Radiological evaluation of postoperative osteomyelitis in long bones: Which is the best tool?

Currently, definitive diagnosis of osteomyelitis involves a combination of clinical signs, symptoms, laboratory tests, imaging modalities and cultures from blood, joint or body fluid. Imaging plays a critical role in the osteomyelitis diagnosis. Each of these tests incurs an additional cost to the patient or healthcare system and their use varies according to the preference of the healthcare professional and the healthcare setup. Imaging plays a critical role in the diagnosis and management of postoperative long bone osteomyelitis, with the aim of reducing long-term complications such as non-union, amputation and pathological fractures. In this review, we discuss the key findings on different radiological modalities and correlate them with disease pathophysiology. Currently, magnetic resonance imaging is the best available imaging modality due to its sensitivity in detecting early signs of long bone osteomyelitis and high soft tissue resolution. Other modalities such as radio-nuclear medicine, computed tomography and ultrasound have been proved to be useful in different clinical scenarios as described in this narrative review.

Modified Algorithm for Managing Postoperative Osteomyelitis Following Fracture Fixation with Cierny-Mader Type

Background: No standardized protocol has been suggested in the treatment of postoperative osteomyelitis following fracture fixation. Our team evaluates the clinical efficacy of the modified algorithm for managing postoperative osteomyelitis following fracture fixation with Cierny-Mader type. Methods: 95wounds were reviewed from March 2009 to February 2016 in our hospital. 61 wounds were treated by the modified algorithm as following： Stable hardware + bone not healed Cierny–Mader 1 type = remove hardware, temporary stabilize; Stable hardware + bone not healed Cierny–Mader 2 type = retain hardware ; Stable hardware + bone not healed Cierny–Mader for type 3 and type 4 = remove hardware, temporary stabilize/ Ilizarov technique; Unstable hardware + bone not healed = remove hardware, temporary stabilize/ Ilizarov technique; Stable hardware + bone healed = remove hardware. 34 wounds were treated by the conventional algorithm. Autodermoplasty, flap transfer, myocutaneous flap and other methods including antibiotic irrigation and drug delivery system were used in wound repair.Results: The patients treated with modified algorithm had a significantly reduced recurrence (P＜0.01) , and increased results of negative bacterial cultures (P＜0.01), but however observed a decrease in the number of retained hardware cases (P＜0.05) . For those treated with tissue reconstruction, there was no significantly (P＞0.05) comparing with the conventional group. Conclusions: The modified algorithm for the postoperative osteomyelitis following fracture fixation according to the stability of the hardware and Cierny-Mader type represent a good clinical efficacy in the management of postoperative osteomyelitis. This procedure is simple and shows promising results, more clinical evidence is needed to confirm the existing findings and optimize the treatment of postoperative osteomyelitis following fracture fixation.

A Modified Management of Implant Associated Postoperative Osteomyelitis With Cierny-Mader Type

Background: No standardized protocol has been suggested in the treatment of postoperative osteomyelitis. Our team evaluates the clinical efficacy of the modified tactics of implant associated postoperative osteomyelitis patients according to Cierny-Mader type. Methods: 95wounds were reviewed from March 2009 to February 2016 in our hospital. 61 wounds were treated by the modified algorithm as following: Stable hardware + bone not healed Cierny–Mader 1 type = remove hardware, temporary stabilize; Stable hardware + bone not healed Cierny–Mader 2 type = retain hardware ; Stable hardware + bone not healed Cierny–Mader for type 3 and type 4 = remove hardware, temporary stabilize/ Ilizarov technique; Unstable hardware + bone not healed = remove hardware, temporary stabilize/ Ilizarov technique; Stable hardware + bone healed = remove hardware. 34 wounds were treated by the conventional algorithm. Autodermoplasty, flap transfer, myocutaneous flap and other methods including antibiotic irrigation and drug delivery system were used in wound repair. Results: The patients treated with modified algorithm had a significantly reduced recurrence (P＜0.01) , and increased results of negative bacterial cultures (P＜0.01), but however observed a decrease in the number of retained hardware cases (P＜0.05) . For those treated with tissue reconstruction, there was no significantly (P＞0.05) comparing with the conventional group. Conclusions: The modified technique for the implant associated postoperative osteomyelitis according to the stability of the hardware and Cierny-Mader type represent a good clinical efficacy in the management of postoperative osteomyelitis. This procedure is simple and shows promising results, more clinical evidence is needed to confirm the existing findings and optimize the treatment of postoperative osteomyelitis. Key Words: Osteomyelitis, Postoperation, Implant

Реостеосинтез грудины в лечении хронического послеоперационного стерномедиастинита

Postoperative osteomyelitis of the sternum and sternomediastinitis are in the group of the most severe purulent complications in thoracic surgery. The authors indicated the possibility of preserving the sternum tissue in the second stage of the treatment of postoperative sternomediastinitis. This approach is supported by the description of the clinical case of successful use of sternum reosteosynthesis in a patient with postoperative sternomediastinitis.