Difficulties and challenges to diagnose and treat post-traumatic long bone osteomyelitis

Hake, Mark E.; Oh, Jong Keon; Kim, J. W.; Ziran, Bruce H.; Smith, Wade R.; Hak, David J.; Mauffrey, Cyril

doi:10.1007/s00590-014-1576-z

Cited by 45 publications

(45 citation statements)

References 17 publications

(16 reference statements)

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“…The Cochrane Library contained four entries on imaging osteomyelitis; these were all meta-analyses of which two dealt with diabetic feet [29, 30], one with chronic, mostly post-traumatic osteomyelitis [17] and one with osteomyelitis of unspecified aetiology [25]. Screening of the reference lists of these and other relevant articles found in PubMed [8, 9, 15, 18, 31–44] yielded 18 additional studies. After removal of duplicates (n = 1023), 3358 unique publications remained and were screened on title and abstract by two authors.…”

Section: Resultsmentioning

confidence: 99%

Accuracy of diagnostic imaging modalities for peripheral post-traumatic osteomyelitis – a systematic review of the recent literature

Govaert

IJpma

McNally

et al. 2017

Eur J Nucl Med Mol Imaging

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AimsPost-traumatic osteomyelitis (PTO) is difficult to diagnose and there is no consensus on the best imaging strategy. The aim of this study is to present a systematic review of the recent literature on diagnostic imaging of PTO.MethodsA literature search of the EMBASE and PubMed databases of the last 16 years (2000–2016) was performed. Studies that evaluated the accuracy of magnetic resonance imaging (MRI), three-phase bone scintigraphy (TPBS), white blood cell (WBC) or antigranulocyte antibody (AGA) scintigraphy, fluorodeoxyglucose positron emission tomography (FDG-PET) and plain computed tomography (CT) in diagnosing PTO were considered for inclusion. The review was conducted using the PRISMA statement and QUADAS-2 criteria.ResultsThe literature search identified 3358 original records, of which 10 articles could be included in this review. Four of these studies had a comparative design which made it possible to report the results of, in total, 17 patient series. WBC (or AGA) scintigraphy and FDG-PET exhibit good accuracy for diagnosing PTO (sensitivity ranged from 50–100%, specificity ranged from 40–97% versus 83–100% and 51%–100%, respectively). The accuracy of both modalities improved when a hybrid imaging technique (SPECT/CT & FDG-PET/CT) was performed. For FDG-PET/CT, sensitivity ranged between 86 and 94% and specificity between 76 and 100%. For WBC scintigraphy + SPECT/CT, this is 100% and 89–97%, respectively.ConclusionsBased on the best available evidence of the last 16 years, both WBC (or AGA) scintigraphy combined with SPECT/CT or FDG-PET combined with CT have the best diagnostic accuracy for diagnosing peripheral PTO.

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Section: Resultsmentioning

confidence: 99%

Accuracy of diagnostic imaging modalities for peripheral post-traumatic osteomyelitis – a systematic review of the recent literature

Govaert

IJpma

McNally

et al. 2017

Eur J Nucl Med Mol Imaging

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“…Depending upon the severity of the injury and the type of host, PTO may reach rates as high as 50%, and failure to control the infection through aggressive surgical debridement and culture-based antibiotic therapy may be limb-threatening [6, 12, 18–25]. Nevertheless, risk factors for recurrent infection following surgical treatment of PTO have received little attention in the medical literature.…”

Section: Discussionmentioning

confidence: 99%

“…We considered patients in remission of infection when there was absence of clinical, laboratory, or radiological signs of infection evaluated during the last medical visit (minimum of one year of follow-up), and in cases in which there was no need for reoperation or administration of an extra course of antibiotic therapy for the same site of infection following the end of therapy [11, 15]. Treatment failure or recurrent infection was defined as infection at the same site that had been previously controlled and required reoperation and/or a second complete course of parenteral antibiotic therapy [13, 15–18]. For the purpose of study analysis, we included only the first episode of recurrence and subsequent episodes were further excluded.…”

Section: Methodsmentioning

confidence: 99%

Predisposing factors for recurrence of chronic posttraumatic osteomyelitis: a retrospective observational cohort study from a tertiary referral center in Brazil

et al. 2017

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BackgroundThe incidence of posttraumatic osteomyelitis (PTO) is increasing despite new treatment strategies. Assessment of patients’ outcomes following PTO is challenging due to multiple variables. The study goals are to determine the frequency of recurrence following PTO treatment and identify factors predisposing patients to treatment failure.MethodsBetween August 01, 2007 to August 30, 2012, a single-center retrospective cohort study was performed among 193 patients diagnosed with PTO following orthopedic surgery for fracture care. Bone and soft tissues were collected for cultures and PTO was defined according to CDC/NHSN criteria. Patient, injury, surgery-associated variables, and microbiological records were reviewed for risk factors associated to recurrence of PTO. Univariate and multivariable analyses using logistic regression were performed, with p <0.05 considered significant.ResultsThirty-eight patients (20%) of 192 diagnosed and treated for PTO failed their treatment. Factors associated with recurrence were age between 61 and 80 years [hazard ratio (HR) = 6.086, 95% confidence interval (CI) = 2.459;15.061, p = <0.001], age above 80 years [HR = 9.975 (95% CI = 3.591;27.714), p = <0.001], intraoperative blood transfusion [HR = 2.239 (95% CI = 1.138;4.406), p = 0.020], and positive culture for Pseudomonas aeruginosa [HR = 2.700 (95% CI = 1.370;5.319), p = 0.004].ConclusionsRisk factors associated with recurrence of PTO are difficult to measure. The present study revealed that elderly patients, intraoperative blood transfusions, and infection due to P. aeruginosa were independently associated with recurrence of PTO. These factors should warn clinicians of a higher failure rate following treatment of PTO. Trial registration: ISRCTN71648577. Registered 18 May 2017. Retrospectively registered.

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“…Seven patients had secondary procedures, including total knee arthroplasty, 1 ankle fusion, 1 proximal or distal tibial osteotomies, 3 tendon transfer, 1 and Achilles tendon lengthening. Follow-up ranged from 14 to 23 years.…”

Section: Resultsmentioning

confidence: 99%

“…[1][2][3] The approach is multidisciplinary and patients should be prepared for a long course of multiple surgeries and possible complications. [1][2][3] The approach is multidisciplinary and patients should be prepared for a long course of multiple surgeries and possible complications.…”

Section: Introductionmentioning

confidence: 99%

Reconstruction of Long Bone Infections Using the Induced Membrane Technique

Mauffrey

Hake

Chadayammuri

et al. 2016

Journal of Orthopaedic Trauma

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Difficulties and challenges to diagnose and treat post-traumatic long bone osteomyelitis

Cited by 45 publications

References 17 publications

Accuracy of diagnostic imaging modalities for peripheral post-traumatic osteomyelitis – a systematic review of the recent literature

Accuracy of diagnostic imaging modalities for peripheral post-traumatic osteomyelitis – a systematic review of the recent literature

Predisposing factors for recurrence of chronic posttraumatic osteomyelitis: a retrospective observational cohort study from a tertiary referral center in Brazil

Reconstruction of Long Bone Infections Using the Induced Membrane Technique

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