Title : Chronic osteomyelitis of the appendicular skeleton in adults
Abstract:
Background:
Chronic osteomyelitis is notoriously difficult to eradicate with multiple clinical failures and relapses after periods of quiescence and apparently successful treatment. The fact that certain bacteria form biofilm with metabolically inactive colonies contributes to the difficulty in achieving cure. The treatment strategy includes surgical resection of all necrotic tissue, dead space management, tissues reconstruction along with prolonged antibiotic therapy. The aim of this study is to highlight the diagnosis and management of chronic osteomyelitis of the appendicular skeleton in adults.
Methods:
A retrospective record review of adult patients who were diagnosed with chronic osteomyelitis of the appendicular skeleton between January 2016 and December 2020.
Results:
We collected 72 cases comprising 60 men and 12 women with a mean age of 35 years. Fifty patients (69%) presented with fracture-related infections, 12 patients (17%) developed chronic osteomyelitis following haematogenous spread and ten (14%) from contiguous wounds. The involved anatomical sites were tibia (n=30, 42%), femur (n=21, 29%), humerus (n=15, 21%), radius (n=3, 4%) and ulna (n=3, 4%). According to the Cierny-Mader classification, 18 patients (25%) presented with anatomical type I, 14 (19%) with type II, 20 (28%) with type III and 20 (28%) with type IV chronic osteomyelitis. Positive microbial cultures were obtained in 49 (68%) cases. The most involved pathogen was by far Staphylococcus aureus (n=31). All patients underwent surgical resection of all necrotic tissue and dead space management followed by soft tissue and bony reconstruction as required by the stage of infection. Antibiotic therapy was prolonged with a mean duration of 162.5 days. Follow-up ranged from 1 to 18 months, with a mean follow-up of 9.2 months. Ten patients (14%) experienced recurrence after the initial procedure to eradicate infection, resulting in an overall resolution rate of 86%.
Conclusions:
The management of chronic osteomyelitis is complicated. A combined antimicrobial and surgical treatment should be tailored to each patient according to the severity and duration of symptoms, as well as to the clinical and radiological response to treatment. Relapse can occur, even following an apparently successful treatment.
Keywords: Bacteria and bacterial infections - Biofilms and microbiomes
Audience take away:
Osteomyelitis is a rare and serious bone infection that can be challenging to diagnose and treat. There are several ways in which our work could benefit the audience, including:
• Providing medical professionals with more accurate and effective methods for diagnosing and treating osteomyelitis. This could improve patient outcomes and reduce healthcare costs.
• Enhancing the understanding of osteomyelitis among healthcare professionals, medical students, and researchers. This could contribute to the development of new treatments and prevention strategies for this condition.
• Offering a potential source of new research ideas for other faculty members who are interested in studying osteomyelitis or related topics.
• Providing a practical solution to a problem that could simplify or make a designer's job more efficient by improving the design and implementation of medical devices or equipment used in the diagnosis or treatment of osteomyelitis.
• Improving the accuracy of a diagnosis of osteomyelitis through the development of more sensitive and specific diagnostic tools, which could reduce the need for unnecessary treatments or procedures and improve patient outcomes. Overall, our research on osteomyelitis could provide numerous benefits to the medical community and potentially have a significant impact on patient outcomes.
