Lower limb post-traumatic osteomyelitis: a systematic review of clinical outcomes

Abstract

Purpose The aim of this study was to examine the patient-reported outcomes of patients presenting with post-traumatic osteomyelitis (PTOM) of the lower limb over the past 15 years. This period was chosen to reflect modern treatment principles and increased centralisation of care. Methods An electronic literature search of the relevant databases (PubMed, Ovid Medline, Embase, and the Cochrane library) was conducted to identify studies published between January 2006 and July 2021 reporting series of greater than 10 patients with PTOM of the tibia or femur at the site of a previous fracture. Studies reporting septic non-union were excluded. Results Sixteen eligible studies were identified and included in the final report. Remission of infection was achieved in 93.2% of cases (range 70–100%), whilst amputation was reported in 1–7% of cases. A variety of patient-reported outcome measures were utilised including the lower extremity functional scale, short musculoskeletal functional assessment, Enneking score, and EQ-5D-3L. Limb-specific functional outcomes returned to levels similar to that of the general population although poorer outcomes were noted in specific cohorts including those with complex anatomic disease and active medical comorbidities. Conclusion Infection following fracture fixation remains a difficult problem to treat. Regardless, using modern treatments and techniques patients can have comparable functional outcomes to that of the general population. High-quality studies are required to advance our knowledge into which types of treatments offer a benefit and how to further improve outcomes.

Silver-Coated Distal Femur Megaprosthesis in Chronic Infections with Severe Bone Loss: A Multicentre Case Series

“…In contrast, the total non-infection-related complication rate was 15.6% after the first stage and 17.8% after the second stage, in line with rates reported in the literature [2,13,27,50]. There were only two above-the-knee amputations, both related to re-infection, with an amputation rate of 4.4%, similar to the amputation rate reported in patients undergoing a two-stage procedure for the first episode of knee infection (4%) [52]; the amputation rate for chronic post-traumatic osteomyelitis, on the other hand, is reported to be up to 17% [53,54].…”

Biological aspects to enhance fracture healing

“…When combined with antibiotics such as gentamicin, calcium sulphate provides a valuable tool in providing a high concentration of local antimicrobial that elutes over a period of 4 weeks ( 133 ). The use of local antibiotics has revolutionised the management of long bone fracture-related infection, reducing recurrence rates from 30 to 40%, to less than 10% ( 134 , 135 , 136 ). Calcium sulphate bone substitutes have also been demonstrated to be efficacious when managing small bone defects (<1 cm), with graft resorption and new bone incorporation occurring over a course of 6 months with good clinical results ( 137 ).…”

Mangled extremity: limb salvage for reconstruction versus primary amputation

“…In their recent systematic review on clinical outcomes of PTOM over the last 15 years Rodham et al [37 ▪▪ ] report an overall eradication rate of PTOM of 93.2% across 16 studies. Noteworthy, the primary remission rates within the studies included in the systematic review were reported ranged between 43% and 91%.…”