Abstract
Treatment of osteomyelitis is a challenge for every surgeon, but even more so in low and middle income countries, because of delay in presentation, lack of resources and troublesome follow-up. We present a series of fifteen patients, treated for osteomyelitis in 2014 in a rural Ghanean hospital with one-year follow up. All bony defects were filled using Bonalive®.
Fifteen consecutive patients with osteomyelitis were included in this study and treated with Bonalive® in March 2014. The group consisted of twelve men and three women (age 10–46y, mean 26y). All patients consented and the study was approved by the hospital's ethical committee. Imaging was performed preoperatively, immediate postoperatively and at various occasions thereafter with final X-rays taken at follow-up in April 2015. All were treated by extensive debridement of the osteomyelitic bone, sequestrectomy, saucerisation and filling of the defect with Bonalive® granules (1,0–2,0 mm in size). Primary closure of the wound was possible in all cases. Fistulae were curetted, not closed. Peroperatively, multiple culture specimens were taken and all patients received a course of intravenous antibiotics for a week, continued orally thereafter for another week. Patients were regularly followed up postoperatively and final review took place in April 2015.
Of all fifteen treated patients, only seven were seen back in April 2015, more than one year postoperatively. The osteomyelitis was located in the femur in seven patients, tibia in seven and the humerus in two. Microbiology showed growth of St. aureus in six patients, Proteus species in six, St. epidermidis in two and pseudomonas in one. Of the seven patients presenting at one year follow-up, all had relief of symptoms for at least three months. Two were completely symptom free, the other five still had one or more draining fistulae. Initial X-rays showed good filling of all osteomyelitic defects with the bioglas granules.
Treatment of osteomyelitis remains a challenge in low and middle income countries. First, there is almost always a delay in presentation and most cases have become chronic by the time they are treated. Secondly, some sequesters were missed and therefore not removed at surgery, due to the lack of good initial x-ray films. Thirdly, there is often no access to microbiological diagnostics. At last, a lot of patients are lost to follow-up.
In our opinion, the Bonalive® product delivered it's claims, but the overall circumstances in which we treated these patients were importantly responsible for the overall suboptimal outcome.
