Two stage management of Cierny-Mader type IV chronic osteomyelitis of the long bones

Wu, Hongyu; Shen, Jie; Yu, Xin; Fu, Jingshu; Yu, Shengpeng; Sun, Dong

doi:10.1016/j.injury.2017.01.007

Cited by 47 publications

(65 citation statements)

References 34 publications

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“…Debridement times, n 1.5 (1)(2)(3)(4) Duration of systemic antibiotics (week)* 8.5 (8)(9)(10)(11) PMMA spacer placing time (weeks) 13.6 (10-24)…”

Section: Patients and Inclusion Criteriamentioning

confidence: 99%

“…The option of bone stabilization is influenced by several factors, including the characteristics of the defects (e.g., the severity of infection and the location and size), the status of the affected soft tissue, firm fixation needed for therapy, and the patient's tolerance [3]. Along with debridement, the infected or unhealthy tissues should be considered to be contaminated, and the surface of internal implants can act as a substratum for the attachment of bacteria and formation of biofilms [29].…”

Section: Bone Grafts and Stabilizationmentioning

confidence: 99%

“…The induced membrane technique has excellent outcomes in treating significant bone defects and consists of 2 stages: 1) use of a polymethyl methacrylate (PMMA) spacer to fill the dead space to induce formation of a bioactive membrane, and 2) removal of the spacer and bone grafting [2]. Recently, Wu et al [3] treated chronic osteomyelitis with two-stage management of the induced membrane technique, and promising results were reported. This two-stage management can also serve as an alternative for the treatment of infected bone defects [4].…”

Section: Introductionmentioning

confidence: 99%

“…However, the infected and nonviable tissues are sometimes difficult to differentiate from healthy tissue in a single debridement, and if the polymethylmethacrylate (PMMA) spacer is inserted at the same time, it can lead to recurrence of infection and failure of the induced membrane technique, as failure to eradicate infection has been reported at rates of 3-20.7% [3,5]. Moreover, it is unnecessary to aggressively eliminate vascularized sclerotic tissue because the poorly vascularized parts can increase stability and decrease bone graft volume.…”

Section: Introductionmentioning

confidence: 99%

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Management of Infected Bone Defects of the Lower Extremities by Three-Stage Induced Membrane Technique

Zhang

Zhu

et al. 2020

Med Sci Monit

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Departmental sources Background: Infected bone defects are therapeutic challenges. Although the induced membrane technique has been used for this problem, there is a 3% to 20.7% failure to eradicate infection, and there have been few reports about its use in tuberculous infection. We present our three-stage induced membrane technique (TSIMT) for treating infected bone defects of the lower extremity. Material/Methods: Forty-one adult patients with infected bone defects of the lower extremities treated by TSIMT were included in a retrospective case-series study between January 2013 and June 2018. The clinical, imaging and laboratory assessment outcomes were analyzed. Results: In the first stage, 3 patients had ankle tuberculous bone defects and 17 patients underwent 2-4 debridements. In the second stage, the average bone defect was 6.0 cm; 1 patient needed an anterolateral thigh flap to cover the wound. In the third stage, 10 patients underwent autograft mixed allograft, and 18 cases used internal fixation. The mean follow-up period was 23.3 months. All patients achieved bone union and clinical eradication of infection. Changes in Lower Extremity Functional Scale (LEFS) scores after 1 year of TSIMT and bone union time are associated with advanced age, longer duration of infected bone defects, active smoking, and external fixation (p<0.05), but are not dependent on bone defect size, debridement times, type of bone graft, or spacer-placing time (p>0.05). Conclusions: TSIMT is effective in treating infected bone defects of the lower extremities. Advanced age, longer duration of infected bone defects, active smoking, and external fixation adversely affect bone union and recovery of infected extremities in a limited time span.

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“…Debridement times, n 1.5 (1)(2)(3)(4) Duration of systemic antibiotics (week)* 8.5 (8)(9)(10)(11) PMMA spacer placing time (weeks) 13.6 (10-24)…”

Section: Patients and Inclusion Criteriamentioning

confidence: 99%

Section: Bone Grafts and Stabilizationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Management of Infected Bone Defects of the Lower Extremities by Three-Stage Induced Membrane Technique

Zhang

Zhu

et al. 2020

Med Sci Monit

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“…For diagnosis as well as treatment, proof of the infection causing pathogen is regarded being crucial. Treatment is usually performed in a staged-manner by infect eradication and bone reconstruction at a later time point [5]. The use of local antibiotics most commonly incorporated into polymethylmethacrylate (PMMA) cement in different forms (e.g.…”

Section: Introductionmentioning

confidence: 99%

Polymicrobial infections and microbial patterns in infected nonunions – a descriptive analysis of 42 cases

et al. 2020

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Background Frequencies of polymicrobial infection and pathogens evidenced in course of infected nonunion treatment are largely unknown. Therefore, this study aims at investigating microbial patterns in infected nonunions. Methods Surgically treated patients with long bone infected nonunion admitted between January 2010 and March 2018 were included in the study. Microbiological culture and polymerase-chain-reaction results of tissue samples of initial and follow-up revision surgeries were assessed and compared with patient and treatment characteristics. Results Forty two patients with a mean age of 53.9 ± 17.7 years were included. In six patients (14.3%) polymicrobial infection was evident. A change of pathogens evidenced in course of the treatment occurred in 21 patients (50%). In 16 patients (38.1%) previously detected bacteria could be determined by microbial testing after further revision surgery. Staphylococcus aureus was most often detected (n = 34, 30.6%), followed by Enterococcus spp. (n = 25, 22.5%) and Staphylococcus epidermidis (n = 18, 16.2%). Five Staphylococcus aureus were resistant to methicillin (MRSA). In patients without polymicrobial infection or further germ detection in course of the treatment, 86.4% of the infections were due to Staphylococcus spp.. Infections due to Streptococcus spp. and gram-negative bacteria were only present in patients with polymicrobial infection and germ-change in course of the treatment. Conclusion A low rate of polymicrobial infections was evidenced in the present study. Germ-change often occurs in course of revision surgeries. Prospective studies with more sensitive diagnostic tools are necessary to elucidate the therapeutical relevance of microbiological testing results for surgical as well as medical treatment in infected nonunions.

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Infected Nonunion of the Clavicle

Shaw

Altıntaş

Miller

et al. 2020

Musculoskeletal Infections

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Case: Infected Nonunion of an Open Clavicle FractureA healthy 45-year-old female sustained a grade I open left clavicle fracture after a fall from a horse. She was taken urgently to the operating room by the initial treating surgeon for single-stage irrigation and debridement of the open fracture followed by open reduction and internal fixation of the clavicle (Fig. 7.1a).Four months later she continued to have pain and was found to have loosening of the clavicle fixation with absence of union at the fracture site (Fig. 7.1b). She was taken back to the operating room by the same surgeon for revision open reduction and internal fixation with repair of the nonunion with iliac crest bone grafting 5 months after her initial injury (Fig. 7.1c; top image).

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Two stage management of Cierny-Mader type IV chronic osteomyelitis of the long bones

Cited by 47 publications

References 34 publications

Management of Infected Bone Defects of the Lower Extremities by Three-Stage Induced Membrane Technique

Management of Infected Bone Defects of the Lower Extremities by Three-Stage Induced Membrane Technique

Polymicrobial infections and microbial patterns in infected nonunions – a descriptive analysis of 42 cases

Infected Nonunion of the Clavicle

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