scholarly journals Treatment of chronic osteomyelitis with antibiotic-impregnated polymethyl methacrylate (PMMA) – the Cierny approach: is the second stage necessary?

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Noam Bor ◽  
Eytan Dujovny ◽  
Barak Rinat ◽  
Nimrod Rozen ◽  
Guy Rubin
Keyword(s):  
Bone Defect ◽  
Chronic Osteomyelitis ◽  
Cement Spacer ◽  
Second Stage ◽  
Orthopedic Surgeons ◽  
Vulnerable Patients ◽  
Radical Debridement ◽  
The Mean ◽  
Definitive Management

Abstract Background Chronic osteomyelitis is a challenge for orthopedic surgeons. Most patients with osteomyelitis receive two-stage management according to Cierny-Mader. The first stage includes radical debridement and insertion of an antibiotic-impregnated cement spacer (ACS) (beads, rods, nails, or blocks) into the bone defect. The second stage is performed 6–8 weeks later, when the spacer is removed and a cancellous autograft is placed within the bone defect. The possibility of ACS as definitive management for osteomyelitis, avoiding the second stage, is presented. Methods Sixteen patients with osteomyelitis received radical debridement and insertion of an ACS in all forms into the bone defect as a definitive management. In 8 patients, the tibia was infected, 4 had femur infection, 2 humerus, 1 fibula, and 1 ankle. The mean age at the time of the first stage of reconstruction was 49 years (range, 13–71 years). According to the Cierny-Mader classification, 1 patient was C-M IA, another was IB, 7 IIIA, 6 IIIB, and 1 was 4A. All B hosts had systemic illnesses. The mean follow-up period was 6 years (1.5–16 years). Results No patient exhibited radiographic evidence of excessive bone loss. Signs of recurrence of osteomyelitis were not noted in any of the patients, and no fractures had occurred by the last follow-up. Conclusion Our study suggests that a proportion of patients with planned retention of ACS appear to function well without requiring further surgical intervention, especially in elderly or vulnerable patients.

Bioactive glass S53P4 to fill-up large cavitary bone defect after acute and chronic osteomyelitis treated with antibiotic-loaded cement beads: a prospective case series with a minimum 2-year follow-up

Injury ◽  
2021 ◽  
Author(s):  
Kodi Edson Kojima ◽  
Fernando Brandão de Andrade e Silva ◽  
Marcos de Camargo Leonhardt ◽  
Vladimir Cordeiro de Carvalho ◽  
Priscila Rosalba Domingos de Oliveira ◽  
...  
Keyword(s):  
Bioactive Glass ◽  
Bone Defect ◽  
Chronic Osteomyelitis ◽  
Case Series ◽  
Prospective Case Series

scholarly journals Investigating clinical characteristics and prognostic factors in patients with chronic osteomyelitis of humerus

2019 ◽  
Vol 7 ◽  
Author(s):  
Hongri Wu ◽  
Shengpeng Yu ◽  
Jingshu Fu ◽  
Dong Sun ◽  
Shulin Wang ◽  
...  
Keyword(s):  
Chronic Osteomyelitis ◽  
Plate Fixation ◽  
Case Series ◽  
Type I ◽  
Cement Spacer ◽  
Nerve Injuries ◽  
Soft Tissue Envelope ◽  
Type Iv ◽  
Significant Difference

Abstract Background Chronic osteomyelitis in the humerus, which has complex neuroanatomy and a good soft tissue envelope, represents a unique clinical challenge. However, there are relatively few related studies in the literature. This article retrospectively reviewed a large case series with the aims of sharing our management experiences and further determining factors associated with the outcomes. Methods Twenty-eight consecutive adult patients with a mean age of 36 years were identified by reviewing the osteomyelitis database of our clinic centre. The database was used to prospectively identify all osteomyelitis cases between 2013 and 2017, and all data then was retrospectively analysed. Results The mean follow-up period was 35 months (range 24–60). The aetiology was trauma in 43% (12) of the patients and haematogenous in 57% (16) of the patients, and Staphylococcus aureus was a solitary agent in 50% (14) of the patients. Host-type (Cierny’s classification) was IA in 8, IIIB in 11 and IVB in 9 patients. All patients required debridement followed by the placement of a temporary antibiotic-impregnated cement spacer (rod). Seventeen patients received a cement-coated plate for internal fixation after debridement, and 13 patients needed bone grafts when the spacer was staged removed. All patients attained an infection-free bone healing state at the final follow-up. The final average DASH (disabilities of the arm, shoulder and hand) score was 18.14 ± 5.39, while 6 patients (two developed traumatic olecranarthritis, four developed radial nerve injuries) showed the lowest levels of limb function (p = 0.000) and were unemployed. Three patients (type I; significant difference between type I versus type III and type IV patients, p < 0.05) experienced recurrence after debridement and underwent a second revision, which was not related to the bone graft (p = 0.226) or plate fixation (p = 0.050). Conclusions Humeral chronic osteomyelitis can be treated with general surgery and anti-infective therapy; medullary (type I) infection presents a challenge, and the antibiotic-coated cement plate provides favourable fixation without increasing recurrence of infections. Clinicians should be aware of potential iatrogenic nerve injuries when treating these patients with complicated cases, and an experienced surgeon may improve the outcome.

Reconstruction of Paprosky type III Acetabular Defects by the Three-dimensional Printed Porous Augment: Techniques and Clinical Outcomes of 18 Consecutive Cases

2020 ◽  
Author(s):  
Jun Fu ◽  
Ming Ni ◽  
Xiang Li ◽  
Wei Chai ◽  
Libo Hao ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Bone Defect ◽  
Three Dimensional ◽  
Acetabular Bone ◽  
Type Iii ◽  
Acetabular Bone Defect ◽  
3D Printed ◽  
The Mean ◽  
Acetabular Defects

Abstract Background and Purpose: A major challenge posed by primary and revision total hip arthroplasty (THA) is the management of severe acetabular bone defect. Previous surgical techniques have certain limitations in the anatomical reconstruction and accurate match of severe acetabular defects. Until now, reports are scanty on the clinical outcomes of acetabular reconstruction by the three-dimensional (3D) printed porous augments in bone defect patients. This study reported the clinical outcomes of reconstruction of Paprosky type III acetabular defects by 3D printed porous augments.Methods: 18 patients with Paprosky type III acetabular defects receiving reconstructive surgery by 3D printed porous augments were included in current study. Their data, including general information, intra-operative findings, imaging results, functional scores and complications were retrospectively analyzed.Results: The mean follow-up time lasted 33.3 ± 2.0 (24-56) months. The average limb-length discrepancy (LLD) was 31.7 ± 4.2 (3-59) mm preoperatively, 7.7 ± 1.4 (1-21) mm postoperatively (p<0.0001) and 7.5 ± 1.2 (0-18) mm at the latest follow-up. The mean vertical position of hip center of rotation (HCOR) from the inter teardrop line changed from preoperative 50.7 ± 3.9 (23.3-75.3) mm to postoperative 22.9 ± 1.9 (10.1-40.3) mm (p<0.0001), with the latest follow-up revealing an HCOR of 22.3 ± 1.7 (11.0-40.5) mm. Follow-up study showed that no hip had radiolucencies and radiological loosening of the acetabular components and augment. The average HHS improved from 40.3 ± 4.5 (10.5-71) before operation to 88.4 ± 1.9 (75-97) at the last follow-up (p<0.0001). Moreover, follow-up exhibited that no periprosthetic joint infection, hip dislocation, fracture and re-revision occurred. Conclusion: Surgical treatment of Paprosky type III acetabular defect with 3D printed porous augment was simple, achieved good match between porous augment and the defect bone surface and the acetabular component, ideally restored LLD and HCOR after operation, significantly improved HHS score and attained good early clinical outcomes. It is a promising personalized solution for patients with severe acetabular bone defect.

scholarly journals The 6 thalamic regions: surgical approaches to thalamic cavernous malformations, operative results, and clinical outcomes

2015 ◽  
Vol 123 (3) ◽  
pp. 676-685 ◽  
Author(s):  
Leonardo Rangel-Castilla ◽  
Robert F. Spetzler
Keyword(s):  
Surgical Approach ◽  
Surgical Approaches ◽  
Cavernous Malformations ◽  
Second Stage ◽  
Common Location ◽  
Orbitozygomatic Approach ◽  
The Mean ◽  
Selection Of ◽  
The Ideal

OBJECT The ideal surgical approach to thalamic cavernous malformations (CMs) varies according to their location within the thalamus. To standardize surgical approaches, the authors have divided the thalamus into 6 different regions and matched them with the corresponding surgical approach. METHODS The regions were defined as Region 1 (anteroinferior), Region 2 (medial), Region 3 (lateral), Region 4 (posterosuperior), Region 5 (lateral posteroinferior), and Region 6 (medial posteroinferior). The senior author’s surgical experience with 46 thalamic CMs was reviewed according to this classification. An orbitozygomatic approach was used for Region 1; anterior ipsilateral transcallosal for Region 2; anterior contralateral transcallosal for Region 3; posterior transcallosal for Region 4; parietooccipital transventricularfor Region 5; and supracerebellar-infratentorial for Region 6. RESULTS Region 3 was the most common location (17 [37%]). There were 5 CMs in Region 1 (11%), 9 in Region 2 (20%), 17 in Region 3 (37%), 3 in Region 4 (6%), 4 in Region 5 (9%), and 8 in Region 6 (17%). Complete resection was achieved in all patients except for 2, who required a second-stage operation. The mean follow-up period was 1.7 years (range 6 months-9 years). At the last clinical follow-up, 40 patients (87%) had an excellent or good outcome (modified Rankin Scale [mRS] scores 0–2) and 6 (13%) had poor outcome (mRS scores 3–4). Relative to their preoperative condition, 42 patients (91%) were unchanged or improved, and 4 (9%) were worse. CONCLUSIONS The authors have presented the largest series reported to date of surgically treated thalamic CMs, achieving excellent results using this methodology. In the authors’ experience, conceptually dividing the thalamus into 6 different regions aids in the selection of the ideal surgical approach fora specific region.

Staged radiosurgery for extra-large cerebral arteriovenous malformations: method, implementation, and results

2008 ◽  
Vol 109 (Supplement) ◽  
pp. 65-72 ◽  
Author(s):  
Wen-Yuh Chung ◽  
Cheng-Ying Shiau ◽  
Hsiu-Mei Wu ◽  
Kang-Du Liu ◽  
Wan-Yuo Guo ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Arteriovenous Malformations ◽  
High Signal ◽  
Minor Bleeding ◽  
Cerebral Arteriovenous Malformations ◽  
Presenting Symptoms ◽  
Second Stage ◽  
The Mean ◽  
Cerebral Avms

Object The effectiveness and safety of radiosurgery for small- to medium-sized cerebral arteriovenous malformations (AVMs) have been well established. However, the management for large cerebral AVMs remains a great challenge to neurosurgeons. In the past 5 years the authors performed preplanned staged radiosurgery to treat extra-large cerebral AVMs. Methods An extra-large cerebral AVM is defined as one with nidus volume > 40 ml. The nidus volume of cerebral AVM is measured from the dose plan—that is, as being the volume contained within the best-fit prescription isodose. From January 2003 to December 2007, the authors treated 6 patients with extra-large AVMs by preplanned staged GKS. Staged radiosurgery is implemented by rigid transformation with translation and rotation of coordinates between 2 stages. The average radiation-targeted volume was 60 ml (range 47–72 ml). The presenting symptoms were seizure in 4 patients and a bleeding episode in 2. One patient had undergone a previous craniotomy and evacuation of hematoma. The mean interval between the 2 radiosurgical sessions was 6.9 months (range 4.5–9.1 months). The prescribed marginal dose given to the nidus volume in each stage ranged from 16 to 18.6 Gy. The expected marginal dose of total nidus was 17–19 Gy. Regular follow-up MR imaging was performed every 6 months. The mean follow-up period was 28 months (range 12–54 months). Results Most of the patients exhibited clinical improvement: relief of headache and reduced frequency of seizure attack. All patients had significant regression of nidus observed on MR imaging follow-up. Two patients had angiogram-confirmed complete obliteration of the nidus 45 and 60 months after the second-stage radiosurgical session. One patient experienced minor bleeding 8 months after the second-stage radiosurgery with mild headache. She had satisfactory recovery without clinical neurological deficit after conservative treatment. Conclusions These preliminary results indicate that staged radiosurgery is a practical strategy to treat patients with extra-large cerebral AVMs. It takes longer to obliterate the AVMs. The observed high signal T2 changes after the radiosurgery appeared clinically insignificant in 6 patients followed up for an average of 28 months. Longer follow-up is necessary to confirm its long-term safety.

Efficacy and comparison of elevation transposition and lipectomy for superficialization of cephalic arteriovenous fistula veins

2018 ◽  
Vol 19 (4) ◽  
pp. 350-357 ◽  
Author(s):  
Michele S Wang ◽  
Shouwen Wang
Keyword(s):  
Ambulatory Surgery ◽  
Primary Patency ◽  
Secondary Patency ◽  
Upper Arm ◽  
Arteriovenous Fistulas ◽  
Second Stage ◽  
Ambulatory Surgery Center ◽  
The Mean ◽  
Surgery Center

Objective: Substantial percentages of cephalic arteriovenous fistulas are situated too deep and require superficialization before use for hemodialysis. The superficialization techniques are diverse: tunnel transposition, elevation, elevation transposition, and lipectomy. Since the fistula veins are not mobilized during lipectomy, it is believed that lipectomy produces better outcomes than other techniques. However, no available report directly compares lipectomy with other techniques. The objective of this report is to compare the outcomes of cephalic elevation transposition with lipectomy. Methods: The clinical data of patients who underwent second-stage cephalic elevation transposition or lipectomy at an ambulatory surgery center from 2009 to 2017 were analyzed ( n = 153). Results: Comparing the cephalic elevation transposition group ( n = 125) with the lipectomy group ( n = 28), the mean body mass index was 36.8 ± 7.6 versus 38.1 ± 7.2 ( p = 0.41); the percentage of upper arm fistulas was 84% versus 61% ( p < 0.01); the mean follow-up was 20.1 ± 17.5 versus 38.6 ± 24.4 months ( p < 0.01); the primary patency rates of the whole fistula conduits were 42% versus 50% at 1 year ( p = 0.08); the secondary patency rates were 99% versus 100% at 1 year ( p = 0.22); the primary patency rates of the superficialized vein segments were 73% versus 68% at 1 year ( p = 0.72); and the mean number of percutaneous interventions required for the superficialized vein segments was 0.49 ± 1.10 versus 0.43 ± 0.71 per access-year ( p = 0.74). Conclusion: Cephalic elevation transposition and lipectomy are both reliable techniques for superficialization of cephalic fistula veins and their outcomes are comparable.

scholarly journals Intermediated-term Results of Salvage Procedure using Tibiocalcaneal Fusion and Strut-fibular Graft for Ankle Arthropathy with Severe Bone Defect

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Byung-Ki Cho ◽  
Seung-Myung Choi
Keyword(s):  
Postoperative Complications ◽  
Bone Defect ◽  
Complete Fusion ◽  
Fibular Graft ◽  
Salvage Procedure ◽  
Foot And Ankle ◽  
Salvage Operation ◽  
The Mean ◽  
End Stage

Category: Ankle Arthritis, Diabetes Introduction/Purpose: Severe bone defect around the ankle joint is a challenging problem in salvage operation. It has been considered as one of major factors leading to the failed fusion, because it can be difficult to make the rigid internal fixation and the compact bone filling. This retrospective study was performed to evaluate the clinical outcomes of the tibiocalcaneal fusion combined with strut-fibular graft as a salvage procedure for end-stage ankle arthropathy with severe bone defect. Methods: Twenty-eight patients were followed for more than 3 years after tibiocalcaneal fusion using the locking compression intramedullary(IM) nail and strut-fibular graft. The mean age was 57.6 years, and the mean follow-up period was 4.2 years. The clinical evaluation consisted of the American Orthopaedic Foot and Ankle Society(AOFAS) scores, Foot and Ankle Ability Measure(FAAM) score. The subjective satisfaction score, postoperative complications, and the reoperation rate were evaluated. As the radiographic evaluation, the period to fusion, the degree of shortening compared with contralateral limb, and the degenerative change on adjacent joints were analysed. Results: AOFAS score significantly improved from preoperative average 28.8 points to 80.4 points at final follow-up (p<0.001). FAAM score had significantly improved from preoperative average 33.5 points (daily activity), 15.4 points (sports activity) to 79.8 points, 68.4 points at final follow-up (p<0.001). The period to fusion were average 18.2 weeks (tibia-fibular graft) and 19.5 weeks (calcaneus-fibular graft), respectively. 26 patients (92.8%) except for 2 patients achieved complete fusion. The degree of limb shortening was maintained from preoperative average 12.8 mm to 14.5 mm at final follow-up (p=0.236). There were 3 cases of postoperative wound infection, 3 cases of superficial peroneal nerve injury, 4 cases of metal irritation, 3 cases of degenerative changes on adjacent joint, and 2 cases of reoperation following the failed fusion. Conclusion: Tibiocalcaneal fusion using the locking compression IM nail and strut-fibular graft appear to be an effective salvage procedure for end-stage ankle arthropathy with severe bone defect. Although longer operation time and more postoperative complications have happened as compared to the cancellous bone graft alone, this surgical technique can contribute to the pain relief and improvement of gait ability through a satisfactory fusion rate and minimization of limb shortening.

scholarly journals Digital Lengthening to Treat Finger Deficiency: An Experience of 201 Digits in 104 Patients

2017 ◽  
Vol 2017 ◽  
pp. 1-5
Author(s):  
Zhenyu Ding ◽  
Xiaozhong Zhu ◽  
Kai Fu ◽  
Xianyou Zheng
Keyword(s):  
Bone Graft ◽  
Tendon Rupture ◽  
Second Stage ◽  
Finger Length ◽  
Alternative Plan ◽  
Metacarpal Bones ◽  
Before And After ◽  
The Mean ◽  
Pin Tract Infection

Objectives. We evaluated the results of digital lengthening by distraction and second-stage bone graft. Methods. We treated finger deficiency of 201 digits in 104 patients (68 males, 36 females) by digital distraction and second-stage bone graft. The distraction was performed with a rate of 1 mm/day (for the first ten days) and 0.5 mm/day followed by using a self-designed bilateral tubal-helical external fixator. The mean follow-up period was 42 months (range 6 to 60 months). Results. The mean lengthening was 29.2 mm (range 25 to 40 mm) and 18.7 mm (range 12 to 32 mm) for metacarpal bones and phalanges, respectively. The mean elongation rate was 174.4% (range 145% to 202%) and 184.8% (range 115% to 283%) for metacarpal bones and phalanges, respectively. The static two-point discriminations and SpO2 showed no significant differences before and after distraction. Four complications were observed (two skin ruptures and two phalangeal splitting). No pin tract infection or tendon rupture showed. Digital lengthening improved functions of the hand. Conclusion. Digital distraction and second-stage bone graft is an effective method to compensate disabilities caused by lack of finger length. It could be an alternative plan for patients with thumb deficiency instead of toe-to-thumb transplant and patients with finger deficiency instead of ray resection.

scholarly journals Novel Piston Technique Versus Ilizarov Technique for The Repair of Bone Defect After Lower Limb Infection

2021 ◽  
Author(s):  
Jiafei Du ◽  
Zifei Yin ◽  
Pengfei Cheng ◽  
Pei Han ◽  
Hao Shen
Keyword(s):  
Bone Defect ◽  
Bone Healing ◽  
Lower Limb ◽  
Functional Results ◽  
Bone Defects ◽  
Ilizarov Technique ◽  
Group A ◽  
The Mean ◽  
Group B

Abstract Background We described the use of a novel Piston technique versus Ilizarov technique to compare the effectiveness and complications for the repair of bone defect after lower limb infection. Patients and methods: We retrospectively reviewed 41 patients who had been treated at our department for lower extremity bone defects following osteomyelitis. They were 38 males and 3 females with a mean age of 43.41 (range 12 to 69 years). The infected bone defects involved 36 tibias and 5 femurs. Piston technique (PT, group A) was used in 12 patients and Ilizarov technique (IT, group B) in 29 ones. The mean duration of follow-up was 28.50 months (PT) and 29.90 months (IT). The modified Application of Methods of Illizarov (ASAMI) criteria was used to evaluate the bone healing and functional recovery. Results Complete eradication of infection and union of docking sites were accomplished well in both groups. The mean external fixator index (EFI) was 42.32 days/cm in group A versus 58.85 days/cm in group B (p < 0.001). The bone outcomes were similar between group A and B (p = 0.558) [excellent (9 vs. 19), good (3 vs.10)]; group A showed better functional outcomes than group B (p < 0.05) [excellent (7 vs. 6), good (4 vs. 12), fair (0 vs. 10) and poor (1 vs. 1)]. Pain was complained most during follow-up and group A had fewer cases of pin tract infection (1 vs. 6), adjacent joint stiffness (3 vs. 8) and delayed healing of the joint (0 vs. 3). Conclusions Satisfactory bone healing can be obtained by using both PT and IT, while PT had better functional results, lower EFI and allowed early removal of the external fixation. We have found that this novel Piston technique can improve the comfort of patients, reduce the incidence of complications, and provide a rapid and convenient rehabilitation.

scholarly journals Challenges in Diagnosis of ChronicOsteomyelitis : ACase Report from Sri Lanka

2020 ◽  
Vol 5 (1) ◽  
pp. 118
Author(s):  
V Thadchanamoorthy ◽  
Kavinda Dayasiri
Keyword(s):  
Biochemical Markers ◽  
Health Care Services ◽  
Chronic Osteomyelitis ◽  
Health Sciences ◽  
Pneumococcal Vaccines ◽  
X Ray ◽  
Care Services ◽  
Orthopedic Surgeons ◽  
Intravenous Antibiotics

The prevalence of osteomyelitis has been continuously decreasing in children with improvement of health care services and introduction of Hemophilus and Pneumococcal vaccines. Despite this, diagnosis and management of osteomyelitis are often a challenge to pediatricians as well as orthopedic surgeons. We report a 13-year old boy who had been treated as for rheumatic fever over 2 years with Benzathene penicillin, but ultimately turned out to have chronic osteomyelitis of right tibia. Evidence of chronic osteomyelitis was radiologically confirmed by X-ray and Computerized tomogram (CT) of right tibia and pus cultures grew staphylococcus aureus. Clinical features and biochemical markers completely resolved upon debridement of pus and intravenous antibiotics. He is currently on follow up at the orthopedic and pediatric clinics in the local hospital.International Journal of Human and Health Sciences Vol. 05 No. 01 January’21 Page: 118-121

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