Abstract
Introduction: Intramedullary reaming has its selected indication in osteomyelitis of long bones when remnants of dead infected bone are intramedullary embedded in a endostal new bone formation. The validity of this method has not yet been proven in long-term follow-ups. We reevaluated our patients in a 10 to 15 years follow-up to look at the recurrence rate of osteomyelitis after intramedullary reaming. We were also interested in the level of activity and the ability of working in our patients today.
Study design: From 1984 till 1992 forty-three patients with forty-four locations of chronic osteomyelitits of long bones were treated by intramedullary reaming. The collective consisted of 38 men and 5 women. The mean duration of the infection was 13.2 years. The causes of osteomyelitis were in 37 cases posttraumatic, in 6 cases haematogenous and one patient suffered from chronic osteomyelitis after removal of a total hip. Main locations of the focus were the diaphysis of the tibia and the femur. Intramedullary reaming was performed in patients with a infection centrally located in the bone protected by a thick periosteal new bone formation. In important endosteal bone formation a window was needed in order to pass with the guide wire for medullary reaming. Reaming went up to 18mm leaving a important cortical thickness of 6 to 10mm. Thorough irrigation focused a total removal of reaming mill. The treatment included a antibiotic therapy from 6 to 12 weeks. Staph. aureus was the most frequent micro-organism. The follow-up data was based on a continously documented clinical observation. Next to visits in our outpatient clinic we received informations by having designed a questionnaire booklet which was answered by the patients.
Results: In the 10 year follow-up in 37 cases (83%) osteomyelitis had never reoccurred. 5 patients needed a revision. 23 patients worked full-time, 3 had a reduced ability of work and 8 had been retired. 27 patients were pain-free, in 7 cases mild pain was found and 1 patient had moderate pain during working or walking. We have reevaluted 21 patients in a 15years follow-up, 7 patients will be followed up by 10/2004. Fifteen patients had died.
Discussion: Intramedullary reaming of the diaphysis of long bones after posttraumatic or haematogenous osteomyelitis proves to be a valuable treatment. The constitution of the bone, the reaming technique and the antibiotic therapy are influencing factors for a positive outcome.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
