Adequate debridement of necrotic bone is of paramount importance for eradication of infection in chronic osteomyelitis. Currently, no tools are available to detect the exact amount of necrotic bone in order to optimize surgical resection. The aim of the present study was to evaluate the feasibility of an intraoperative illumination method (VELscope®) and the correlation between intraoperative and pathohistological findings in surgically treated chronic fracture related infection patients. Ten consecutive patients with chronic fracture related infections of the lower extremity were included into this prospectively performed case series. All patients had to be treated surgically for fracture related infections requiring bony debridement. An intraoperative illumination method (VELscope®) was used to intraoperatively differentiate between viable and necrotic bone. Tissue samples from the identified viable and necrotic bone areas were histopathologically examined and compared to intraoperative findings.Aim
Method
Statistical analyses were performed using statistical software. Probability of Type I error was set to 5% (alpha=0.05).
Osteonecrosis was found in 81 (97.6%) hips revised after fracture (p<
.0001). The vertical size of avascular necrosis in hips after acute postnecrotic fracture (21.1mm±8.5) was bigger (p<
.0001) than in both chronic (7.3mm±7.3) and acute mechanic (0.9 mm±1.2) fractures. Even though 33 (66.0%) of 50 patients with acute postnecrotic fracture were men (p=.0237), no significant differences between males and females were found with respect to age of patients (p=.3445) or duration of prosthesis implantation (p=.1232).
The proposed classification may help to understand causes of periprosthetic fractures after hip resurfacing arthroplasty.