Risk factors associated with infection recurrence of posttraumatic osteomyelitis treated with Ilizarov bone transport technique—a retrospective study of 149 cases

Yalikun, Ainizier; Yushan, Maimaiaili; Li, Wenqiang; Abulaiti, Alimujiang; Yusufu, Aihemaitijiang

doi:10.1186/s12891-021-04430-2

Cited by 16 publications

(13 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition, chronicity of infection is a known risk factor for failure of treatment of osteomyelitis. 25 This association was also found in this study, with increasing time from fracture fixation to treatment of osteomyelitis demonstrated to be an independent risk factor for failure of treatment of osteomyelitis. This difficulty in treating infections with larger delays in diagnosis is believed to be due to biofilm creation and decreased antibiotic efficacy.…”

Section: Discussionsupporting

confidence: 83%

Risk Factors and Characteristics of Recalcitrant Osteomyelitis After Initial Surgical and Antibiotic Treatment

Shah

Kanhere

Dowell

et al. 2023

Journal of Orthopaedic Trauma

View full text Add to dashboard Cite

Objectives: To evaluate the injury, patient, and microbiological characteristics that place patients at risk for recalcitrant fracture–related infection and osteomyelitis despite appropriate initial treatment. Design: Retrospective chart review. Setting: Three level I trauma centers. Patients and Participants: Two hundred and fifty-seven patients undergoing surgical debridement and antibiotic therapy for osteomyelitis from 2003 to 2019. Main Outcome Measurements: Patients were categorized as having undergone serial bone debridement if they had 2 separate procedures a minimum of 6 weeks apart with a full course of appropriate antibiotics in between. Patient records were reviewed for age, injury location, body mass index, smoking status, comorbidities, and culture results including the presence of multidrug-resistant organisms and culture-negative osteomyelitis. Results: A total of 257 patients were identified; 49% (n = 125) had a successful single course of treatment, and 51% (n = 132) required repeat debridement for recalcitrant osteomyelitis. At the index treatment for osteomyelitis, the most common organisms in both groups were methicillin-resistant (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA). There was no significant difference in incidence of polymicrobial infection between the 2 groups (25% vs. 20%, P = 0.49). The most common organisms cultured at the time of repeat saucerization remained MRSA and MSSA; however, the same organism was cultured from both the index and repeat procedures in only 28% (n = 37) of cases. Diabetic patients, intravenous drug use status, delay to diagnosis, and open fractures of the lower leg are independent risk factors for failure of initial treatment of posttraumatic osteomyelitis. Conclusions: Successful eradication of fracture-related infection and posttraumatic osteomyelitis is difficult and fails 51% of the time despite standard surgical and antimicrobial therapy. Although MRSA and MSSA remain the most common organisms cultured, patients who fail initial treatment for osteomyelitis often do not culture the same organisms as those obtained at the index procedure. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

show abstract

Section: Discussionsupporting

confidence: 83%

Risk Factors and Characteristics of Recalcitrant Osteomyelitis After Initial Surgical and Antibiotic Treatment

Shah

Kanhere

Dowell

et al. 2023

Journal of Orthopaedic Trauma

View full text Add to dashboard Cite

show abstract

“…On the other hand, a recurrence rate of 0% to 12.26% has been reported for osteomyelitis patients treated with other, more advanced techniques. 3,6,[19][20][21] Yalikun et al 19 reported 149 cases of tibial osteomyelitis treated with the bone transport technique, and an 11.4% recurrence rate was achieved with a mean follow-up of 37.5 months. Similarly, Wang et al 21 recently showed that the recurrence rate of osteomyelitis (n = 424) was 12.26%.…”

Section: Discussionmentioning

confidence: 99%

Incidence and risk factors of recurrence in limb osteomyelitis patients after antibiotic‐loaded cement spacer for definitive bone defect treatment

Wu,

Sun,

Wang

et al. 2023

Bone Joint Res

View full text Add to dashboard Cite

AimsThis study was designed to characterize the recurrence incidence and risk factors of antibiotic-loaded cement spacer (ALCS) for definitive bone defect treatment in limb osteomyelitis.MethodsWe included adult patients with limb osteomyelitis who received debridement and ALCS insertion into the bone defect as definitive management between 2013 and 2020 in our clinical centre. The follow-up time was at least two years. Data on patients’ demographics, clinical characteristics, and infection recurrence were retrospectively collected and analyzed.ResultsIn total, 314 patients with a mean age of 52.1 years (SD 12.1) were enrolled. After a mean of 50 months’ (24 to 96) follow-up, 53 (16.9%) patients had infection recurrence including 32 tibiae, ten femora, ten calcanea, and one humerus. Of all patients with recurrence, 30 (9.6%) occurred within one year and 39 (12.4%) within two years. Among them, 41 patients needed reoperation, five received antibiotics treatment only, and seven ultimately required amputations. Following multivariable analysis, we found that patients infected with Gram-negative bacilli were more likely to have a recurrence (odds ratio (OR) 2.38, 95% confidence interval (CI) 1.20 to 6.94; p = 0.046) compared to Staphylococcus aureus; segmental bone defects (OR 5.25, 95% CI 1.80 to 15.26; p = 0.002) and smoking (OR 3.00, 95% CI 1.39 to 6.50; p = 0.005) were also independent risk factors for recurrence after treatment.ConclusionPermanent ALCS might be an alternative strategy for definitive bone defect management in selected osteomyelitis cases. However, the overall high recurrence found suggests that it should be cautiously treated. Additionally, segmental defects, Gram-negative infections, and smoking were associated with an increased risk of infection recurrence.Cite this article: Bone Joint Res 2023;12(8):467–475.

show abstract

“…Previously reported risk factors about infection recurrence in cases of infected nonunion treated by bone transport technique may include a number of previous operations and Pseudomonas aeruginosa infection. 6 Infection recurrence was significantly lower in the BTM group than in the BT group ( P value 0.04), although the number of previous operations were significantly higher in the BTM group than in the BT group. This could be explained by the higher infection rates with P. aeruginosa (33.3%) in the BT group.…”

Section: Discussionmentioning

confidence: 81%

“…1,2 The most widely used surgical techniques in treatment of infected bone defects includes Masquelet (induced membrane) 3 and conventional Ilizarov bone transport. 4,5 However, bone transport has been associated with several complications including recurrence of infection (10%-20%), 6 docking site delayed union (13.48%), or nonunion (17%-40%), which is a significant concern in conventional bone transport which increases the external fixation time and necessitates the need for docking site bone graft. [7][8][9][10][11] The Masquelet technique 3 has provided numerous biological, mechanical, and therapeutic benefits in treatment of infected bone defects through formation of membrane around the cement spacer.…”

Section: Introductionmentioning

confidence: 99%

Bone Transport Through Induced Membrane Versus Conventional Bone Transport in Management of Infected Long-Bone Defects of Lower Limbs: A Randomized Controlled Trial

Thakeb

Kozman

ElGebeily

et al. 2023

Journal of Orthopaedic Trauma

View full text Add to dashboard Cite

Objectives: To compare bone transport through induced membrane (BTM) and conventional bone transport (BT) regarding docking site union and infection recurrence in the management of infected long-bone defects. Design: Prospective, randomized, controlled study. Setting: Tertiary-level center. Participants: Thirty patients with infected nonunited long-bone fractures of lower limbs were included. Intervention: Fifteen patients were treated by BTM in group A, and 15 patients were treated by BT in group B. Outcome Measurements: The outcome measures were external fixation time, external fixation index, and docking time. Bone and functional outcomes were evaluated by the Association for the Study and Application of the Method of Ilizarov scoring system. Postoperative complications were evaluated according to the Paley classification. Results: The mean docking time was significantly lower in the BTM group than in the BT group (3.6 ± 0.82 months vs. 4.8 ± 0.86 months, respectively; P value 0.001). Docking site nonunion and infection recurrence were significantly lower in the BTM group than in the BT group (0% vs. 40%; P value 0.02 and 0% vs. 33.3%; P value 0.04, respectively), with no significant difference in the external fixation index (P value 0.08). Conclusions: This is the first prospective, randomized, controlled study comparing BTM and BT techniques, showing that BTM had significantly faster docking site union, lower incidence of postoperative complications including docking site nonunion and infection recurrence rates, and lower number of additional procedures needed at the expense of 2-staged operation in comparison with BT. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

show abstract

Risk factors associated with infection recurrence of posttraumatic osteomyelitis treated with Ilizarov bone transport technique—a retrospective study of 149 cases

Cited by 16 publications

References 28 publications

Risk Factors and Characteristics of Recalcitrant Osteomyelitis After Initial Surgical and Antibiotic Treatment

Risk Factors and Characteristics of Recalcitrant Osteomyelitis After Initial Surgical and Antibiotic Treatment

Incidence and risk factors of recurrence in limb osteomyelitis patients after antibiotic‐loaded cement spacer for definitive bone defect treatment

Bone Transport Through Induced Membrane Versus Conventional Bone Transport in Management of Infected Long-Bone Defects of Lower Limbs: A Randomized Controlled Trial

Contact Info

Product

Resources

About