Abstract
Introduction
Posttraumatic and postoperative osteomyelitis (PPO) with bacteria colonisation during trauma and associated surgery is an increasing clinical problem. This study investigated the treatment of PPO by surgical revision including irrigation, debridement, and temporary hardware maintenance. In addition, a drainage was inserted as persisting fistula to control osteomyelitis until fracture healing was achieved. Trauma- and osteomyelitis-related factors that influenced the study outcome were determined.
Patients and methods
67 consecutive patients with PPO were included. At onset of PPO, patients had incomplete fracture healing. Patients were subdivided by time of PPO occurrence (acute, subacute or chronic), initial soft tissue trauma, anatomical location, and initial fracture type (AO classification). The study outcome measures included radiographic and clinical follow-up.
Results
59 patients could be followed for an average of 23 months after revision surgery. A bone healing was achieved by 89 % of patients after 14.7 ± 13.4 weeks. Fractures of the lower extremity, open fractures and comminuted C-type fractures took significantly longer to achieve bone healing (p < 0.05 each). Time of PPO occurrence did not influence bone healing. After fracture consolidation, no re-infection was found.
Conclusions
This study showed high rates of bone healing, indicating that this strategy with persisting fistula should be considered as alternative treatment option in patients with PPO.
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References
Walter G, Kemmerer M, Kappler C, Hoffmann R (2012) Treatment algorithms for chronic osteomyelitis. Dtsch Arztebl Int 109(14):257–264
Lew DP, Waldvogel FA (2004) Osteomyelitis. Lancet 24–30 364(9431):369–379
Costerton JW, Stewart PS, Greenberg EP (1999) Bacterial biofilm: a common cause of persistent infections. Science 284:1318–1322
Ziran BH (2007) Osteomyelitis. J Trauma 62:S59–S60
Gustilo RB, Anderson JT (1976) Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am 58(4):453–458
Boxma H, Broekhuizen T, Patka P, Oosting H (1996) Randomised controlled trail of single-dose antibiotic prophylaxis in surgical treatment of closed fractures: The Dutch Trauma Trial. Lancet 27 347(9009):1133–1137
Hansis M (1996) Pathophysiology of infection––a theoretical approach. Injury 27(Suppl 3):SC5–SC8
Tsukayama DT (1999) Pathophysiology of posttraumatic osteomyelitis. Clin Orthop Relat Res 360:22–29
Gillespie WL, Walenkamp G (2010) Antibiotic prophylaxis for surgery for proximal femoral and other closed long bone fractures. Cochrane Database Syst Rev 17(3)
Schierholz JM, Morsczeck C, Brenner N, König DP, Yücel N, Korenkov M, Neugebauer E, Rump AF, Waalenkamp G, Beuth J, Pulverer G, Arens S (2004) Special aspects of implant-associated infection in orthopedic surgery. From the pathophysiology to custom-tailored prevention strategies. Orthopade 33(4):397–404
Poultsides LA, Liaropoudis LL, Malizos KN (2010) The socioeconomic impact of musculoskeletal infections. J Bone Joint Surg (Am) 92:e13
Schnettler R, Steinau H-U (2004) Septische Knochenchirurgie, 1st edn. Auflage Thieme, Stuttgart
Rightmire E, Zurakowski D, Vrahas M (2008) Acute infections after fracture repair management with hardware in place. Clin Orthop Relat Res 466:466–472
Hofmann GO, Bar T, Buhren V (1997) The osteosynthesis implant and early postoperative infection: healing with or without the removal of the material? Chirurg 68:1175–1180
Rosen H (1990) The treatment of nonunions and pseudarthroses of the humeral shaft. Orthop Clin North Am 21:725–742
Bahrs C, Oehm J, Rolauffs B, Eingartner C, Weise K, Dietz K, Helwig PZ (2007) T-plate osteosynthesis-an obsolete osteosynthesis procedure for proximal humeral fractures? Middle-term clinical and radiological results. Orthop Unfall 145:186–194
Müller ME, Nazarian S, Koch P et al (1990) The comprehensive classification of fractures of long bones. Springer, Berlin, Heidelberg, New York
Tiemann AH, Homagk L, Diefenbeck M, Mückley T, Hofmann GO (2007) Preservation of hip prosthesis with local surgical revision and creation of a fistula persistens: an option for palliative treatment of periprosthetic infection in old, polymorbid patients? Unfallchirurg 110(12):1021–1029
Willenegger H, Ledermann M (1970) Surgical treatment of infection after osteosynthesis. Hefte Unfallheilkd 102:41–52
Klemm K (1974) Die Behandlung der sekundär-chronischen Osteomyelitis. In: Bücherei des Orthopäden, Band 13, Kapitel 3.2.3. Spüldrainage, 163
Tan Y, Wang X, Li H, Zheng Q, Feng G, Pan Z (2011) The clinical efficacy of the vacuum-assisted closure therapy in the management of adult osteomyelitis. Arch Orthop Trauma Surg 131(2):255–259
Diefenbeck M, Mennenga U, Gückel P, Tiemann AH, Mückley T, Hofmann GO (2011) Vacuum-assisted closure therapy for the treatment of acute postoperative osteomyelitis. Z Orthop Unfall 149(3):336–341
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Aytaç, S., Schnetzke, M., Swartman, B. et al. Posttraumatic and postoperative osteomyelitis: surgical revision strategy with persisting fistula. Arch Orthop Trauma Surg 134, 159–165 (2014). https://doi.org/10.1007/s00402-013-1907-2
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DOI: https://doi.org/10.1007/s00402-013-1907-2