Therapeutic decision in chronic osteomyelitis: sinus track culture versus intraoperative bone culture

Akinyoola, AL; Adegbehingbe, Olayinka O; Aboderin, Aaron O.

doi:10.1007/s00402-008-0621-y

Cited by 29 publications

(32 citation statements)

References 13 publications

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“…In former situations, the dead bone acts as a foreign body and continues to generate discharge from the wound. Negative sinus tract culture reports have been reported by other researchers too who reported it to have a very low sensitivity, specificity, and positive predictive value 24–26. We found all the intraoperative specimen cultures to be positive, suggesting it to be a more preferable method to decide an appropriate antibiotic regimen in chronic osteomyelitis.…”

Section: Discussionsupporting

confidence: 46%

Use of antibiotic cement-impregnated intramedullary nail in treatment of infected non-union of long bone

et al. 2009

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Background:In cases with infected non-union, the primary step is eradication of the infection before attempting to achieve union. Release of antibiotics from the bone cement at a high concentration and its penetration to the surrounding tissues, including cortical and cancellous bone, prompted the use of antibiotic cement in the control of bone infection. The aim of this study is to summarize our experience with the use of antibiotic cement-impregnated intramedullary nail (ACIIN) for control of infection in cases of infected non-union with bone defect.Materials and Methods:We prospectively studied 25 cases of infected non-union (23 femora and two tibiae). There were 24 males and one female, with the mean age being 33 years (range, 21–58 years). All patients had high-velocity road traffic accidents except one patient who had farmland injury. There were seven closed fractures, one grade I compound, two grade II compound fractures, five grade IIIA compound fractures, and 10 grade IIIB compound fractures. ACIIN was used in all cases after adequate debridement. Patients were classified according to the amount of bone defect present after debridement: group 1 with bone defect <4 cm (n=13), group 2 with bone defect ≥4–<6 cm (n=7), and group 3 with bone defect ≥6 cm (n=5). Infection control was judged on the basis of discharge through the wound and laboratory parameters. All patients were followed-up, with an average follow-up time of 29 months (range, 18–40 months). The mean duration of retention of the intramedullary rod was 8 weeks (range, 6–12 weeks).Results:In group 1, all cases achieved infection control, with three patients achieving bone union without any need of secondary procedure. In group 2, all cases achieved infection control but the time taken was significantly longer than for group 1 (P value 0.0002). All the cases required a secondary procedure in the form of either interlocking intramedullary nailing with iliac crest bone graft or Ilizarov ring fixator application to achieve union. None of the cases in group 3 achieved infection control.Conclusion:ACIINs are useful for infection control in cases of infected non-union with bone defect <6 cm. In cases with defect >6 cm, other alternatives should be used.

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Section: Discussionsupporting

confidence: 46%

Use of antibiotic cement-impregnated intramedullary nail in treatment of infected non-union of long bone

et al. 2009

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“…Long term infection and repeated debridement create excessive fibrosis around the nonunion site and hinder antibiotic permeability 21 . Hence, delivery of antibiotics to the local site is far more beneficial than systemic administration of antibiotics.…”

Section: Discussionmentioning

confidence: 99%

Role of Antibiotic Cement Coated Nailing in Infected Nonunion of Tibia

Bhatia

Sharma

et al. 2017

MOJ

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IntroductionInfected nonunion of long bones is a chronic and debilitating disorder. It is more difficult to deal with when the implant used for internal fixation itself becomes a potential media for infection because of bacterial adhesion and biofilm formation. Traditionally, it is managed by two-stage procedure for controlling the infection first and then treating the nonunion. This study has been undertaken to explore antibiotic cement coated nailing as single stage treatment modality for treating infection and achieving stability at the same time.Materials and MethodsTwenty patients (above 18 years of age) with infected nonunion of tibia with bone gap less than 2 cm were managed using antibiotic cement coated K-nail. Antibiotic cement nail was prepared using endotracheal tube method. Antibiotics used were a combination of vancomycin and teicoplanin.ResultsInfection was controlled in 95% of the patients. Bony union was achieved in 12 of 20 (60%) patients with antibiotic cement nailing as the only procedure with average time of union of 32 weeks. Remaining 8 patients required additional procedures like bone grafting or exchange nailing and these were done in six patients, with union of fracture. Two patients refused to undergo further procedures. Complications encountered were difficult nail removal in three cases, broken nail in two cases, and bent nail in one case. Recurrence of infection was observed in two patients. Average period of follow-up was 13 months.ConclusionAntibiotic cement impregnated nailing is a simple, economical and effective single stage procedure for the management of infected nonunion of tibia. It is advantageous over external fixators, as it eliminates the complications of external fixators and has good patient compliance. The method utilizes existing easily available instrumentation and materials and is technically less demanding, and therefore can be performed at any general orthopaedic center.

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“…Biopsy of the infected area is an invasive procedure and not always diagnostic (50% sensitivity has been reported) (6)(7)(8). MRI is a sensitive but nonspecific technique and is contraindicated in patients with a prosthesis or bone implant (9).…”

Section: Discussionmentioning

confidence: 99%

⁶⁸Ga-Citrate PET/CT for Evaluating Patients with Infections of the Bone: Preliminary Results

Nanni¹,

Errani²,

Boriani³

et al. 2010

J Nucl Med

117

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The aim of this work was to preliminarily evaluate the sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of 68 Ga-citrate PET/CT in a population of patients with suspected bone infections. Methods: We enrolled 31 patients with suspected osteomyelitis or diskitis who underwent a total of forty 68 Ga-citrate PET/CT scans. The results were compared with different combinations of diagnostic procedures (MRI, radiography, CT, or white blood cell scintigraphy), biopsy (when diagnostic), and follow-up data (at least 1 y) to determine the performance of 68 Ga-citrate PET/CT. Results: We found a sensitivity of 100%, a specificity of 76%, a positive predictive value of 85%, a negative predictive value of 100%, and an overall accuracy of 90%. Conclusion: Although preliminary, these data confirm a possible role for 68 Ga-citrate in the diagnosis of bone infections, especially in consideration of its favorable characteristics.

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Therapeutic decision in chronic osteomyelitis: sinus track culture versus intraoperative bone culture

Abstract: IBC appears to predict more reliably the complete etiologic organisms than STCs in chronic osteomyelitis.

Cited by 29 publications

References 13 publications

Use of antibiotic cement-impregnated intramedullary nail in treatment of infected non-union of long bone

Use of antibiotic cement-impregnated intramedullary nail in treatment of infected non-union of long bone

Role of Antibiotic Cement Coated Nailing in Infected Nonunion of Tibia

⁶⁸Ga-Citrate PET/CT for Evaluating Patients with Infections of the Bone: Preliminary Results

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Therapeutic decision in chronic osteomyelitis: sinus track culture versus intraoperative bone culture

Abstract: IBC appears to predict more reliably the complete etiologic organisms than STCs in chronic osteomyelitis.

Cited by 29 publications

References 13 publications

Use of antibiotic cement-impregnated intramedullary nail in treatment of infected non-union of long bone

Use of antibiotic cement-impregnated intramedullary nail in treatment of infected non-union of long bone

Role of Antibiotic Cement Coated Nailing in Infected Nonunion of Tibia

68Ga-Citrate PET/CT for Evaluating Patients with Infections of the Bone: Preliminary Results

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⁶⁸Ga-Citrate PET/CT for Evaluating Patients with Infections of the Bone: Preliminary Results