽  
Host Status ◽  
One Year ◽  
Long Bone Osteomyelitis ◽  
Eq Vas

Aims This study presents patient-reported quality of life (QoL) over the first year following surgical debridement of long bone osteomyelitis. It assesses the bone involvement, antimicrobial options, coverage of soft tissues, and host status (BACH) classification as a prognostic tool and its ability to stratify cases into ‘uncomplicated’ or ‘complex’. Methods Patients with long-bone osteomyelitis were identified prospectively between June 2010 and October 2015. All patients underwent surgical debridement in a single-staged procedure at a specialist bone infection unit. Self-reported QoL was assessed prospectively using the three-level EuroQol five-dimension questionnaire (EQ-5D-3L) index score and visual analogue scale (EQ-VAS) at five postoperative time-points (baseline, 14 days, 42 days, 120 days, and 365 days). BACH classification was applied retrospectively by two clinicians blinded to outcome. Results In total, 71 patients with long-bone osteomyelitis were included. There was significant improvement from time of surgery to one year postoperatively in mean EQ-VAS (58.2 to 78.9; p < 0.001) and mean EQ-5D-3L index scores (0.284 to 0.740; p < 0.001). At one year following surgery, BACH ‘uncomplicated’ osteomyelitis was associated with better QoL compared to BACH ‘complex’ osteomyelitis (mean EQ-5D-3L 0.900 vs 0.685; p = 0.020; mean EQ-VAS 87.1 vs 73.6; p = 0.043). Patients with uncomplicated bone involvement (BACH type B1, cavitary) reported higher QoL at all time-points when compared to complex bone involvement (B2, segmental or B3, osteomyelitis involving a joint). Patients with good antimicrobial options (Ax or A1) gave higher outcome scores compared to patients with multidrug-resistant isolates (A2). The need for microvascular tissue transfer (C1 and C2) did not impact significantly on QoL. Patients without major comorbidities (uncomplicated, H1) reported higher QoL compared to those with significant disease (complex, H2). Conclusion Uncomplicated osteomyelitis, as defined by BACH, gave higher self-reported QoL when compared to complex cases. The bone involvement, antimicrobial options, and host status variables were able to stratify patients in terms of QoL. These data can be used to offer prognostic information to patients who are undergoing treatment for long bone osteomyelitis.

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