Comparison of Bone Preserving and Radical Surgical Treatment in 32 Cases of Calcaneal Osteomyelitis

Ireneusz Babiak; Piotr Pędzisz; Mateusz Kulig; Jakub Janowicz; Paweł Małdyk

doi:10.7150/jbji.14342

Comparison of Bone Preserving and Radical Surgical Treatment in 32 Cases of Calcaneal Osteomyelitis

Journal of Bone and Joint Infection ◽

10.7150/jbji.14342 ◽

2016 ◽

Vol 1 (1) ◽

pp. 10-16 ◽

Cited By ~ 10

Author(s):

Ireneusz Babiak ◽

Piotr Pędzisz ◽

Mateusz Kulig ◽

Jakub Janowicz ◽

Paweł Małdyk

Keyword(s):

Infection Control ◽

Functional Result ◽

Diffuse Type ◽

Level Of Evidence ◽

Below The Knee ◽

Drilling Operations ◽

Eradication Of Infection ◽

Superficial Type ◽

Gentamicin Sponge ◽

Skin Coverage

Abstract. Introduction. Radical procedures like calcanectomy and amputation performed for calcaneal osteomyelitis are regarded as effective in eradication of infection even though potentially functionally disabling. Bone sparing procedures offer better functional result at the expense of potentially worse infection control. The aim of the study has been to assess the influence of the surgical radicalism as much as the extent of bone infection on the final outcome in the surgical therapy of chronic calcaneal osteomyelitis (CO). Material and method. 32 patients with chronic CO have comprised the group under study: 8 with superficial type, 12 localised type and 12 with diffuse type according to Cierny-Mader classification. The aim of the treatment was to heal infection, preserve the heel shape and achieve good skin coverage over the calcaneus. The therapy consisted of 9 debridement surgeries with or without flaps, 8 drilling-operations of the calcaneus with application of collagen-gentamicin-sponge in bore holes, 15 partial and 2 total calcanectomies, and 4 below-the knee amputations. Results. The healing of infection and wound has been achieved after 7 of 9 debridements, 6 of 8 drilling-operations, 13 of 15 partial and all total calcanectomies. Conclusion. Bone preserving operations in chronic calcaneal osteomyelitis provided inferior infection control (76,47% vs 88,24%) and worse patient satisfaction (88,24% vs 100%) and almost camparable ambulation (100% vs 93,33%). Drilling of the calcaneus with application of collagen sponge containing gentamicin performed in chronic diffuse calcaneal osteomyelitis seems to offer a viable alternative to partial or radical calcanectomy. Level of evidence: V.

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Comparison of 2g vs 1 g of Prophylactic Cefazolin in Surgical Site Infections in Trauma Surgery Below the Knee

Foot & Ankle International ◽

10.1177/1071100720903723 ◽

2020 ◽

Vol 41 (5) ◽

pp. 582-589

Author(s):

Fay R. K. Sanders ◽

Rosanne M.G. Kistemaker ◽

Mirjam van ’t Hul ◽

Tim Schepers

Keyword(s):

Primary Outcome ◽

Clinical Effect ◽

Trauma Surgery ◽

Surgical Site Infections ◽

Clinical Results ◽

Pharmacokinetic Studies ◽

Foot And Ankle ◽

Level Of Evidence ◽

Below The Knee ◽

Ankle Surgery

Background: The rate of surgical site infections (SSIs) after foot or ankle surgery remains high, despite the implementation of antibiotic prophylaxis. Recently, guidelines suggest a single dose of 2 g instead of 1 g of cefazolin for implant surgery; this decision is largely based on pharmacokinetic studies. However, the clinical effect of this higher dose has never been investigated in foot and ankle surgery. This retrospective cohort study investigated the effect of 2 g compared with 1 g of prophylactic cefazolin on the incidence of SSIs in foot and ankle surgery. Methods: All patients undergoing trauma-related surgery of the foot, ankle, or lower leg between September 2015 and March 2019 were included. The primary outcome was the incidence of an SSI. SSIs were compared between patients receiving 1 g and 2 g of cefazolin as surgical prophylaxis, using a propensity score to correct for possible confounders. Results: A total of 293 patients received 1 g and 126 patients received 2 g of cefazolin. The overall number of SSIs was 19 (6.5%) in the 1-g group and 6 (4.8%) in the 2-g group. Corrected for possible confounders, this was not statistically significant (OR, 0.770; P = .608). Conclusion: Even though the decrease in SSI rate from 6.5% to 4.8% was found not to be statistically significant, it might be clinically relevant considering the reduction in morbidity, mortality, and healthcare costs. Research linking pharmacokinetic and clinical results of prophylactic cefazolin is needed to establish whether or not the current recommendations and guidelines are sufficient for preventing SSIs in foot and ankle surgery. Level of Evidence: Level III, retrospective comparative series.

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Clinical Application of Antimicrobial Bone Graft Substitute in Osteomyelitis Treatment: A Systematic Review of Different Bone Graft Substitutes Available in Clinical Treatment of Osteomyelitis

BioMed Research International ◽

10.1155/2016/6984656 ◽

2016 ◽

Vol 2016 ◽

pp. 1-9 ◽

Cited By ~ 23

Author(s):

T. A. G. van Vugt ◽

J. Geurts ◽

J. J. Arts

Keyword(s):

Bone Graft ◽

Clinical Studies ◽

Local Treatment ◽

Complication Rates ◽

Success Rates ◽

Level Of Evidence ◽

Levels Of Evidence ◽

Systemic Antibiotic Therapy ◽

Eradication Of Infection ◽

Bone Graft Substitutes

Osteomyelitis is a common occurrence in orthopaedic surgery, which is caused by different bacteria. Treatment of osteomyelitis patients aims to eradicate infection by debridement surgery and local and systemic antibiotic therapy. Local treatment increases success rates and can be performed with different antimicrobial bone graft substitutes. This review is performed to assess the level of evidence of synthetic bone graft substitutes in osteomyelitis treatment. According to the PRISMA statement for reporting systematic reviews, different types of clinical studies concerning treatment of osteomyelitis with bone graft substitutes are included. These studies are assessed on their methodological quality as level of evidence and bias and their clinical outcomes as eradication of infection. In the fifteen included studies, the levels of evidence were weak and in ten out of the fifteen studies there was a moderate to high risk of bias. However, first results of the eradication of infection in these studies showed promising results with their relatively high success rates and low complication rates. Due to the low levels of evidence and high risks of bias of the included studies, these results are inconclusive and no conclusions regarding the performed clinical studies of osteomyelitis treatment with antimicrobial bone graft substitutes can be drawn.

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Management of Neurologic Deformity of the Ankle and Foot With Concurrent Osteomyelitis With the Ilizarov Method

Foot & Ankle International ◽

10.1177/1071100717739396 ◽

2017 ◽

Vol 39 (2) ◽

pp. 226-235 ◽

Cited By ~ 5

Author(s):

Nikolay Mikhailovich Kliushin ◽

Anatoliy Sergeyevich Sudnitsyn ◽

Koushik Narayan Subramanyam ◽

Jefferson George

Keyword(s):

External Fixation ◽

Case Series ◽

Interquartile Range ◽

Ilizarov Method ◽

Retrospective Case ◽

Level Of Evidence ◽

Eradication Of Infection ◽

Tract Infections ◽

Ankle And Foot

Background: The combination of neurologic deformity of the ankle and foot with osteomyelitis is a therapeutic challenge. We investigated the role of Ilizarov with regard to eradication of infection, correction of deformities and improvement of patient function. Methods: We retrospectively reviewed 77 patients (77 feet) with neurologic deformity of the ankle and foot with osteomyelitis treated sequentially in 3 stages by Ilizarov method. The 3 stages were (1) active debridement and Ilizarov stabilization, (2) further strengthening of Ilizarov fixator and active osteosynthesis consisting of strategies like arthrodesis, osteotomy distraction, bone transport, or combination thereof, (3) consolidation of fusion/regeneration achieved in second stage. Patients with Charcot arthropathy were not included in the study. There were 43 males and 34 females with mean age of 34.4 (range, 18 to 70) years. All patients had a minimum of 1 year follow-up and 49 patients had 5 years follow-up. Results: Mean duration of external fixation was 179.9 (range, 128 to 413) days. The success of infection eradication was 90.9% and 91.9% at the end of 1 and 5 years, respectively. We achieved plantigrade feet in all cases with no recurrence of deformity. The American Orthopaedic Foot & Ankle Score (AOFAS) improved from a median preoperative value of 74 (interquartile range, 65 to 75.25) to 81 (interquartile range, 77 to 88) ( P < .0001). The improvement of the score was by 7 points only considering the painless nature of the pathology, and the fact that pain contributed to 40% of total score. A total of 39 complications occurred in 30 patients which were managed successfully by alteration of rehabilitation and carefully chosen interventions. Conclusion: Ilizarov external fixation was an effective technique to address problems associated with neurologic foot and ankle deformity with infection. It allowed eradication of infection and achievement of a stable plantigrade foot. It had some disadvantages like lengthy duration of treatment, pin-tract infections, need for operative expertise, and supervised rehabilitation, but we feel these were definitely outweighed by its benefits. Level of Evidence: Level IV, retrospective case series.

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Dorsal Dupuytren’s disease: a systematic review of published cases and treatment options

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193419852171 ◽

2019 ◽

Vol 44 (9) ◽

pp. 963-971 ◽

Cited By ~ 2

Author(s):

Raphael Carloni ◽

Silvia Gandolfi ◽

Benedicte Elbaz ◽

Albane Bonmarchand ◽

Roberto Beccari ◽

...

Keyword(s):

Systematic Review ◽

Functional Result ◽

Treatment Options ◽

Proximal Interphalangeal Joint ◽

Dupuytren’S Disease ◽

Level Of Evidence ◽

Dupuytren's Disease ◽

Female Ratio ◽

Knuckle Pads ◽

Male To Female

Dorsal lesions in Dupuytren’s disease are rare and data concerning their epidemiology and management are sparse. We conducted a systematic review to summarize reported cases of dorsal Dupuytren’s disease. Pubmed, Cochrane, and Embase databases were searched from 1893 to 2018, and 17 articles were selected (525 patients). The male to female ratio was 3.8:1. The dorsal disease was bilateral in 225 patients (50%). The index was the most commonly affected finger (48 patients). The proximal interphalangeal joint was the most commonly affected (484 cases). The most frequently reported lesions were knuckle pads (503 patients), dorsal nodules between interphalangeal joints (14 patients), boutonnière deformities (12 patients), and swan-neck deformities (2 patients). Nearly half of the included patients were treated surgically. Postoperative functional result depended on the treated lesion. Most of the included studies had a low level of evidence. Higher-quality studies are necessary to confirm our findings.

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Tibiotalocalcaneal Fusion With Antibiotic Cement-Coated Nails for Refractory Deep Infection After Ankle ORIF

Foot & Ankle International ◽

10.1177/1071100720939884 ◽

2020 ◽

Vol 41 (11) ◽

pp. 1391-1397

Author(s):

Mario Herrera-Pérez ◽

Rodrigo Díaz-Fernández ◽

Diego Rendón-Díaz ◽

Juan Boluda-Mengod ◽

José Luis Pais-Brito ◽

...

Keyword(s):

Clinical Signs ◽

Deep Infection ◽

Open Reduction Internal Fixation ◽

Modified Technique ◽

Level Of Evidence ◽

Antibiotic Cement ◽

Complex Patients ◽

Eradication Of Infection ◽

Therapeutic Study ◽

Surgical Treatments

Background: Deep infection after open reduction internal fixation (ORIF) of ankle fractures represents a challenge to the orthopaedic surgeon, particularly in patients in whom conventional surgical treatments have failed. The aim of this study was to assess the results of a modified technique of tibiotalocalcaneal fusion using a retrograde locked intramedullary nail covered in cement with antibiotics. Methods: Six patients treated using the authors’ technique were analyzed retrospectively. All patients had deep infection after ankle osteosynthesis and several surgical procedures (debridement, external fixation, etc) had failed. Radiographs were analyzed to confirm the healing of the bone. Outcome was measured by maintained construct stability and eradication of infection (no clinical signs of infection and normal values of laboratory markers). The average age of the series was 64.2 (range, 50-75) years, and the average follow-up period was 19.5 (range, 8-41) months. Results: Tibiotalocalcaneal stability and eradication of the infection were achieved in all patients, along with the normalization of clinical and radiologic parameters. In the patient who underwent a talectomy, one of the calcaneal locking screws broke, with no clinical repercussions. Conclusion: Tibiotalocalcaneal fusion with antibiotic cement-coated retrograde nails was useful in providing clinically acceptable results in the control of chronic infection in complex patients after the failure of previous surgeries. Level of Evidence: Level IV, therapeutic study.

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