Single-stage debridement with implantation of antibiotic-loaded calcium sulphate in 34 cases of localized calcaneal osteomyelitis

Jiang, Nan; Zhao, Xingqi; Wang, Lei; Lin, Qing; Hu, Yanjun; Yu, Bin

doi:10.1080/17453674.2020.1745423

Cited by 28 publications

(22 citation statements)

References 25 publications

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“…21 More recently, the management of osteomyelitis in dedicated multidisciplinary bone infection units have been shown to produce better results illustrating the highly specialised nature of this work. [22][23][24] Similar results were seen in our series with successful eradication of infection in all Cierny and Mader anatomical types in 94% of cases using a single-stage approach and a tailored dead space management strategy. Apart from obviating the need for second surgery, single-stage management of chronic osteomyelitis is also more cost-effective and has been shown to offer similar if not better clinical outcomes in resolution rates of infection.…”

Section: Discussionsupporting

confidence: 81%

The management of chronic osteomyelitis in adults: outcomes of an integrated approach

et al. 2021

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BACKGROUND: This study presents the outcomes of the management of chronic osteomyelitis of the appendicular skeleton according to an integrated approach at a dedicated bone infection unit in South Africa. METHODS: A retrospective record review identified 80 patients who were treated between January 2016 and December 2018. RESULTS: Sixty patients (75%) presented with fracture-related infections, 17 patients (21%) developed chronic osteomyelitis following haematogenous spread and three (4%) from contiguous wounds. According to the Cierny and Mader classification, 21 patients presented with anatomical type I, 14 with type II, 24 with type III and 21 with type IV chronic osteomyelitis. Positive microbial cultures were obtained in 63 (79%) cases. Follow-up for the cohort ranged from 1 to 29 months, with a mean follow-up of 10.4 months. The overall complication rate for the cohort was 6% and included sterile drainage from the surgical site after management with bioactive glass (S53P4), refracture after hardware removal, and development of non-union. Five patients experienced recurrence after the initial procedure to eradicate infection, resulting in an overall resolution rate of 94%. CONCLUSION: Using single-stage surgeries and tailored dead space management strategies according to a comprehensive integrated approach developed in South Africa, results comparable to international literature can be achieved. Level of evidence: Level 4. Keywords: chronic osteomyelitis, dead space management, bioactive glass, Lautenbach technique

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Section: Discussionsupporting

confidence: 81%

The management of chronic osteomyelitis in adults: outcomes of an integrated approach

et al. 2021

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“…In our study, the infection eradication rate was 94.29%, while the recurrence rate was low. Jiang et al reported that the incidence of aseptic wound exudation in the treatment of localized calcaneal osteomyelitis with calcium sulfate alone was 32.35% (11/34 patients) [17]. In comparison, our incidence of aseptic wound exudation was 2.86% (1/35 patients), which was lower compared to previous that ranged from 6.00% (6/100) [18] to 33.33% (7/21) [19].…”

Section: Discussioncontrasting

confidence: 70%

Gastrocnemius Muscle Flap with Vancomycin/gentamicin-calcium Sulphate and Autogenous Iliac Bone Graft for the Phase Ⅰ Treatment of Localized Osteomyelitis after Tibial Plateau Fracture Surgery

Ruan

Guo

et al. 2021

Preprint

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Purpose: To investigate the clinical effect of gastrocnemius muscle flaps combined with vancomycin /gentamicin-calcium sulphate combined and autologous iliac bone graft in the phase Ⅰ treatment of traumatic focal osteomyelitis (Cierny-Mader type III) after tibial plateau fracture surgery.Methods: From July 2009 to January 2018, 35 patients with localized osteomyelitis (Cierny-Mader type III) who met the inclusion criteria were followed up and treated. All patients were infected after undergoing internal fracture fixation surgery. Among them, 18 cases were plate-exposed, 14 cases were due to sinus tracts, two were due to skin necrosis, and one was bone-exposed. We treated patients with several measures. All cases were then followed up. The follow-up indicators included: Hospital for Special Surgery knee scores (HSS), the time of laying drainage pipe, bone healing time, infection control rate, and the incidence of nonunion and other complications.Results: All patients were followed up for 24-60 months. None of them underwent amputation. For repairing soft tissue defects, 17 cases were covered with a muscle flap using the medial head of gastrocnemius alone, 15 cases were treated with the lateral head of gastrocnemius muscle, and three cases were covered with the combination of the two heads. Compared to the preoperative score, we found at that the average HSS improved at the one-year and two-year follow up (54 vs. 86 vs. 87).Conclusion: Using a gastrocnemius muscle flap combined with vancomycin/gentamicin-calcium sulfate and autogenous iliac bone was an effective method for the phase Ⅰ treatment of osteomyelitis (Cierny-Mader type III) after tibial plateau fracture surgery. In the primary treatment of focal traumatic osteomyelitis, it can decrease the treatment time, number of surgeries, pain of patients, time of bone healing, postoperative exudation, and infection recurrence rate and increase the healing bone’s strength.

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“…All the included 16 studies were published between 2002 and 2021 [ 15 , 23 , 25 , 29 – 41 ]. Of the included studies, three consecutive case–control studies were retrospective in nature; the remaining were case series, including 2 prospective studies and 11 retrospective studies.…”

Section: Resultsmentioning

confidence: 99%

“…Due to the inconsistency on the properties of CS materials and surgical procedures, aseptic wound leakage and re-fracture have gradually got increasing attention, which may become the causes of reoperation or infection recurrence [ 22 ]. Jiang et al [ 23 ] found that the incidence of aseptic wound leakage after antibiotic-loaded CS implantation treated COM was very high. Therefore, in this review, we comprehensively evaluate the efficacy and complications of CS loaded with multiple antibiotics in the treatment of COM (including delayed healing, reoperation, refracture and aseptic wound leakage).…”

Section: Introductionmentioning

confidence: 99%

Antibiotic-loaded calcium sulfate in clinical treatment of chronic osteomyelitis: a systematic review and meta-analysis

Shi

Wu²,

et al. 2022

J Orthop Surg Res

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Background Present work was aimed to gather accessible evidence on the eradication rates and related postoperative complications of antibiotic-loaded calcium sulfate (CS) as an implant in the treatment of chronic osteomyelitis (COM). Methods Databases including PubMed, EMBASE, Medline, Ovid and Cochrane library were searched from their dates of initiation until November 2021. Two independent authors scrutinized the relevant studies based on the effectiveness of radical debridement combined with antibiotic-loaded CS for COM; data extraction and quality assessment of the Methodological Index for Non-Randomized Studies (MINORS) criteria were also performed by the authors. In addition, clinical efficacy mainly depended on the evaluation of eradication rates and complications, and all the extracted data are pooled and analyzed by STATA 16.0. Results A total of 16 studies with 917 patients (920 locations) were recruited, with an overall eradication rate of 92%. Moreover, the overall reoperation rate, overall refracture rate, overall delayed wound healing rate, and the rate of aseptic wound leakage were 9.0%, 2.0%, 20.0%, and 12.0%, respectively. Moreover, the choice of tobramycin-loaded CS or vancomycin combined with gentamicin-loaded CS did not affect the eradication rate, and the incidence of postoperative complications in COM patients (all $$P>0.05$$ P > 0.05 ). The general quality of the included studies was fair. Conclusions Our meta-analysis indicated that the overall eradication rate of COM treated with antibiotic-loaded CS was 92%. Delayed healing is the most common postoperative complication. The choice of tobramycin-loaded CS or vancomycin combined with gentamicin-loaded CS did not affect the eradication rate and the incidence of postoperative complications in COM patients.

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Single-stage debridement with implantation of antibiotic-loaded calcium sulphate in 34 cases of localized calcaneal osteomyelitis

Cited by 28 publications

References 25 publications

The management of chronic osteomyelitis in adults: outcomes of an integrated approach

The management of chronic osteomyelitis in adults: outcomes of an integrated approach

Gastrocnemius Muscle Flap with Vancomycin/gentamicin-calcium Sulphate and Autogenous Iliac Bone Graft for the Phase Ⅰ Treatment of Localized Osteomyelitis after Tibial Plateau Fracture Surgery

Antibiotic-loaded calcium sulfate in clinical treatment of chronic osteomyelitis: a systematic review and meta-analysis

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