Current Concepts in Posttraumatic Osteomyelitis: A Diagnostic Challenge with New Imaging Options

Cierny-Mader (C-M) Type III osteomyelitis is defined as a localised lesion with both medullary and cortical involvement that is stable mechanically after debridement. The treatment of C-M Type III osteomyelitisis is difficult and requires a precise protocol to achieve a disease-free longterm follow-up. We report here the results of our study on 26 patients (19 men and 7 women; average age: 34.7 years) with C-M Type III osteomylelitis who were treated with radical debridement, irrigation, vancomycin-impregnated custom-made beads and culture-specific systemic antibiotics. Those patients with metaphyseal involvement were treated with deroofing of the cortex and debridement by means of a "trough" (16 patients); those with diaphyseal involvement were treated with both intramedullary reaming and debridement from a trough (ten patients). Antibiotic cement rods were used as an additional therapy in five patients with diaphyseal involvement. Recurrence developed in three patients and was attributed to inadequate debridement; all three patients were treated again in the same manner with success. The mean follow-up is currently 3.6 years (range: 2-6 years). All of the patients have normal clinical, radiographic and laboratory parameters, and all are ambulatory and have returned to their pretreatment level of activity or better. We conclude that C-M Type III chronic osteomyelitis can be safely treated with this protocol.Résumé L'ostéomyélite de type III Cierny-Mader (C-M) peut se définir comme une localisation de lésions localisées à la fois sur la médullaire et la corticale et qui reste stable sur le plan mécanique après mise à plat. Son traitement est difficile et demande un protocole précis. Pour cette étude, nous avons suivi les résultats de 26 patients (19 hommes et 7 femmes) dont l'âge moyen était de 34.7 ans, traités par mise à plat, irrigation, et billes de vancomycine. Dans les lésions métaphysaires, la mise à plat est réalisée à travers une fenêtre (16 patients), dans les lésions diaphysaires on réalise à la fois un alésage des lésions et une mise à plat par la fenêtre (10 patients). En addition aux billes de vancomycine, un ciment aux antibiotiques a été utilisé chez 5 patients avec lésions diaphysaires. Trois patients ont présenté une récidive secondaire à une mise à plat insuffisante. Tous ces patients ont été à nouveau traités de la même manière et avec succès. Le suivi moyen a été de 3.6 ans (2 à 6 ans) et aucun patient n'a présenté d'anomalie post-opératoire des différents paramètres clinique, radiographique et biologique. Les patients peuvent marcher et ont retrouvé leur activité d'avant le traitement. L'ostéomyé-lite chronique de type III de CM peut être traitée avec succès selon ce protocole.

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“…1, 2). The anatomical pattern of involvement, skip lesions and soft tissue and medullary extension were revealed [9].…”

Section: Methodsmentioning

confidence: 99%

Cierny-Mader Type III chronic osteomyelitis: the results of patients treated with debridement, irrigation, vancomycin beads and systemic antibiotics

Kınık

Karaduman

2007

International Orthopaedics (SICO

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“…Gadolinium-enhanced imaging is helpful in the discrimination of fibrovascular scars from inflammatory active foci. 13,14 Edema pattern on T2-weighted sequences and contrast media enhancement after intravenous gadolinium due to hyperemia and increased endothelial permeability were found as a typical MRI morphology in donors 4 weeks after harvest (group A, Figure 1) and corresponds to the suggested inflammatory and regenerative changes ('acute injury pattern').…”

Section: Discussionmentioning

confidence: 94%

Pelvic magnetic resonance imaging after bone marrow harvest – a retrospective study in 50 unrelated marrow donors

Kroschinsky

Kittner

Mauersberger

et al. 2005

Bone Marrow Transplant

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Summary:A total of 50 unrelated marrow donors were examined by pelvic magnetic resonance imaging (MRI) to investigate the morphological sequelae of bone marrow harvesting (BMH). Signal increase in T2-weighted sequences and contrast media enhancement in T1 sequences at the operative sites were found as typical MRI morphology 4 weeks after harvest (group A, n ¼ 16), corresponding to edema, hyperemia and proliferative activity. Although tissue repair was completed in the majority of donors 1 year after BMH, about 36% of donors in group B (n ¼ 16) had abnormal findings. These included a persistence of the 'acute injury' signal pattern (2/16, 12%), and signal alterations due to fatty marrow conversion (4/16, 24%). The proportion of MRI abnormalities increased to over 70% in two-time donors (group C, n ¼ 11), which might indicate a cumulation of tissue damage after repetitive harvests. If donors had experienced prolonged discomfort after BMH (group D, n ¼ 7), MRI revealed pathological signals in 86%. In conclusion, the MRI morphology reflects the pathophysiological reactions after BMH, including inflammation and tissue repair. A further prospective evaluation in a larger number of donors is necessary to confirm these results and to identify the factors which influence the extent and duration of tissue damage. Bone Marrow Transplantation (2005) 35, 667-673.

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“…Posttraumatic osteomyelitis may occur as a direct result of bony injury after trauma or arise as a nosocomial infection after the treatment of trauma [1]. The inflammatory process can be limited to a single portion of the bone or can involve several regions: marrow, cortex, periosteum, or the surrounding soft tissue [2].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Cranial Osteomyelitis in an Otherwise Healthy Ten-Year-Old Male

Arnold¹,

Govindan

Anderson³

2009

Pediatr Neurosurg

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Frontal bone osteomyelitis is a relatively rare entity, particularly in the otherwise healthy pediatric population. Most cases trace their origins to either previous frontal sinusitis or trauma. In children, three origins for cranial osteomyelitis appear to dominate: Pott’s puffy tumor, skull base osteomyelitis secondary to ear infection, or post-surgical complications. However, on extremely rare occasions, risk factors or etiology may not be ascertained. We present a case of spontaneous frontal bone osteomyelitis in a ten-year-old African-American male with no previous history of cranial surgeries, frontal sinusitis, or major trauma.

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Current Concepts in Posttraumatic Osteomyelitis: A Diagnostic Challenge with New Imaging Options

Cited by 82 publications

References 48 publications

Cierny-Mader Type III chronic osteomyelitis: the results of patients treated with debridement, irrigation, vancomycin beads and systemic antibiotics

Cierny-Mader Type III chronic osteomyelitis: the results of patients treated with debridement, irrigation, vancomycin beads and systemic antibiotics

Pelvic magnetic resonance imaging after bone marrow harvest – a retrospective study in 50 unrelated marrow donors

Spontaneous Cranial Osteomyelitis in an Otherwise Healthy Ten-Year-Old Male

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