Effectiveness of an Antibiotic-impregnated Bioabsorbable Carrier for the Treatment of Chronic Intramedullary and Diffuse Osteomyelitis.

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Abstract

Conflict of interest statement: Source of support: Nil Conflict of interest: Dr. Badri Narayan is associated as the Specialty Section Editor (Trauma) of this journal and this manuscript was subjected to this journal's standard review procedures, with this peer review handled independently of this editorial board member and his research group. 11. Bone Jt Open. 2023 Aug 24;4(8):643-651. doi: 10.1302/2633-1462.48.BJO-2023-0017.R1. Surgical debridement in long bone chronic osteomyelitis: is wide tumour-like resection necessary? Langit MB(1)(2), Tay KS(1), Al-Omar HK(1), Barlow G(3), Bates J(4), Chuo CB(5), Muir R(1), Sharma H(1). Author information: (1)Department of Orthopaedics, Hull University Teaching Hospitals NHS Trust, Hull, UK. (2)Department of Orthopedics, Philippine Orthopedic Center, Quezon City, Philippines. (3)Department of Infectious Diseases, Hull University Teaching Hospitals NHS Trust, Hull, UK. (4)Department of Radiology, Hull University Teaching Hospitals NHS Trust, Hull, UK. (5)Department of Plastic and Reconstructive Surgery, Hull University Teaching Hospitals NHS Trust, Hull, UK. AIMS: The standard of wide tumour-like resection for chronic osteomyelitis (COM) has been challenged recently by adequate debridement. This paper reviews the evolution of surgical debridement for long bone COM, and presents the outcome of adequate debridement in a tertiary bone infection unit. METHODS: We analyzed the retrospective record review from 2014 to 2020 of patients with long bone COM. All were managed by multidisciplinary infection team (MDT) protocol. Adequate debridement was employed for all cases, and no case of wide resection was included. RESULTS: A total of 53 patients (54 bones) with median age of 45.5 years (interquartile range 31 to 55) and mean follow-up of 29 months (12 to 59) were included. In all, ten bones were Cierny-Mader type I, 39 were type III, and five were type IV. All patients were treated with single-staged management, except for one (planned two-stage stabilization). Positive microbial cultures grew in 75%. Overall, 46 cases (85%) had resolution of COM after index procedure, and 49 (90.7%) had resolution on last follow-up. Four patients (7%) underwent second surgical procedure and six patients (11%) had complications. CONCLUSION: We challenge the need for wide tumour-like resection in all cases of COM. Through detailed preoperative evaluation and planning with MDT approach, adequate debridement and local delivery of high concentration of antibiotic appears to provide comparable outcomes versus radical debridement. © 2023 Author(s) et al. DOI: 10.1302/2633-1462.48.BJO-2023-0017.R1 PMCID: PMC10446974