Chronic osteomyelitis of long bones is one of the most severe complications in orthopedics. Different options exist for treatment of this disease, however there is still no generally accepted comprehensive protocol that could potentially guide us in each particular step. There are many classifications that were designed to help us to make clinical decision, however even the most widely used Cierny-Mader classification does not count more a half of factors, assessment of which is essential for choosing the best treatment plan. This fact may be explained by the complexity of the disease process, diversity of treatment options and multistage approach to the management of these patients. Therefore, the purpose of this study was to work out a treatment protocol and clinical classification system, which will improve final outcomes in patients with chronic osteomyelitis of long bones. Three orthopedic surgeons and one general surgeon who specialize on bone and joint infection independently of each other made a review of literature dedicated to the topic of chronic osteomyelitis. Each surgeon created a list of factors that are essential to assess for successful treatment of chronic osteomyelitis. After four lists were thoroughly matched and discussed, 10 most important factors were defined. Each surgeon proposed his own protocol of treatment, based on existent data and own experience. All four protocols were discussed and analyzed to come up with new the most comprehensive one. Therefore, the new protocol was created. After the list of factors and protocol were created, surgeons independently of each other defined the most important factors for every stage in the new protocol. Thus new multi-stage classification of chronic osteomyelitis (MSC-CO) was proposed.Aim
Method
To evaluate the effectiveness of various tactics in treating septic complications following large joint replacement. Analysis of the outcomes of treatment 171 patients with SC following LJR from 2010 to 2014. Primary operations performed in 33 different hospitals; the time elapsed before complications from the date of primary intervention – from 3 days to 17 years. Depending on the type of complications, all patients were divided into 2 groups: those with superficial surgical site infections (SSSI) and deep surgical site infections (DSSI) associated with a prosthesis. In the treatment of these patients we followed different tactics using method of negative pressure wound therapy (NPWT), the antibiotic impregnated collagen sponge (AICS*) and antibacterial cement spacers (ACS). We obtained the results allowing to assess the impact of these methods on the effectiveness of treatment, recurrence rate and mortality in patients of different groups. By combining different methods were able to reduce the number of relapses from 20% to 0% in patients with SSSI and significantly improve treatment outcomes in patients with DSSI. This analysis helped us to determine the most appropriate tactics of treatment depending on the type of complications. The obtained results indicate the prospects of using NPWT, the AICS and ACS in the treatment of septic complications following large joint replacement and the role of these methods in the reduction of recurrence and mortality rates. Selection of the optimal tactics will significantly reduce the number of unsatisfactory results of treatment in these patients.
To evaluate the results of the reconstructive surgical treatment of complicated forms of infected osteoarthropathy with diabetic foot syndrome (DFS). The analysis of the results of the treatment of 58 patients with infectious complications of osteoarthropathy with the neuropathic form of the DFS, the average age 57.7+1.2 years. In 5 patients with Type I according to the Sanders & Frykberg classification, grade C according to the Roger classification of with neuropathic ulcers caused by deformation of the bones we employed corrective mini-osteotomy. In 32 patients with Type I, grade D with the infected ulcers associated with destruction of the metatarsal bones and the metatarsophalangeal joints, we performed the resection of the affected bones, subsequently filling the defects with antibiotic impregnated collagen sponge (AICS*), and then we closed the wound with primary suture. In 15 patients with Type II, grade D we performed the resection of the affected bones and stabilize the mid-foot using compressive screws and AICS. In 4 patients with Type III, grade D we perfomed the following resection of the affected bones we used AICS and the extrafocal corrective osteosynthesis using the Ilizarov's method. In 2 patients with Type IV+V, grade D we did an amputation using the Syme's technique and osteosynthesis using the Ilizarov's method. There was one case of septic instability of the compressive screw after more than one month: the screw was then removed; and there was one case of an unstable bone fragment: its removal was necessary. No recurrence of the trophic ulcers or osteomyelitis of the foot bones was observed during a 6 – 24 mounth follow-up in any other treated patients. The described methods are promising in the treatment of patients with DFS; their effectiveness can be evaluated after randomized trials will be completed.
