Author : Michalis Panteli
Publisher :
ISBN 13 :
Total Pages : pages
Book Rating : 4.:/5 (116 download)
Book Synopsis Diagnosis and Long-Term Outcomes of Posttraumatic Lower Limb Osteomyelitis by : Michalis Panteli
Download or read book Diagnosis and Long-Term Outcomes of Posttraumatic Lower Limb Osteomyelitis written by Michalis Panteli and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Introduction: Post-traumatic osteomyelitis (PTOM) is an uncommon but potentially devastating complication of trauma. The aim of our study was to describe the demographics, treatment strategies and long-term outcomes of patients presenting with post-traumatic osteomyelitis (PTOM).Patients and Methods: All consecutive patients presenting to a level 1 Trauma centre with a confirmed diagnosis of PTOM of the tibia or femur were retrospectively identified, with a minimum follow-up of five years. Patients younger than 18 years old and patients presenting without a history of trauma were excluded from further analysis. Treatment was individualised according to the patient needs and the preferences of the operating surgeon. Outcomes were assessed according pain levels and return to function. Limb function was assessed according to the Lower Extremity Functional Index (LEFI), and quality of life with the EQ-5D-3L. Results: Seventy-one patients (59 male, average age 46 years) were included. PTOM involved the tibia in 45 patients and the femur in 26 patients. Eighteen patients originally sustained an open fracture. The average time from injury to presentation was 23.6 months (median 12 months; range 3-84 months). Patients were followed-up for an average of 86 months (80 months; 60-186 months) requiring on average 2.8 surgical procedures (2 procedures; 1-12 procedures), and 2.3 readmissions (2 readmissions; 0-10 readmissions). Treatment of PTOM included removal of metalwork, radical soft tissue and bone debridement as required and administration of local and/or systemic antibiotics. The reamer-irrigator-aspirator (RIA) technique was utilised in 31 cases. Fifty-one patients received local antibiotics via a cement nail (24), spacer (16), beads (6), or a combination of techniques (5). Twenty patients required soft tissue coverage including a free-flap (10), pedicled flap (4), skin graft alone (1), or combination of techniques (5). Patients received, on average, 13.8 days (14 days; 0-47 days) of intravenous and 38.5 days (28 days; 0-365 days) of oral antibiotics.Forty-four per-cent of patients were left with a moderately/severely-impaired limb, with eight patients requiring an amputation (above knee in one patient). Recurrence of disease occurred in 16 patients. Both the use of RIA and delivery of local antibiotics were associated with significantly improved outcomes (p
