Aims. Chronic osteomyelitis may recur if dead space management, after
excision of infected bone, is inadequate. This study describes the
results of a strategy for the management of deep bone infection
and evaluates a new antibiotic-loaded biocomposite in the eradication
of infection from bone defects. Patients and Methods. We report a prospective study of 100 patients with chronic osteomyelitis,
in 105 bones. Osteomyelitis followed injury or surgery in 81 patients.
Nine had concomitant septic arthritis. 80 patients had comorbidities
(Cierny-Mader (C-M) Class B hosts). Ten had infected nonunions. All patients were treated by a multidisciplinary team with a
single-stage protocol including debridement, multiple sampling,
culture-specific systemic antibiotics, stabilisation, dead space
filling with the biocomposite and primary skin closure. . Results. Patients were followed up for a mean of 19.5 months (12 to 34).
Infection was eradicated in 96 patients with a single procedure
and all four recurrences were successfully managed with repeat surgery.
Adverse events were uncommon, with three fractures, six wound leaks
and three unrelated deaths. Outcome was not dependant on C-M host
class, microbial culture, wound leakage or presence of nonunion. Conclusion. This single-stage protocol, facilitated by the absorbable local
antibiotic, is effective in the treatment of chronic osteomyelitis.
It offers a more patient-friendly treatment compared with other
published treatment options. Cite this article: Bone Joint J 2016;98-B:1289–96