Long-term outcomes of lower limb post-traumatic osteomyelitis

Abstract

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.

Mangled extremity: limb salvage for reconstruction versus primary amputation

“…In recent years several publications have reported on the midterm patient reported outcomes of post traumatic osteomyelitis (PTOM) [28–32,33 ▪▪ ]. With respect to the LEFS (Lower Extremity Functional Score) outcomes in the PTOM population were substantially worse than those seen in the standard fracture population, even in cases with a complete remission of the infection.…”

“…One of the longest follow up periods (111 months) is reported by Rodham et al [33 ▪▪ ] on a cohort of 72 patients with chronic osteomyelitis [46 tibia, 26 femur, median age 47 years, interquartile range (IQR) 24, range 18–72]. Patients with PTOM report functional outcomes below that of the general population, even when in remission.…”

“…While Rodham et al saw persistent functional deficits even after the infection had been eradicated, Wu et al [32] report a moderately reduced functional outcome with an average LEFS score of 65.6 (ranging between 37 and 80), which equals 82% of maximal function. In a similar context Egol et al [33 ▪▪ ] report an average dysfunction score [short musculoskeletal function assessment (SMFA)] of 53.8 (range 41.9–76.3) and a main bother index of 51.5 (range 42.6–73.9), which indicates no overall difference in function compared to the general population.…”

Solute carrier family 11 member 1 genetic polymorphisms rs17235409 and rs3731865 associate with susceptibility to extremity post‐traumatic osteomyelitis in a Chinese Han population

“…Osteomyelitis (OM), known as bone infection and distinguished by inflammation‐related bone erosion with or without new bone formation, involves the osseous tissue with or without the surrounding soft tissue (Lew & Waldvogel, 1997). Post‐traumatic osteomyelitis (PTOM), also referred to as fracture‐related infection (FRI), often occurs following injury and orthopaedic surgery (Rodham et al., 2022). It was estimated that 1%–2% of patients with closed fractures might develop PTOM.…”

“…Post-traumatic osteomyelitis (PTOM), also referred to as fracture-related infection (FRI), often occurs fol-Nan Jiang and Yong-Cong Zhong contributed equally to this study. lowing injury and orthopaedic surgery (Rodham et al, 2022). It was estimated that 1%-2% of patients with closed fractures might develop PTOM.…”