Efstathios Drampalos1, Hasan Raza Mohammad2, Chris Kosmidis3, Moez Balal4, Jason Wong5, Anand Pillai6. 1. Trauma and Orthopaedics Department, Wythenshawe Hospital, Manchester, United Kingdom. Electronic address: Efstathios.Drampalos@uhsm.nhs.uk. 2. Trauma and Orthopaedics Department, Wythenshawe Hospital, Manchester, United Kingdom. Electronic address: hasan.mohammad@uhsm.nhs.uk. 3. Trauma and Orthopaedics Department, Wythenshawe Hospital, Manchester, United Kingdom. Electronic address: Chris.Kosmidis@uhsm.nhs.uk. 4. Trauma and Orthopaedics Department, Wythenshawe Hospital, Manchester, United Kingdom. Electronic address: Moez.Balal@uhsm.nhs.uk. 5. Trauma and Orthopaedics Department, Wythenshawe Hospital, Manchester, United Kingdom. Electronic address: Jason.Wong@uhsm.nhs.uk. 6. Trauma and Orthopaedics Department, Wythenshawe Hospital, Manchester, United Kingdom. Electronic address: Anand.Pillai@uhsm.nhs.uk.
Abstract
BACKGROUND: Chronic osteomyelitis necessities appropriate infected bone and soft tissue excision. The authors describe the Silo surgical technique for the treatment of calcaneal osteomyelitis using a new antibiotic-loaded absorbable calcium sulphate/hydroxyapatite biocomposite. METHODS: The Silo method involves debridement of the dead bone and local delivery of antibiotic in drilled tunnels using the biocomposite. It is combined with multiple sampling and culture-specific systemic antibiotic treatment guided by a multidisciplinary team. Twelve consecutive diabetic patients with heel ulcers and calcaneal osteomyelitis were treated with the above method. All had comorbidities (Cierny-Mader (C-M) Class B hosts). The mean age was 68 years (range 50-85). A retrospective review of radiographs and electronic medical records was conducted. RESULTS: Patients were followed up until clinical cure of the ulcer for a mean of 16 weeks (range 12-18). Infection was eradicated in all 12 patients with a single stage procedure following a bone preserving technique. One patient required a subsequent flap operation and six vacuum-assisted closure (V.A.C.). There was also one case of prolonged wound leakage and no calcaneal fractures. CONCLUSIONS: The Silo technique is an effective method of local delivery of antibiotics and can be effectively implemented into the single-stage treatment of calcaneal osteomyelitis offering increased bone preservation and local delivery of antibiotic, decreasing the need for a major amputation. LEVEL OF EVIDENCE: Level IV- case series. Crown
BACKGROUND:Chronic osteomyelitis necessities appropriate infected bone and soft tissue excision. The authors describe the Silo surgical technique for the treatment of calcaneal osteomyelitis using a new antibiotic-loaded absorbable calcium sulphate/hydroxyapatite biocomposite. METHODS: The Silo method involves debridement of the dead bone and local delivery of antibiotic in drilled tunnels using the biocomposite. It is combined with multiple sampling and culture-specific systemic antibiotic treatment guided by a multidisciplinary team. Twelve consecutive diabeticpatients with heel ulcers and calcaneal osteomyelitis were treated with the above method. All had comorbidities (Cierny-Mader (C-M) Class B hosts). The mean age was 68 years (range 50-85). A retrospective review of radiographs and electronic medical records was conducted. RESULTS:Patients were followed up until clinical cure of the ulcer for a mean of 16 weeks (range 12-18). Infection was eradicated in all 12 patients with a single stage procedure following a bone preserving technique. One patient required a subsequent flap operation and six vacuum-assisted closure (V.A.C.). There was also one case of prolonged wound leakage and no calcaneal fractures. CONCLUSIONS: The Silo technique is an effective method of local delivery of antibiotics and can be effectively implemented into the single-stage treatment of calcaneal osteomyelitis offering increased bone preservation and local delivery of antibiotic, decreasing the need for a major amputation. LEVEL OF EVIDENCE: Level IV- case series. Crown
Authors: Kor H Hutting; Wouter B Aan de Stegge; Jaap J van Netten; Wouter A Ten Cate; Luuk Smeets; Gijs M J M Welten; Dick M Scharn; Jean-Paul P M de Vries; Jeff G van Baal Journal: J Clin Med Date: 2021-01-19 Impact factor: 4.241