Vivek Chadayammuri1, Benoit Herbert1, Jiandong Hao1, Andreas Mavrogenis2, Juan C Quispe1, Ji Wan Kim3, Heather Young4, Mark Hake1, Cyril Mauffrey5. 1. Department of Orthopaedics, Denver Health Medical Center, School of Medicine, University of Colorado, 777 Bannock Street, Denver, CO, 80204, USA. 2. First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece. 3. Department of Orthopaedic Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, 1435, Jwa-dong, Haeundae-gu, Busan, 612-862, Republic of Korea. 4. Division of Infectious Disease, Denver Health Medical Center, School of Medicine, University of Colorado, 777 Bannock Street, Denver, CO, 80204, USA. 5. Department of Orthopaedics, Denver Health Medical Center, School of Medicine, University of Colorado, 777 Bannock Street, Denver, CO, 80204, USA. Cyril.mauffrey@dhha.org.
Abstract
AIMS: To evaluate short-term clinical and functional outcomes following operative treatment of long bone post-traumatic osteomyelitis (PTOM). METHODS: We retrospectively analyzed a consecutive cohort of 142 adult patients undergoing operative treatment of long bone PTOM at our Level I trauma center over a 10-year study period. In addition to subjective patient evaluations, surveyed postoperative outcomes included incidence of residual infection, fracture malunion or nonunion, and requirement for limb amputation. All included patients had a minimum follow-up of 12 months postoperatively. RESULTS: Patients suffering an adverse postoperative outcome tended to have a higher incidence of polymicrobial infection (25.4 vs. 11.4%, p = 0.042) and requirement for skin grafting (58.1 vs. 37.9%, p = 0.024) and free-flap procedures (43.6 vs. 19.5%, p = 0.003) compared to those achieving complete healing. Sequential administration of parenteral and oral antibiotic therapies was associated with a reduced incidence of adverse postoperative outcome (p = 0.047). DISCUSSION: Patients with long bone PTOM and extensive soft tissue defects often fail to develop complete remission of their symptoms by 12 months postoperatively. Sequential administration of parenteral and oral antibiotics may help to limit infection recurrence. Further research is required to inform optimal treatment strategy.
AIMS: To evaluate short-term clinical and functional outcomes following operative treatment of long bone post-traumatic osteomyelitis (PTOM). METHODS: We retrospectively analyzed a consecutive cohort of 142 adult patients undergoing operative treatment of long bone PTOM at our Level I trauma center over a 10-year study period. In addition to subjective patient evaluations, surveyed postoperative outcomes included incidence of residual infection, fracture malunion or nonunion, and requirement for limb amputation. All included patients had a minimum follow-up of 12 months postoperatively. RESULTS:Patients suffering an adverse postoperative outcome tended to have a higher incidence of polymicrobial infection (25.4 vs. 11.4%, p = 0.042) and requirement for skin grafting (58.1 vs. 37.9%, p = 0.024) and free-flap procedures (43.6 vs. 19.5%, p = 0.003) compared to those achieving complete healing. Sequential administration of parenteral and oral antibiotic therapies was associated with a reduced incidence of adverse postoperative outcome (p = 0.047). DISCUSSION: Patients with long bone PTOM and extensive soft tissue defects often fail to develop complete remission of their symptoms by 12 months postoperatively. Sequential administration of parenteral and oral antibiotics may help to limit infection recurrence. Further research is required to inform optimal treatment strategy.
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