Single-stage treatment of chronic localized tibial osteomyelitis with local debridement and antibiotic-loaded calcium sulfate implantation: a retrospective study of 42 patients

Abstract

Background: Although various methods have been introduced, the management of chronic tibial osteomyelitis remains a challenge. This study aims to assess a combined treatment method, local debridement combined with antibiotic-loaded calcium sulfate implantation, for the management of the local (Cierny-Mader type III) tibial osteomyelitis. Methods: Forty-two patients (43 limbs) with type III tibial osteomyelitis, from January 2012 to December 2018, who received the treatment method mentioned above were included in the study. The infection remission rate, recurrence rate, complications rate, and bone healing rate were respectively analyzed. Results: With a mean follow-up of 42.8 months, 38 limbs (37 patients) (88.4%, 38/43) achieved infection remission without recurrence. Among those patients pain, limitation of movement, sinus tracts, topical redness, and swelling were generally eliminated. Only 4 patients felt slight pain after a long-distance walk, while another 6 patients showed minor but acceptable discomfort in affected limbs. Five patients (11.6%) suffered from osteomyelitis recurrence that required secondary surgical and medical treatment, but no amputation was necessary to eliminate the infection. Prolonged aseptic drainage was the most frequent complication that was observed in 13 patients (30.0%). They were successfully managed by appropriate wound caring in 10 patients and by surgical intervention, months later, in 3 patients. According to the final X-ray examination, bone losses caused by local debridement were generally repaired, though the shape of the tibia was not well-restored to its initial form in 17 limbs. No fracture was recorded during follow-up. Conclusion: Local debridement combined with antibiotic-loaded calcium sulfate implantation is effective and safe in a single-stage treatment of chronic Cierny-Mader III tibial osteomyelitis.

One-stage debridement and bone transport versus first-stage debridement and second-stage bone transport for the management of lower limb post-traumatic osteomyelitis

“…Post-traumatic osteomyelitis on the lower extremity is a kind of refractory disease for orthopedic surgeons and usually caused by an open fracture or inappropriate open reduction and internal fixation (ORIF). Once established, patients are prone to suffer from a variety of disastrous complications, which can significantly reduce the quality of life [ 1 ]. To date, the treatment of those types of infection remains challenging, as orthopedic surgeons need to take various factors into consideration, which at least include persistent and stubborn infection, poor soft tissue coverage, subsequent segmental bone defects, and potential limbs deformity [ [2] , [3] , [4] ].…”

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

“…The remaining locations of COM included humerus (21/597, 3.52%), radius (12/597, 2.01%), pelvis (7/597,1.17%), fibula (7/597, 1.17%), ankle (6/597, 1.01%), hip joint (5/597, 0.84%), ulna (5/597, 0.84%), knee (4/597, 0.67%), talus (3/597, 0.50%), clavicle, forefoot, and fourth metatarsal each account for one case (1/597, 0.17%). A several COM patients had two involved locations [ 33 , 37 ].…”

Intramedullary Canal Injection of Vancomycin- and Tobramycin-loaded Calcium Sulfate: A Novel Technique for the Treatment of Chronic Intramedullary Osteomyelitis

“…Previous studies using CS as the vehicle for local antibiotic delivery have used a single antibiotic. 6 , 11 , 22 , 27 Recently, Zhou et al 32 retrospectively studied 43 tibiae with CM type III COM managed by debridement and vancomycin/gentamicin-loaded CS implantation with a remission rate of 88.4% without recurrence for a mean follow-up of 42.8 months. 32 Zhang et al 33 also presented a case series of 19 patients managed with intramedullary reaming, irrigation, and vancomycin/gentamicin-loaded CS implantation for treatment of infection after intramedullary nailing, with successful infection remission in 18 patients.…”