Treatment of Long Bone Osteomyelitis With a Mechanically Stable Intramedullar Antibiotic Dispenser: Nineteen Consecutive Cases With a Minimum of 12 Months Follow-Up

Background: The Ilizarov external fixation technique has been widely used for the treatment of long-bone infected non-unions. After surgical infected bone resection, to allow filling of the remaining bone gap, biomaterials with antibacterial properties could be used. The aim of this study was to report outcomes of infected tibial non-unions treated using the Ilizarov technique and antibacterial bioactive glass. Methods: Between April 2009 and December 2014, 26 patients with infected tibial non-unions were treated with the Ilizarov technique and possible use of the bioactive glass, S53P4. The Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria, a clinical and radiographic evaluating tool, was used for assessing the sample. Results: The average age at the start of treatment was 51 years. The mean follow-up time was 113 weeks. According to the ASAMI Functional Scoring System, 10 excellent (38.5%) cases and 12 good (46.1%) values were recorded. According to the ASAMI Radiological System, they were excellent in 16 (61.5%) cases and good in nine (34.6%). Conclusions: Treatment of infected tibial non-unions using the Ilizarov technique was effective in bone segment regeneration. To fill the remaining bone gap, additional bioactive glass S53P4 could be used, allowing a decrease in re-interventions and minimizing complications.

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Adult Long Bone Osteomyelitis

Musculoskeletal Infections ◽

10.3109/9780203911280-9 ◽

2003 ◽

pp. 166-199

Keyword(s):

Long Bone ◽

Long Bone Osteomyelitis

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Outcome of tibial diaphyseal fracture fixation with Surgical Implant Generation Network (SIGN) nail

Journal of Patan Academy of Health Sciences ◽

10.3126/jpahs.v6i2.27206 ◽

2019 ◽

Vol 6 (2) ◽

pp. 5-11

Author(s):

Balakrishnan M. Acharya ◽

Rojan Tamrakar ◽

Pramod Devkota ◽

Abhishek K. Thakur ◽

Suman K. Shrestha

Keyword(s):

Road Traffic ◽

Bone Fractures ◽

Long Bone ◽

Fracture Union ◽

Surgical Implant ◽

Non Union ◽

Generation Network ◽

Diaphyseal Fractures ◽

The Mean

Introductions: Fractures of diaphyseal region of the tibial bone are amongst the most commonly seen extremity injuries in the developing countries. The surgical implant generation network (SIGN) intramedullary (IM) nail was designed for the treatment of long bone fractures in the developing nations. Methods: From March 2008 to December 2018, a total of 104 patients with 104 tibial diaphyseal fractures were treated with SIGN IM nail. The follow-up visits were arranged at 6, 12, 24 weeks and one-year post operatively. During follow-up visits, the signs of fracture union clinically as well as radiologically and the presence of complications any were recorded and analyzed. Results: The mean age of the patients was 32.81 (16 – 65) years, male 74 (71.2%) and female 30 (28.8%). Majority of the patients 70 (67.3%) had fractures after road traffic accidents. The mean time of surgery was 13.58 (1 – 463) days. Six (5.8%) patients had delayed union and no non-union was detected. We had 10 cases (9.6%) of mal-alignment but were on acceptable range. Conclusions: In the developing country like Nepal, the SIGN nail is an effective surgical implant for the management of the tibial diaphyseal fractures with good result of fracture union and low rates of nonunion, mal-alignment and manageable complications.

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A Case Report of Giant Cell Tumor of Proximal Fibula in Children

Nepalese Journal of Cancer ◽

10.3126/njc.v4i1.31783 ◽

2020 ◽

Vol 4 (1) ◽

pp. 64-67

Author(s):

Sushil Adhikari ◽

Arun Sigdel ◽

Rajesh Kumar Sah ◽

Luna Devkota

Keyword(s):

Giant Cell Tumor ◽

Giant Cell ◽

Cell Tumor ◽

Long Bone ◽

Lytic Lesion ◽

Radiographic Appearance ◽

X Ray ◽

Proximal Fibula ◽

Aggressive Tumor

Giant cell tumour (GCT) is histopathologically benign tumor of long bone particularly in distal femur and the proximal tibia. It commonly occurs in adults of age 20-40 years but rare in children. GCT is considered to be locally aggressive tumor and tendency of recurrence is higher even after surgery. The clinical features are nonspecific, the principle symptoms are pain, swelling and limiting adjacent joint movements. Diagnosis is based on the radiographic appearance and histopathological findings .In our case X-ray showed ill defined lytic lesion on proximal fibula with cortical thinning and MRI finding revealed expansile lyticlesion in meta-epiphysis of right fibula 16×16×28mm adjacent to growth plate with fluid level. The sclerotic rim appears hypo intense on T1 & hyper intense on T2. Core needle biopsy showed giant cell tumor on proximal fibula. Considering the risk of recurrence wide local excision was done. Management of GCT of proximal fibula in young patient is critical for preventing recurrence and enhancing functional outcomes by saving adjacent anatomical structure. No evidence of local recurrence and metastasis was found in 24 months of follow up.

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Intramedullary reaming modality for management of postoperative long bone infection: a prospective randomized controlled trial in 44 patients

Patient Safety in Surgery ◽

10.1186/s13037-019-0215-3 ◽

2019 ◽

Vol 13 (1) ◽

Cited By ~ 1

Author(s):

Carlos Augusto Finelli ◽

Fernando Baldy dos Reis ◽

Helio Alvachian Fernandes ◽

Adriana Dell’Aquila ◽

Rogério Carvalho ◽

...

Keyword(s):

Intramedullary Nail ◽

Controlled Trial ◽

Long Bone ◽

Cement Spacer ◽

Coagulase Negative Staphylococci ◽

Radiological Criteria ◽

Intramedullary Reaming ◽

Prospective Randomized Controlled Trial ◽

Retrograde Nail

Abstract Background Studies addressing the management of intramedullary infection are mainly retrospective and with a limited number of cases. Reaming can be performed using either conventional reaming or using the reamer/irrigator/aspirator (RIA) system. Until now there have been no comparative prospective studies between these two methods. We aimed to compare the efficacy of RIA with conventional reaming followed by insertion of antibiotic-loaded cement, for the treatment of intramedullary nail infection of long bones. We assessed the rate of remission between groups after two-year follow-up and identified microorganisms using tissue cultures and sonication of explanted intramedullary nail (IMN). Methods A noninferiority, randomized clinical trial was carried out between August 2013 and August 2015 involving 44 patients of whom a locked IMN implant of the femur and/or tibia was retrieved and who all met the clinical and radiological criteria for IMN-associated osteomyelitis. Patients were randomized into two groups: RIA alone versus conventional reaming followed by antibiotic-loaded cement insertion. Both groups also underwent six-weeks of antibiotic treatment according to the results of the antibiogram. Patients were evaluated after 1, 3, 6, 12 and 24 months for radiological and clinical follow-up. Results After 24 months, the rate of infection remission was similar between the two groups, 87% in the RIA group and 95.5% in the conventional reaming group (p = 0.60). Among four patients who had recurrence of infection, the time to reappearance of symptoms varied from 20 days to twenty-two months. Staphylococcus aureus and coagulase-negative Staphylococci were isolated in 23 (40.4%) and 13 (22.9%) patients, respectively. Interestingly, we identified 20% (9/45) of polymicrobial infection. Conclusion This study concludes that the RIA system alone, is noninferior to conventional reaming followed by antibiotic cement spacer in the treatment of IMN infection. However, RIA shows greater efficacy in the collection of infected medullary bone tissue, mainly in cases of infected retrograde nail of the femur. Trial registration ISRCTN82233198. Retroactively registered on July 29, 2019.

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Outcome of nonunion fractures in dogs treated with fixation, compression resistant matrix, and recombinant human bone morphogenetic protein-2

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-16-05-0082 ◽

2017 ◽

Vol 30 (02) ◽

pp. 153-159 ◽

Cited By ~ 3

Author(s):

Anna Massie ◽

Mark Fuller ◽

Frank Verstraete ◽

Boaz Arzi ◽

Amy Kapatkin

Keyword(s):

Bone Morphogenetic Protein ◽

Bone Fractures ◽

Perioperative Complications ◽

Human Bone ◽

Bone Morphogenetic Protein 2 ◽

Long Bone ◽

Morphogenetic Protein ◽

Human Bone Morphogenetic Protein ◽

Recombinant Human Bone

SummaryObjectives: To report the use of compression resistant matrix (CRM) infused with recombinant human bone morphogenetic protein (rhBMP-2) prospectively in the healing of non union long-bone fractures in dogs.Methods: A longitudinal cohort of dogs that were presented with nonunion fractures were classified and treated with CRM soaked with rhBMP-2 and fracture fixation. They were followed with serial radiographs and evaluated for healing times and complications according to the time frame and definitions previously established for orthopaedic clinical cases.Results: Eleven nonunion fractures in nine dogs were included. Median healing time was 10 weeks (range: 7–20 weeks). Major perioperative complications due to bandage morbidity were encountered in two of 11 limbs and resolved. All other complications were minor. They occurred perioperatively in eight of 11 limbs. Minor follow-up complications included short-term in one of two limbs, mid-term in one of three, and long-term in four of five limbs. Nine limbs returned to full function and two limbs returned to acceptable function at the last follow-up.Clinical significance: Nonunion fractures given a poor prognosis via standard-of-care treatment were successfully repaired using CRM with rhBMP-2 accompanying fixation. These dogs, previously at high risk of failure, returned to full or acceptable function.

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Can we predict outcome after treatment of long bone osteomyelitis?

The Bone & Joint Journal ◽

10.1302/0301-620x.102b11.bjj-2020-0284.r1 ◽

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.

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