Takeout or delivery? Reoperation rates in lower extremity long bone osteomyelitis treated with debridement and local antibiotic delivery systems

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma Pub Date : 2024-11-22 DOI:10.1016/j.jcot.2024.102839

Nolan M. Reinhart , Jackson P. Tate , Jacob S. Budin , Julianna E. Winter , Olivia C. Lee , William F. Sherman

{"title":"Takeout or delivery? Reoperation rates in lower extremity long bone osteomyelitis treated with debridement and local antibiotic delivery systems","authors":"Nolan M. Reinhart , Jackson P. Tate , Jacob S. Budin , Julianna E. Winter , Olivia C. Lee , William F. Sherman","doi":"10.1016/j.jcot.2024.102839","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Early diagnosis and treatment of osteomyelitis is essential to prevent potential complications including sepsis, extensive bone resection, amputation, and death. Despite current treatment strategies for management of osteomyelitis, recurrence rates reported in the literature are upwards of 25 %. Current evidence comparing the efficacy of differing surgical treatments of osteomyelitis is inconclusive. The purpose of this study is to compare rates of re-debridement and amputation in patients who receive either debridement alone or debridement with placement of local antibiotic delivery systems as initial treatment for lower extremity long bone osteomyelitis.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was performed to investigate complication rates after surgical treatment methods for osteomyelitis of the femur and tibia. The rates of re-debridement and amputation were compared in patients who received either debridement alone or debridement with placement of local antibiotic delivery systems.</div></div><div><h3>Results</h3><div>This study reports 73 % lower rates of re-debridement after debridement and local antibiotic delivery in tibial osteomyelitis, and 83 % lower rates of re-debridement after debridement and placement of local antibiotic delivery systems in femoral osteomyelitis compared to debridement alone. There was no significant difference in amputation rates between treatment groups for either tibial (7.4 vs 5.7 %; OR: 1.31; 95 % CI, 0.92–1.87) or femoral osteomyelitis (2.4 vs 1.4 %; OR: 1.65; 95 % CI, 0.71–4.01).</div></div><div><h3>Conclusion</h3><div>There was a significantly decreased likelihood of re-debridement for patients who underwent initial treatment with combined debridement and placement of antibiotic delivery systems compared to debridement alone. Providers may consider this when comparing treatment options for their patients with lower extremity osteomyelitis.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"59 ","pages":"Article 102839"},"PeriodicalIF":0.0000,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Orthopaedics and Trauma","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0976566224005083","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"Medicine","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Early diagnosis and treatment of osteomyelitis is essential to prevent potential complications including sepsis, extensive bone resection, amputation, and death. Despite current treatment strategies for management of osteomyelitis, recurrence rates reported in the literature are upwards of 25 %. Current evidence comparing the efficacy of differing surgical treatments of osteomyelitis is inconclusive. The purpose of this study is to compare rates of re-debridement and amputation in patients who receive either debridement alone or debridement with placement of local antibiotic delivery systems as initial treatment for lower extremity long bone osteomyelitis.

Methods

A retrospective cohort study was performed to investigate complication rates after surgical treatment methods for osteomyelitis of the femur and tibia. The rates of re-debridement and amputation were compared in patients who received either debridement alone or debridement with placement of local antibiotic delivery systems.

Results

This study reports 73 % lower rates of re-debridement after debridement and local antibiotic delivery in tibial osteomyelitis, and 83 % lower rates of re-debridement after debridement and placement of local antibiotic delivery systems in femoral osteomyelitis compared to debridement alone. There was no significant difference in amputation rates between treatment groups for either tibial (7.4 vs 5.7 %; OR: 1.31; 95 % CI, 0.92–1.87) or femoral osteomyelitis (2.4 vs 1.4 %; OR: 1.65; 95 % CI, 0.71–4.01).

Conclusion

There was a significantly decreased likelihood of re-debridement for patients who underwent initial treatment with combined debridement and placement of antibiotic delivery systems compared to debridement alone. Providers may consider this when comparing treatment options for their patients with lower extremity osteomyelitis.

查看原文本刊更多论文

外卖还是送餐？采用清创和局部抗生素给药系统治疗下肢长骨骨髓炎的再手术率

背景骨髓炎的早期诊断和治疗对于预防潜在并发症（包括败血症、大面积骨切除、截肢和死亡）至关重要。尽管目前有治疗骨髓炎的策略，但文献报道的复发率高达 25%。目前，比较不同骨髓炎手术疗法疗效的证据尚无定论。本研究旨在比较下肢长骨骨髓炎患者在接受单纯清创术或清创术并放置局部抗生素给药系统作为初始治疗时的再次清创率和截肢率。方法本研究进行了一项回顾性队列研究，调查股骨和胫骨骨髓炎手术治疗方法后的并发症发生率。结果该研究报告显示，与单纯清创相比，胫骨骨髓炎患者在清创并使用局部抗生素后的再清创率降低了73%，股骨骨髓炎患者在清创并使用局部抗生素后的再清创率降低了83%。胫骨骨髓炎（7.4 vs 5.7 %；OR：1.31；95 % CI，0.92-1.87）或股骨髓炎（2.4 vs 1.4 %；OR：1.65；95 % CI，0.71-4.01）的截肢率在治疗组之间没有明显差异。医疗服务提供者在比较下肢骨髓炎患者的治疗方案时可以考虑这一点。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Clinical Orthopaedics and Trauma Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

0.00%

发文量

181

审稿时长

92 days

期刊介绍： Journal of Clinical Orthopaedics and Trauma (JCOT) aims to provide its readers with the latest clinical and basic research, and informed opinions that shape today''s orthopedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. JCOT publishes content of value to both general orthopedic practitioners and specialists on all aspects of musculoskeletal research, diagnoses, and treatment. We accept following types of articles: • Original articles focusing on current clinical issues. • Review articles with learning value for professionals as well as students. • Research articles providing the latest in basic biological or engineering research on musculoskeletal diseases. • Regular columns by experts discussing issues affecting the field of orthopedics. • "Symposia" devoted to a single topic offering the general reader an overview of a field, but providing the specialist current in-depth information. • Video of any orthopedic surgery which is innovative and adds to present concepts. • Articles emphasizing or demonstrating a new clinical sign in the art of patient examination is also considered for publication. Contributions from anywhere in the world are welcome and considered on their merits.