[Infection on continuous bone of lower limb: 127 cases].
OBJECTIVE
Infection on continuous bone is a specific diagnostic and therapeutic entity. Treatment requires debridement of infected and necrotic soft tissue and bone, dead space management, effective antibiotic therapy in the bone and good skin coverage with well-vascularized tissues. Results of treatment of infection on continuous bone of the lower limb are presented in this series.


METHODS
This retrospective series included 127 cases of osteomyelitis affecting continuous bone of the lower limb (tibia or femur). Septic nonunion and infected arthroplasties were excluded. All patients underwent surgery. The therapeutic protocol was based on debridement, filling of the osteomyelitic cavity as needed (flap, bone grafting, foreign material) and skin cover (by direct closure or flap). Antibiotics were given systematically. Patients were reviewed at minimum two years follow-up.


RESULTS
Osteomyelitis was located on the tibia in 66% and was posttraumatic in 75% of cases. Localized osteomyelitis (type III of the Cierny-Mader anatomic classification) was found in 50% of patients. Staphylococcus aureus was the causal agent in 66% of cases. Flaps were performed in more than half of cases and most of them were local flaps. Systematic antibiotic therapy was given for an average three months. With an average four years follow-up, eradication of the infection was obtained in 80% of patients. Ten patients were lost to follow-up. No statistical difference was noted for final outcome according to the physiological hoste class, the anatomic localization (tibia or femur), bacteriological findings, duration of antibiotics, use of flaps, or filling of the osteomyelitic cavity. Treatment of type I and II osteomyelitis was more successful than type III or IV infection (NS). Failure rate increased with the number of previous surgical procedures (p=0.02).


CONCLUSIONS
Infection on continuous bone is a characteristic entity, rarely clearly separated from other bone infections in reported series that combine these infection with septic nonunions and infected arthroplasties. Surgery is essential and is based on quality debridement. The use of flaps (for both dead space management and skin coverage) improves the results for the treatment of such infections but long-term follow-up is needed for a more accurate assessment of success rate.
Bauer
T
T
Service de Chirurgie Orthopédique et Traumatologique, Hôpital Ambroise-Paré, 9, avenue Charles-de-Gaulle, 92100 Boulogne. tbauer@freesurf.fr
Lhotellier
L
L
Mamoudy
P
P
Lortat-Jacob
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D018786:Bone Substitutes / Q000627:therapeutic use; D016025:Bone Transplantation / Q000379:methods; D003646:Debridement; D005260:Female; D005264:Femoral Fractures / Q000150:complications; D005269:Femur / Q000293:injuries / Q000601:surgery*; D005500:Follow-Up Studies; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000145:classification / Q000382:microbiology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D016038:Skin Transplantation; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000601:surgery; D013524:Surgical Flaps; D013977:Tibia / Q000293:injuries / Q000601:surgery*; D013978:Tibial Fractures / Q000150:complications; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D018786:Bone Substitutes