One-stage debridement and bone transport versus first-stage debridement and second-stage bone transport for the management of lower limb post-traumatic osteomyelitis
Background: Treatment of lower limb post-traumatic osteomyelitis used to be a staged process, with radical debridement of bone and soft tissues at first stage, followed by a second-stage limb reconstruction operation to restore the limb integrity. Some studies recently reported that achieving infect...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-05-01
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| Series: | Journal of Orthopaedic Translation |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214031X20301595 |
| _version_ | 1818865475345448960 |
|---|---|
| author | Chun-Hao Zhou Ying Ren Hui-Juan Song Abdulnassir Adem Ali Xiang-Qing Meng Lei Xu, Ph. D, MD Hong-An Zhang Jia Fang Cheng-He Qin, Ph. D, MD |
| author_facet | Chun-Hao Zhou Ying Ren Hui-Juan Song Abdulnassir Adem Ali Xiang-Qing Meng Lei Xu, Ph. D, MD Hong-An Zhang Jia Fang Cheng-He Qin, Ph. D, MD |
| author_sort | Chun-Hao Zhou |
| collection | DOAJ |
| description | Background: Treatment of lower limb post-traumatic osteomyelitis used to be a staged process, with radical debridement of bone and soft tissues at first stage, followed by a second-stage limb reconstruction operation to restore the limb integrity. Some studies recently reported that achieving infection eradication and limb reconstruction at single-stage seems to be an effective method for lower limb infection, but a comparative study remains lacking. This study aims to compare the results of radical debridement combined with a first/second-staged osteotomy and bone transport, for the management of lower limb post-traumatic osteomyelitis. Methods: From January 2013 to June 2018, a total of 102 patients with lower limb post-traumatic osteomyelitis met the criteria were included for analysis, in which 70 patients received one-stage debridement, antibiotic-loaded implantation, metaphysis osteotomy and bone transport were named as one-stage group, while 32 patients with first-stage debridement and antibiotic-loaded calcium sulfate implantation, second-stage osteotomy and bone transport were devised as two-stage group. The outcomes of hospitalization (hospital stay, costs of treatment, surgical time, antibiotic usage) and follow-up (infection-free, treatment failure, infection recurrence, external fixation index (EFI) and docking site union) between the two groups were retrospectively compared. Results: For outcomes of hospitalization, patients in the one-stage group had batter results on hospital stay (18.2 days versus 28.9 days, P < 0.05), surgical time (164.8 min versus 257.4 min, P < 0.05), cost of treatment (¥101726.1 versus ¥126718.8, P < 0.05) and the course of antibiotic usage (10.3 days versus 12.0 days, P < 0.05). During the follow-up, 87.1% (61/70) patients in the one-stage group compared to 93.8% (30/32) patients in the two-stage group achieved infection-free (P > 0.05) without any additional debridement operation. 94.3% (66/70) patients in the one-stage group earned wound healing after the operation, comparing to 96.9% (31/32) patients healed in the two-stage group (P > 0.05). Uncontrolled infection was observed on 4 (5.7%) patients in the one-stage group and 1 (3.1%) patients in the two-stage group (P > 0.05), with a result of three achieved infection free in the one-stage group and one patient suffered from amputation in each group respectively. 5 (7.2%) patients in the one-stage group and 1 (3.2%) patient in the two-stage group encountered with infection recurrence (P > 0.05) and were well-managed with re-debridement and antibiotics usage. Significance was not found between two groups on EFI (74.8 days/cm versus 69.0 days/cm, P > 0.05) and docking site nonunion rate (14.5% versus 18.9%, P > 0.05), indicating that bone transport in different stages played a less essential role on bone generation process. The other complications, such as prolonged aseptic drainage [24.3% (17/70) versus 21.9% (7/32)], re-fracture [5.8% (4/69) versus 3.2% (1/31)], pin-tract infection [23.2% (16/69) versus 19.4% (6/31)], joint stiffness and deformity [26.1% (18/69) versus 32.3% (10/31)], also showed less significance when comparing between two groups (P > 0.05), suggesting that different transport stages play little role on complications formation. Conclusions: One-stage radical debridement and bone transport was proven to be a safe and effective method for treating static (or near static) lower limb osteomyelitis. Translational potential statement: Translational potential statement One-stage debridement and bone transport is sample, effective and time-saving, with similar complications compared to conventional two-stage protocol. This treatment protocol might provide an alternative for the treatment of static (or near static) lower limb osteomyelitis. |
| first_indexed | 2024-12-19T10:48:08Z |
| format | Article |
| id | doaj.art-c950fac55d734815b667e3b139b51356 |
| institution | Directory Open Access Journal |
| issn | 2214-031X |
| language | English |
| last_indexed | 2024-12-19T10:48:08Z |
| publishDate | 2021-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Orthopaedic Translation |
| spelling | doaj.art-c950fac55d734815b667e3b139b513562022-12-21T20:25:10ZengElsevierJournal of Orthopaedic Translation2214-031X2021-05-01282127One-stage debridement and bone transport versus first-stage debridement and second-stage bone transport for the management of lower limb post-traumatic osteomyelitisChun-Hao Zhou0Ying Ren1Hui-Juan Song2Abdulnassir Adem Ali3Xiang-Qing Meng4Lei Xu, Ph. D, MD5Hong-An Zhang6Jia Fang7Cheng-He Qin, Ph. D, MD8Department of Orthopaedics and Traumatology, Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, PR China; Department of Orthopaedics and Traumatology, Guangdong Second Provincial General Hospital, Guangzhou, 510317, PR ChinaDepartment of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, PR ChinaDepartment of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, PR ChinaDepartment of Orthopaedics and Traumatology, Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, PR ChinaDepartment of Orthopaedics and Traumatology, Guangdong Second Provincial General Hospital, Guangzhou, 510317, PR ChinaDepartment of Orthopaedics and Traumatology, Guangdong Second Provincial General Hospital, Guangzhou, 510317, PR ChinaDepartment of Orthopaedics and Traumatology, Guangdong Second Provincial General Hospital, Guangzhou, 510317, PR ChinaDepartment of Orthopaedics and Traumatology, Guangdong Second Provincial General Hospital, Guangzhou, 510317, PR ChinaDepartment of Orthopaedics and Traumatology, Guangdong Second Provincial General Hospital, Guangzhou, 510317, PR China; Corresponding author. Department of Orthopaedics and Traumatology, Guangdong second provincial general hospital, Guangzhou, 510317, PR China.Background: Treatment of lower limb post-traumatic osteomyelitis used to be a staged process, with radical debridement of bone and soft tissues at first stage, followed by a second-stage limb reconstruction operation to restore the limb integrity. Some studies recently reported that achieving infection eradication and limb reconstruction at single-stage seems to be an effective method for lower limb infection, but a comparative study remains lacking. This study aims to compare the results of radical debridement combined with a first/second-staged osteotomy and bone transport, for the management of lower limb post-traumatic osteomyelitis. Methods: From January 2013 to June 2018, a total of 102 patients with lower limb post-traumatic osteomyelitis met the criteria were included for analysis, in which 70 patients received one-stage debridement, antibiotic-loaded implantation, metaphysis osteotomy and bone transport were named as one-stage group, while 32 patients with first-stage debridement and antibiotic-loaded calcium sulfate implantation, second-stage osteotomy and bone transport were devised as two-stage group. The outcomes of hospitalization (hospital stay, costs of treatment, surgical time, antibiotic usage) and follow-up (infection-free, treatment failure, infection recurrence, external fixation index (EFI) and docking site union) between the two groups were retrospectively compared. Results: For outcomes of hospitalization, patients in the one-stage group had batter results on hospital stay (18.2 days versus 28.9 days, P < 0.05), surgical time (164.8 min versus 257.4 min, P < 0.05), cost of treatment (¥101726.1 versus ¥126718.8, P < 0.05) and the course of antibiotic usage (10.3 days versus 12.0 days, P < 0.05). During the follow-up, 87.1% (61/70) patients in the one-stage group compared to 93.8% (30/32) patients in the two-stage group achieved infection-free (P > 0.05) without any additional debridement operation. 94.3% (66/70) patients in the one-stage group earned wound healing after the operation, comparing to 96.9% (31/32) patients healed in the two-stage group (P > 0.05). Uncontrolled infection was observed on 4 (5.7%) patients in the one-stage group and 1 (3.1%) patients in the two-stage group (P > 0.05), with a result of three achieved infection free in the one-stage group and one patient suffered from amputation in each group respectively. 5 (7.2%) patients in the one-stage group and 1 (3.2%) patient in the two-stage group encountered with infection recurrence (P > 0.05) and were well-managed with re-debridement and antibiotics usage. Significance was not found between two groups on EFI (74.8 days/cm versus 69.0 days/cm, P > 0.05) and docking site nonunion rate (14.5% versus 18.9%, P > 0.05), indicating that bone transport in different stages played a less essential role on bone generation process. The other complications, such as prolonged aseptic drainage [24.3% (17/70) versus 21.9% (7/32)], re-fracture [5.8% (4/69) versus 3.2% (1/31)], pin-tract infection [23.2% (16/69) versus 19.4% (6/31)], joint stiffness and deformity [26.1% (18/69) versus 32.3% (10/31)], also showed less significance when comparing between two groups (P > 0.05), suggesting that different transport stages play little role on complications formation. Conclusions: One-stage radical debridement and bone transport was proven to be a safe and effective method for treating static (or near static) lower limb osteomyelitis. Translational potential statement: Translational potential statement One-stage debridement and bone transport is sample, effective and time-saving, with similar complications compared to conventional two-stage protocol. This treatment protocol might provide an alternative for the treatment of static (or near static) lower limb osteomyelitis.http://www.sciencedirect.com/science/article/pii/S2214031X20301595OsteomylitisSegmental bone defectBone transportDistraction osteogenesisExternal fixation |
| spellingShingle | Chun-Hao Zhou Ying Ren Hui-Juan Song Abdulnassir Adem Ali Xiang-Qing Meng Lei Xu, Ph. D, MD Hong-An Zhang Jia Fang Cheng-He Qin, Ph. D, MD One-stage debridement and bone transport versus first-stage debridement and second-stage bone transport for the management of lower limb post-traumatic osteomyelitis Journal of Orthopaedic Translation Osteomylitis Segmental bone defect Bone transport Distraction osteogenesis External fixation |
| title | One-stage debridement and bone transport versus first-stage debridement and second-stage bone transport for the management of lower limb post-traumatic osteomyelitis |
| title_full | One-stage debridement and bone transport versus first-stage debridement and second-stage bone transport for the management of lower limb post-traumatic osteomyelitis |
| title_fullStr | One-stage debridement and bone transport versus first-stage debridement and second-stage bone transport for the management of lower limb post-traumatic osteomyelitis |
| title_full_unstemmed | One-stage debridement and bone transport versus first-stage debridement and second-stage bone transport for the management of lower limb post-traumatic osteomyelitis |
| title_short | One-stage debridement and bone transport versus first-stage debridement and second-stage bone transport for the management of lower limb post-traumatic osteomyelitis |
| title_sort | one stage debridement and bone transport versus first stage debridement and second stage bone transport for the management of lower limb post traumatic osteomyelitis |
| topic | Osteomylitis Segmental bone defect Bone transport Distraction osteogenesis External fixation |
| url | http://www.sciencedirect.com/science/article/pii/S2214031X20301595 |
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