Can we predict outcome after treatment of long bone osteomyelitis?

Hotchen, Andrew J.; Dudareva, Maria; Corrigan, Ruth; Ferguson, Jamie; McNally, Martin

doi:10.1302/0301-620x.102b11.bjj-2020-0284.r1

Cited by 28 publications

(27 citation statements)

References 21 publications

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“…As a classification system, it is a useful guide for predicting outcomes. Osteomyelitis classified as ‘uncomplicated’ is a good prognostic indicator for improved quality of life following intervention ( 36 ).…”

Section: Resultsmentioning

confidence: 99%

Management of fracture-related infection in low resource settings: how applicable are the current consensus guidelines?

Tissingh

Marais

Loro³

et al. 2022

EFORT Open Reviews

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The global burden of fracture-related infection (FRI) is likely to be found in countries with limited healthcare resources and strategies are needed to ensure the best available practice is context appropriate. This study has two main aims: (i) to assess the applicability of recently published expert guidance from the FRI consensus groups on the diagnosis and management of FRI to low- and middle-income countries (LMICs); (ii) to summarise the available evidence on FRI, with consideration for strategies applicable to low resource settings. Data related to the International Consensus Meeting Orthopaedic Trauma Work Group and the International Fracture Related Infection Consensus Group FRI guidelines were collected including panel membership, country of origin, language of publication, open access status and impact factor of the journal of publication. The recommendations and guidelines were then summarised with specific consideration for relevance and applicability to LMICs. Barriers to implementation were explored within a group of LMIC residents and experienced workers. The authorship, evidence base and reach of the FRI consensus guidelines lack representation from low resource settings. The majority of authors (78.5–100%) are based in high-income countries and there are no low-income country collaborators listed in any of the papers. All papers are in English. The FRI consensus guidelines give a clear set of principles for the optimum management of FRI. Many of these – including the approach to diagnosis, multidisciplinary team working and some elements of surgical management – are achievable in low resource settings. Current evidence suggests that it is important that a core set of principles is prioritised but robust evidence for this is lacking. There are major organisational and infrastructure obstacles in LMICs that will make any standardisation of FRI diagnosis or management challenging. The detail of how FRI consensus principles should be applied in low resource settings requires further work. The important work presented in the current FRI consensus guidelines is relevant to low resource settings. However, leadership, collaboration, creativity and innovation will be needed to implement these strategies for communities who need it the most.

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Section: Resultsmentioning

confidence: 99%

Management of fracture-related infection in low resource settings: how applicable are the current consensus guidelines?

Tissingh

Marais

Loro³

et al. 2022

EFORT Open Reviews

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“…Amputation is frequently utilised as a surrogate for poor outcome or treatment failure; however, there is an increasing body of literature supporting early amputation under circumstances, where the outcome is likely to be poor, or the morbidity of treatment high. Multiple studies in trauma have demonstrated that early amputation results in fewer overall complications, more rapid resolution of symptoms and equivalent or superior functional outcomes to those undergoing limb reconstruction techniques [44][45][46][47]. It is important, therefore, that the concept of functional amputation, where this approach is considered as a treatment choice rather than a last resort, is developed and discussed with patients at an early stage.…”

Section: Amputationmentioning

confidence: 99%

Long-term outcomes of lower limb post-traumatic osteomyelitis

Rodham

Panteli²,

Qin³

et al. 2022

Eur J Trauma Emerg Surg

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Purpose Whilst recurrence and amputation rates in post-traumatic osteomyelitis (PTOM) are described, limb specific functional outcomes are not, leading to a knowledge gap when counselling patients prior to management. We aim to investigate the patient reported outcomes (PROMS) of this patient group to provide reference for discussions with patients prior to embarking on treatment. Methods Single institution cross-sectional retrospective study of all patients presenting with PTOM of the tibia/femur over a 7-year period. Alongside recurrence and amputation rates, patient reported outcomes were recorded including the lower extremity functional scale (LEFS), EQ-5D-3L and EQ-VAS. Results Seventy-two patients (59 male; median age 46 years) were identified. Treatment was principle-based and included debridement (with Reamer-Irrigator-Aspirator (RIA) in 31/72), local antibiotics (52/72), soft tissue reconstruction (21/72) and systemic antibiotic therapy in all cases. PROMS were collected in 84% of all eligible patients at a median of 112-month post-treatment. Twelve patients experienced recurrence, whilst nine underwent amputation. The median LEFS was 60, the EQ-5D-3L index score was 0.760, and the EQ-VAS was 80. These scores are substantially lower than those seen in the general population (77, 0.856 and 82.2, respectively). LEFS was significantly higher, where RIA was utilised (69.6 vs 52.8; p = 0.02), and in those classified as BACH uncomplicated (74.4 vs 58.4; p = 0.02). EQ-5D-3L was also higher when RIA was utilised (0.883 vs 0.604; p = 0.04), with no difference in EQ-VAS scores. Conclusions Patients with PTOM report functional outcomes below that of the general population, even when in remission. Improved outcomes were associated with uncomplicated disease and the use of RIA.

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“…In 2018, organizations including the European Bone and Joint Infection Society and the Association for the Study of Internal Fixation worked together to develop a consensus on FRI to standardize the clinical reports and improve the quality of published literature ( Metsemakers et al, 2018 ; Govaert et al, 2020 ). Despite advances in the treatment of FRI, the diagnosis and treatment of FRI are still in the process of continuous exploration due to its diversity and complexity ( Foster et al, 2020 ; Hak, 2020 ; Hotchen et al, 2020 ; Metsemakers et al, 2020 ). Understanding the epidemiology and risk factors for FRI may lead to better prevention and treatment methods in the future.…”

Section: Introductionmentioning

confidence: 99%

Epidemiology and Drug Resistance of Fracture-Related Infection of the Long Bones of the Extremities: A Retrospective Study at the Largest Trauma Center in Southwest China

et al. 2022

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ObjectiveTo describe the demographic characteristics, risk factors, and bacterial resistance of fracture-related infection (FRI) of the long bones of the extremities.Materials and MethodsThis single-center study retrospectively evaluated patients with FRI of the long bones of the extremities at West China Hospital between January 2012 and December 2017, and analyzed the demographic characteristics, risk factors, distribution of pathogenic bacteria, and bacterial drug resistance.ResultsAmong 9,900 patients, 535 patients (5.4%) were diagnosed with FRI. The most common site of FRI was tibiofibular (298, 55.7%), with 424 cases (79.2%) of open fractures, and 282 cases (52.7%) due to traffic injuries. The 41–50 years age group had the highest incidence of FRI with 157 (29.3%) cases. Overall, 546 strains of 52 types of bacteria were detected in FRI patients, with 105 strains of multidrug-resistant (MDR) bacteria. Methicillin-resistant Staphylococcus aureus (48, 8.8%) and extended-spectrum-β-lactamase Escherichia coli (32, 5.8%) accounted for the largest proportion. Multivariate logistic regression analysis showed that sex (odds ratio [OR] 1.813; 95% confidence interval [CI], 1.071∼3.070; P = 0.027) and fracture type (OR 3.128; 95% CI, 1.683∼5.815; P < 0.001) were independent risk factors for monomicrobial infection (MI). Female sex (OR 4.190; 95% CI, 1.212∼14.486; P = 0.024) was an independent risk factor for polymicrobial infection (PI).ConclusionThis study clarified the infection rates, changes in the bacterial spectrum, and drug resistance characteristics, and risk factors of FRI of the long bones of the extremities in the largest trauma center in southwest China.

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Can we predict outcome after treatment of long bone osteomyelitis?

Cited by 28 publications

References 21 publications

Management of fracture-related infection in low resource settings: how applicable are the current consensus guidelines?

Management of fracture-related infection in low resource settings: how applicable are the current consensus guidelines?

Long-term outcomes of lower limb post-traumatic osteomyelitis

Epidemiology and Drug Resistance of Fracture-Related Infection of the Long Bones of the Extremities: A Retrospective Study at the Largest Trauma Center in Southwest China

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