Background Childhood chronic haematogenous osteomyelitis (CCHOM) is a severe condition in paediatric patients. The optimal timing of debridement and the subsequent method of bone reconstruction in CCHOM patients remain controversial. The purpose of this study was to assess the treatment efficacy of Masquelet technique with early debridement and internal fixation in CCHOM of long bones. Methods Between January 2016 and January 2021, a total of 21 patients (18 males, 3 females) with CCHOM of long bone were included. The mean age was 10.4 years (range, 2–18 years). All cases were treated by a two-stage surgical protocol of Masquelet technique. In the first stage, aggressive debridement, sequestrectomy, and inducing membrane by bone cement spacer were performed after definite diagnosis. In the second stage, cement spacer was removed, and autologous and allogeneic bone was grafted. Internal fixation was used for the first and/or second stage depending on stability requirements. The patients’ clinical and imaging results were retrospectively analysed. Results The mean follow-up was 31.7 months (range, 21–61 months). None of the patients experienced recurrence of infection. Radiographic bone union time was 4.3 months (range, 2.5–11 months). Five cases underwent re-operation due to complications such as bone resorption or refracture. By the last follow-up visit, bones had healed and all of the patients had resumed daily living and sports activities. Conclusion The Masquelet technique with early debridement and internal fixation is a viable surgical method for the management of large long bone defects of CCHOM patients.
Background Childhood chronic haematogenous osteomyelitis (CCHOM) is a severe condition in paediatric patients. The optimal timing of debridement and the subsequent method of bone reconstruction in CCHOM patients remain controversial. The purpose of this study was to assess the treatment efficacy of Masquelet technique with early debridement and internal fixation in CCHOM of long bones. Methods Between January 2016 and January 2021, a total of 21 patients (18 males, 3 females) with CCHOM of long bone were included. The mean age was 10.4 years (range, 2–18 years). All cases were treated by a two-stage surgical protocol of Masquelet technique. In the first stage, aggressive debridement, sequestrectomy, and inducing membrane by bone cement spacer were performed after definite diagnosis. In the second stage, cement spacer was removed, and autologous and allogeneic bone were grafted. Internal fixation was used for the first and/or second stage depending on stability requirements. The patients’ clinical and imaging results were retrospectively analysed. Results The mean follow-up was 31.7 months (range, 21–61 months). None of the patients experienced recurrence of infection. Radiographic bone union time was 4.3 months (range, 2.5–11 months). Five cases underwent re-operation due to complications such as bone resorption or refracture. By the last follow-up visit, bones had healed and all of the patients had resumed daily living and sports activities. Conclusions The Masquelet technique with early debridement and internal fixation is a viable surgical method for the management of large long bone defects of CCHOM patients.
Background To evaluate the clinical efficacy and feasibility of a two-stage surgery using the induced membrane technique combined with antibiotic-loaded bone cement sustained-release for patients with chronic hematogenous osteomyelitis (CHOM) of the femur or tibia. Methods In this case series study, data of patients with CHOM underwent the two-stage surgery in our Hospital between January 2016 and June 2019 were retrospectively analyzed. Results A total of 18 patients (16 men) with an average age of 32.1 (range from 16 to 56) years old were included. The average duration of disease was 17.8 (range from 1.2 to 42) years. The infection was located in tibia in 10 cases and femur in 8 cases. Besides, 10 cases had sinus tract or local redness, swelling, as well as fever of the affected limbs preoperatively. After the surgery, all patients were followed up for 29.1 (range from 22 to 47) months. At the end of follow-up, no recurrence of infection, swelling and pus was found. The white blood cell count, C-reactive protein (CRP) level, and erythrocyte sedimentation rate (ESR) were all returned to normal ranges. Conclusions The two-stage surgery using the induced membrane technique combined with antibiotic-loaded bone cement sustained-release might be a feasible and effective treatment for adult patients with CHOM.
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