Cierny-Mader (C-M) Type III osteomyelitis is defined as a localised lesion with both medullary and cortical involvement that is stable mechanically after debridement. The treatment of C-M Type III osteomyelitisis is difficult and requires a precise protocol to achieve a disease-free longterm follow-up. We report here the results of our study on 26 patients (19 men and 7 women; average age: 34.7 years) with C-M Type III osteomylelitis who were treated with radical debridement, irrigation, vancomycin-impregnated custom-made beads and culture-specific systemic antibiotics. Those patients with metaphyseal involvement were treated with deroofing of the cortex and debridement by means of a "trough" (16 patients); those with diaphyseal involvement were treated with both intramedullary reaming and debridement from a trough (ten patients). Antibiotic cement rods were used as an additional therapy in five patients with diaphyseal involvement. Recurrence developed in three patients and was attributed to inadequate debridement; all three patients were treated again in the same manner with success. The mean follow-up is currently 3.6 years (range: 2-6 years). All of the patients have normal clinical, radiographic and laboratory parameters, and all are ambulatory and have returned to their pretreatment level of activity or better. We conclude that C-M Type III chronic osteomyelitis can be safely treated with this protocol.Résumé L'ostéomyélite de type III Cierny-Mader (C-M) peut se définir comme une localisation de lésions localisées à la fois sur la médullaire et la corticale et qui reste stable sur le plan mécanique après mise à plat. Son traitement est difficile et demande un protocole précis. Pour cette étude, nous avons suivi les résultats de 26 patients (19 hommes et 7 femmes) dont l'âge moyen était de 34.7 ans, traités par mise à plat, irrigation, et billes de vancomycine. Dans les lésions métaphysaires, la mise à plat est réalisée à travers une fenêtre (16 patients), dans les lésions diaphysaires on réalise à la fois un alésage des lésions et une mise à plat par la fenêtre (10 patients). En addition aux billes de vancomycine, un ciment aux antibiotiques a été utilisé chez 5 patients avec lésions diaphysaires. Trois patients ont présenté une récidive secondaire à une mise à plat insuffisante. Tous ces patients ont été à nouveau traités de la même manière et avec succès. Le suivi moyen a été de 3.6 ans (2 à 6 ans) et aucun patient n'a présenté d'anomalie post-opératoire des différents paramètres clinique, radiographique et biologique. Les patients peuvent marcher et ont retrouvé leur activité d'avant le traitement. L'ostéomyé-lite chronique de type III de CM peut être traitée avec succès selon ce protocole.

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III.

Background We aimed to determine the ideal surgical timing in the first 24 hours after admission to the hospital of pediatric supracondylar humerus fractures (SHF) that do not require emergent intervention. Materials and Methods Patients who underwent surgery in our institution between January 2011 and January 2019 due to pediatric Gartland type 3 SHFs were evaluated retrospectively. Open fractures, fractures associated with vascular injury and compartment syndrome, flexion type fractures were excluded. A total of 150 Gartland type 3 were included. The effect of early (<12 hours) or late (>12 hours) surgical interventions, daytime or night-time surgeries, working or non-working hour surgeries on operative parameters (operative duration and open reduction rate, reduction quality on postoperative early radiographs) were evaluated in pediatric SHFs. Results Early (<12 hours) or late (>12 hours), daytime or nighttime, working or non-working hour surgeries were found to be similar in Gartland type 3 patients regarding early postoperative reduction quality, duration of surgery, open reduction rate (p>0.05). Mean times passed from first admission to hospital until surgery were longer in working hour, late (>12 hours) and daytime surgery groups than non-working hour, early (<12 hours) and night-time surgery groups (p<0.001). Conclusion Although delaying the operation to the working hours seems to prolong the time until surgery in pediatric Gartland type 3 SHF patients who do not require emergent intervention such as open fractures, neurovascular impairment and compartment syndrome, there may not be a time interval that makes a difference for the patients if surgery is performed within the first 24 hours, thus the surgery could be scheduled according to the surgeons’ preference. Level of Evidence: Level 3, Retrospective cohort study