Eva Steinhausen, Rolf Lefering, Martin Glombitza, Nikolaus Brinkmann, Carsten Vogel, Bastian Mester, Marcel Dudda
{"title":"Reply to McNally's comment on \"Bioactive glass S53P4 vs. autologous bone graft for filling defects in patients with chronic osteomyelitis and infected non-unions - a single center experience\" by Steinhausen et al. (2021).","authors":"Eva Steinhausen, Rolf Lefering, Martin Glombitza, Nikolaus Brinkmann, Carsten Vogel, Bastian Mester, Marcel Dudda","doi":"10.5194/jbji-6-203-2021","DOIUrl":"https://doi.org/10.5194/jbji-6-203-2021","url":null,"abstract":"Eva Steinhausen1,3, Rolf Lefering2, Martin Glombitza1, Nikolaus Brinkmann1, Carsten Vogel3, Bastian Mester3, and Marcel Dudda1,3 1Department of Orthopedic and Trauma Surgery, BG Klinikum Duisburg, University of Duisburg-Essen, 47249 Duisburg, Germany 2Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Cologne, Germany 3Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University of Duisburg Essen, Essen, Germany","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"6 6","pages":"203-205"},"PeriodicalIF":0.0,"publicationDate":"2021-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8188879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39089932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Comment on \"Bioactive glass S53P4 vs. autologous bone graft for filling defects in patients with chronic osteomyelitis and infected non-unions - a single center experience\" by Steinhausen et al. (2021).","authors":"Martin McNally","doi":"10.5194/jbji-6-199-2021","DOIUrl":"https://doi.org/10.5194/jbji-6-199-2021","url":null,"abstract":"I read with interest the recent paper by Steinhausen et al. (2021). This paper reports the outcome of a retrospective review of bioactive glass compared to autologous bone graft (ABG) in a staged surgical protocol for treating established bone infection. The authors claim that bioglass is equally effective as ABG in eradicating infection but acknowledge that their evidence is weak. The surgical treatment of chronic bone infection has been reported for well over a century. In 1931, Jacob Kulowski published his classical series of 130 cases of osteomyelitis, treated by Orr’s method (Kulowski, 1931). His surgical debridement technique was similar to that described by Steinhausen et al. (2021), and he achieved a recurrence rate of 24 % (mean follow-up: 19 months), in the pre-antibiotic era, with no defect fillers. In this new series of 83 patients, the recurrence rate with bioglass was 29 % and 19 % for ABG. Clearly the addition of bioglass or bone graft has not improved outcome. The authors state that the longer follow-up period for the ABG group is not a source of bias because “most complications occurred within 12 months”. This same group previously published 50 of their 51 bioglass cases (Malat et al., 2018) with a mean follow-up of 12.3 months and a recurrence rate of 14 %. This has increased to 29 % with a longer follow-up (mean 20.5 months). It would appear that the recurrence rate doubled in the 8 months after the first year. There are no large randomized trials directly comparing the use of bioglass with other options, and the authors correctly report that outcomes of small studies are inconclusive. However, there are two high-quality animal studies (Xie et al., 2009; Boot et al., 2020). In a rabbit model of MRSA osteomyelitis, Xie et al. (2009) reported that bioglass was no more effective than debridement alone (success rate 36 % for debridement and 18 % for debridement and bioglass) but the addition of local antibiotics to calcium sulfate or bioglass increased success to 73 % and 81 % respectively. Boot et al. (2020) studied the effect of hydrogel and bioglass in an infected tibial nail model. They showed that bioglass or hydrogel without antibiotics produced no reduction in infection, but vancomycin-loaded hydrogel could eradicate established infection. It has been widely claimed that bioglass has the advantage of reducing the risk of antimicrobial resistance. This paper shows that cases treated with bioglass required significant additional systemic antimicrobial therapy after repeated surgery or recurrence. It has been shown that repeated surgery promotes change in bacterial cultures (Rupp et al., 2020). Recurrent, and often suboptimal, systemic therapy drives selection pressure and multi-drug resistance. There is no evidence that local antimicrobial therapy contributes to this. The recent study of Bidossi et al. (2020) demonstrated that prolonged exposure to high-dose local antibiotics in a ceramic carrier was not associated with any ad","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"6 6","pages":"199-201"},"PeriodicalIF":0.0,"publicationDate":"2021-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8188880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39107795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ahmed Siddiqi, Zuhdi E Abdo, Bryan D Springer, Antonia F Chen
{"title":"Pursuit of the ideal antiseptic irrigation solution in the management of periprosthetic joint infections.","authors":"Ahmed Siddiqi, Zuhdi E Abdo, Bryan D Springer, Antonia F Chen","doi":"10.5194/jbji-6-189-2021","DOIUrl":"https://doi.org/10.5194/jbji-6-189-2021","url":null,"abstract":"<p><p>Irrigation and debridement in the treatment of periprosthetic joint infection (PJI) serve an integral role in the eradication of bacterial burden and subsequent re-infection rates. Identifying the optimal irrigation agent, however, remains challenging, as there is limited data on superiority. Direct comparison of different irrigation solutions remains difficult because of variability in treatment protocols. While basic science studies assist in the selection of irrigation fluids, in vitro results do not directly translate into clinical significance once implemented in vivo. Dilute povidone iodine, hydrogen peroxide, chlorhexidine gluconate, acetic acid, sodium hypochlorite, hypochlorous acid, and preformed combination solutions all have potential against a broad spectrum of PJI pathogens with their own unique advantages and disadvantages. Future clinical studies are needed to identify ideal irrigation solutions with optimal bactericidal properties and low cytotoxicity for PJI treatment.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"6 6","pages":"189-198"},"PeriodicalIF":0.0,"publicationDate":"2021-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8182666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39096934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Antonio Loro, Andrew Hodges, George William Galiwango, Francesca Loro
{"title":"Vascularized fibula flap in the management of segmental bone loss following osteomyelitis in children at a Ugandan hospital.","authors":"Antonio Loro, Andrew Hodges, George William Galiwango, Francesca Loro","doi":"10.5194/jbji-6-179-2021","DOIUrl":"https://doi.org/10.5194/jbji-6-179-2021","url":null,"abstract":"<p><p><b>Background</b>: Hematogenous osteomyelitis is commonly observed in the pediatric population across sub-Saharan Africa. This retrospective case series was designed to evaluate the complications and outcomes of treatment using a vascularized fibula flap (VFF) to fill segmental bone defects secondary to osteomyelitis in children in a low-resource setting in CoRSU Rehabilitation Hospital, Uganda. <b>Methods</b>: Clinical notes and radiographs of children with a diagnosis of osteomyelitis that subsequently underwent a VFF procedure between October 2013 and December 2017 were reviewed. All patients were clinically and radiographically evaluated in 2019. <b>Results</b>: Forty-four children, with an average bone defect of 10.5 cm, were included. Eighty-four percent of children had successful VFF limb reconstruction. Integration of the graft was radiologically sound in 20.8 weeks on average. The postoperative phase was uneventful in 29 % of patients. Complications were observed in the remaining patients, including flap failure (6), donor leg neurapraxia (3), cutaneous paddle necrosis (11), graft fracture (2), skin graft loss (6), fixator failure (1) and non-union (2). Functional outcomes were rated as excellent in 13 patients, good in 14, fair in 9 and poor in 8. There was no recurrence of the bone infection in any of the enrolled children. <b>Conclusion</b>: Despite being a complex and demanding procedure, VFF is a good option for reconstructing post-osteomyelitis bone defects, particularly when associated with loss of soft tissue envelope. Considering the more than satisfactory functional and clinical outcomes, this procedure should be kept in mind for these complex pediatric cases of bone and soft tissue loss, even in a low-resource setting.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"6 6","pages":"179-187"},"PeriodicalIF":0.0,"publicationDate":"2021-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8182670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39096933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Costal osteomyelitis due to <i>Bartonella</i> <i>henselae</i> in a 10-year-old girl.","authors":"Arnaud Salmon-Rousseau, Christelle Auvray, Quentin Besset, Claire Briandet, Claire Desplantes, Pascal Chavanet","doi":"10.5194/jbji-6-171-2021","DOIUrl":"https://doi.org/10.5194/jbji-6-171-2021","url":null,"abstract":"<p><p><i>Bartonella henselae</i> is the bacterial agent responsible for cat scratch disease. This infection is frequently the cause of localized lymphadenitis in children. It is also sometimes responsible for endocarditis, encephalitis, hepatic peliosis and in rare cases osteomyelitis. We describe the second known case of unifocal thoracic osteomyelitis in a 10-year-old child.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"6 6","pages":"171-178"},"PeriodicalIF":0.0,"publicationDate":"2021-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8182667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39096932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Connor J Barker, Alan Marriot, Munir Khan, Tamsin Oswald, Samuel J Tingle, Paul F Partington, Ian Carluke, Mike R Reed
{"title":"Hip aspiration culture: analysing data from a single operator series investigating periprosthetic joint infection.","authors":"Connor J Barker, Alan Marriot, Munir Khan, Tamsin Oswald, Samuel J Tingle, Paul F Partington, Ian Carluke, Mike R Reed","doi":"10.5194/jbji-6-165-2021","DOIUrl":"https://doi.org/10.5194/jbji-6-165-2021","url":null,"abstract":"<p><p><b>Introduction</b>: We undertook this study to know the sensitivity, specificity and post-test probabilities of hip aspiration when diagnosing periprosthetic hip infections. We also examined \"dry tap\" (injection with saline and aspiration) results and aspiration volumes. <b>Methods</b>: This is a retrospective cohort study of patients aspirated for suspected periprosthetic joint infection between July 2012 and October 2016. All aspirations were carried out by one trained surgical care practitioner (SCP). All aspirations followed an aseptic technique and fluoroscopic guidance. Aspiration was compared to tissue biopsy taken at revision. Aspiration volumes were analysed for comparison. <b>Results</b>: Between January 2012 and September 2016, 461 hip aspirations were performed by our SCP. Of these 125 progressed to revision. We calculated sensitivity 59 % (confidence interval (CI) 35 %-82 %) and specificity 94 % (CI 89 %-98 %). Pre-test probability for our cohort was 0.14. Positive post-test probability was 0.59 and negative post-test probability 0.06. Aspiration volume for infected ( <math><mrow><mi>n</mi> <mo>=</mo> <mn>17</mn></mrow> </math> ) and non-infected ( <math><mrow><mi>n</mi> <mo>=</mo> <mn>108</mn></mrow> </math> ) joints was compared and showed no significant difference. Dry taps were experienced five times; in each instance the dry tap agreed with the biopsy result. <b>Conclusions</b>: Our data show that hip aspiration culture is a highly specific investigation for diagnosing infection but that it is not sensitive. Aspiration volume showed no significant difference between infected and non-infected groups. Each time a joint was infiltrated with saline to achieve a result, the result matched tissue sampling.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"6 6","pages":"165-170"},"PeriodicalIF":0.0,"publicationDate":"2021-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8137858/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39060474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jamie Ferguson, Myriam Alexander, Stuart Bruce, Matthew O'Connell, Sue Beecroft, Martin McNally
{"title":"A retrospective cohort study comparing clinical outcomes and healthcare resource utilisation in patients undergoing surgery for osteomyelitis in England: a case for reorganising orthopaedic infection services.","authors":"Jamie Ferguson, Myriam Alexander, Stuart Bruce, Matthew O'Connell, Sue Beecroft, Martin McNally","doi":"10.5194/jbji-6-151-2021","DOIUrl":"https://doi.org/10.5194/jbji-6-151-2021","url":null,"abstract":"<p><p><b>Aims</b>: An investigation of the impact of a multidisciplinary bone infection unit (BIU) undertaking osteomyelitis surgery with a single-stage protocol on clinical outcomes and healthcare utilisation compared to national outcomes in England. <b>Patients and Methods</b>: A tertiary referral multidisciplinary BIU was compared to the rest of England (ROE) and a subset of the 10 next busiest centres based on osteomyelitis treatment episode volume (Top Ten), using the Hospital Episodes Statistics database (HES). A total of 25 006 patients undergoing osteomyelitis surgery between April 2013 and March 2017 were included. Data on secondary healthcare resource utilisation and clinical indicators were extracted for 24 months before and after surgery. <b>Results</b>: Patients treated at the BIU had higher orthopaedic healthcare utilisation in the 2 years prior to their index procedure, with more admissions ( <math><mrow><mi>p</mi> <mo><</mo></mrow> </math> 0.001) and a mean length of stay (LOS) over 4 times longer than other groups (10.99 d, compared to 2.79 d for Top Ten and 2.46 d for the ROE, <math><mrow><mi>p</mi> <mo><</mo></mrow> </math> 0.001). During the index inpatient period, the BIU had fewer mean theatre visits (1.25) compared to the TT (1.98, <math><mrow><mi>p</mi> <mo><</mo></mrow> </math> 0.001) and the ROE (1.64, <math><mrow><mi>p</mi> <mo>=</mo></mrow> </math> 0.001). The index inpatient period was shorter in the BIU (11.84 d), 33.6 % less than the Top Ten (17.83 d, <math><mrow><mi>p</mi> <mo><</mo></mrow> </math> 0.001) and 29.9 % shorter than the ROE (16.88 d, <math><mrow><mi>p</mi> <mo><</mo></mrow> </math> 0.001). During follow-up, BIU patients underwent fewer osteomyelitis-related reoperations than Top Ten centres ( <math><mrow><mi>p</mi> <mo>=</mo></mrow> </math> 0.0139) and the ROE ( <math><mrow><mi>p</mi> <mo>=</mo></mrow> </math> 0.0137). Mortality was lower (4.71 %) compared to the Top Ten (20.06 %, <math><mrow><mi>p</mi> <mo><</mo></mrow> </math> 0.001) and the ROE (22.63 %, <math><mrow><mi>p</mi> <mo><</mo></mrow> </math> 0.001). The cumulative BIU total amputation rate was lower (6.47 %) compared to the Top Ten (15.96 %, <math><mrow><mi>p</mi> <mo><</mo></mrow> </math> 0.001) and the ROE (12.71 %, <math><mrow><mi>p</mi> <mo><</mo></mrow> </math> 0.001). Overall healthcare utilisation was lower in the BIU for all inpatient admissions, LOS, and Accident and Emergency (A&E) attendances. <b>Conclusion</b>: The benefits of managing osteomyelitis in a multi-disciplinary team (MDT) specialist setting included reduced hospital stays, lower reoperation rates for infection recurrence, improved survival, lower amputation rates, and lower overall healthcare utilisation. These results support the establishment of centrally funded multidisciplinary bone infection units that will improve patient outcomes and reduce healthcare utilisation.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"6 5","pages":"151-163"},"PeriodicalIF":0.0,"publicationDate":"2021-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8137857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39060473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Don Bambino Geno Tai, Nathan J Brinkman, Omar Abu Saleh, Douglas R Osmon, Matthew P Abdel, Christina G Rivera
{"title":"Safety and tolerability of liquid amikacin in antibiotic-loaded bone cement - a case series.","authors":"Don Bambino Geno Tai, Nathan J Brinkman, Omar Abu Saleh, Douglas R Osmon, Matthew P Abdel, Christina G Rivera","doi":"10.5194/jbji-6-147-2021","DOIUrl":"https://doi.org/10.5194/jbji-6-147-2021","url":null,"abstract":"<p><p>High-dose liquid antibiotics are uncommon in bone cement. We present a case series of patients in which up to 16 mL of liquid amikacin (250 mg mL <math><msup><mi></mi> <mrow><mo>-</mo> <mn>1</mn></mrow> </msup> </math> ) was successfully incorporated into bone cement to treat periprosthetic joint infections. We did not observe adverse drug reactions definitively attributed to its use.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"6 5","pages":"147-150"},"PeriodicalIF":0.0,"publicationDate":"2021-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8131961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39060472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Martina Galea Wismayer, Kurstein Sant, Ryan Giordmaina, Martin McNally
{"title":"Osteomyelitis in heterotopic ossification in a patient with congenital gigantism of the leg.","authors":"Martina Galea Wismayer, Kurstein Sant, Ryan Giordmaina, Martin McNally","doi":"10.5194/jbji-6-141-2021","DOIUrl":"https://doi.org/10.5194/jbji-6-141-2021","url":null,"abstract":"<p><p>This paper presents the first report of osteomyelitis in heterotopic ossification in a patient with macrodystrophia lipomatosa. Careful review of magnetic resonance imaging allowed correct diagnosis and design of a limited surgical excision. Osteomyelitis should be considered in the differential diagnosis of pain and discharge when heterotopic ossification is present.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"6 5","pages":"141-145"},"PeriodicalIF":0.0,"publicationDate":"2021-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8131960/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39060471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mats Bue, Arnar Óskar Bjarnason, Jan Duedal Rölfing, Karina Larsen, Juozas Petruskevicius
{"title":"Prospective evaluation of pin site infections in 39 patients treated with external ring fixation.","authors":"Mats Bue, Arnar Óskar Bjarnason, Jan Duedal Rölfing, Karina Larsen, Juozas Petruskevicius","doi":"10.5194/jbji-6-135-2021","DOIUrl":"https://doi.org/10.5194/jbji-6-135-2021","url":null,"abstract":"<p><p><b>Introduction</b>: Pin site infection is a common complication to external ring fixation. While the aetiology is well described, monitoring of onset, location, and the distribution of infection among the pin sites still needs further attention. The present pilot study evaluates the feasibility of a prospective registration procedure for reporting, evaluating, and monitoring of pin site infections in patients treated with external ring fixation. This may promote communication between team members and assist decision-making regarding treatment. <b>Methods</b>: A total of 39 trauma, limb deformity, and bone infection patients (15 female, 24 males; mean age 49 years (range: 12-88)) treated with external ring fixation were followed in the outpatient clinic using the pin site registration tool. Pin site infection (Checketts and Otterburn (CO) grade, onset, location), use of oral or intravenous antibiotics, and any unplanned procedures due to pin sites complications (wire removal and/or replacement, premature frame removal, amputation, etc.) were registered until frame removal. <b>Results</b>: The mean (SD) frame time was 164 (83) d (range: 44-499). We performed 3296 observations of 568 pin sites. Pin infection was registered in 171 of the 568 pin sites (30 %), of which 112 (65 %) were categorized as CO 1, 42 (25 %) as CO 2, 9 (5 %) as CO 3, and 8 (5 %) as CO 5. Neither CO 4 nor CO 6 was observed. A total of 35 patients (90 %) encountered CO 1-3 at least once during the observation time, while 1 patient (2.5 %) developed a major infection at eight pin sites (CO 5). Antibiotics were administered to <math><mrow><mn>22</mn> <mo>/</mo> <mn>39</mn></mrow> </math> (56 %) of the patients. <b>Conclusion</b>: In an effort to monitor pin site infections in this complex patient group and to ensure the best clinical outcomes, our registration procedure in the outpatient clinic helped to recognize pin site infections early and eased communication between team members providing a concise overview of the treatment course.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"6 5","pages":"135-140"},"PeriodicalIF":0.0,"publicationDate":"2021-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8131963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39075888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}