title: Posttraumatic and postoperative osteomyelitis: surgical revision strategy with persisting fistula.
abstract: BACKGROUND
  Posttraumatic and postoperative osteomyelitis (PPO) with bacteria colonisation during trauma and associated surgery is an increasing clinical problem. This study investigated the treatment of PPO by surgical revision including irrigation, debridement, and temporary hardware maintenance. In addition, a drainage was inserted as persisting fistula to control osteomyelitis until fracture healing was achieved. Trauma- and osteomyelitis-related factors that influenced the study outcome were determined.
  
  
  METHODS
  67 consecutive patients with PPO were included. At onset of PPO, patients had incomplete fracture healing. Patients were subdivided by time of PPO occurrence (acute, subacute or chronic), initial soft tissue trauma, anatomical location, and initial fracture type (AO classification). The study outcome measures included radiographic and clinical follow-up.
  
  
  RESULTS
  59 patients could be followed for an average of 23 months after revision surgery. A bone healing was achieved by 89% of patients after 14.7 ± 13.4 weeks. Fractures of the lower extremity, open fractures and comminuted C-type fractures took significantly longer to achieve bone healing (p < 0.05 each). Time of PPO occurrence did not influence bone healing. After fracture consolidation, no re-infection was found.
  
  
  CONCLUSIONS
  This study showed high rates of bone healing, indicating that this strategy with persisting fistula should be considered as alternative treatment option in patients with PPO.
authors: Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Abteilung für Unfallchirurgie und Orthopädie, Ludwig Guttmann Strasse 13, 67071, Ludwigshafen am Rhein, Germany, saytac@bgu-ludwigshafen.de.
authors: Sâra
authors: S
authors: Aytaç
authors: Marc
authors: M
authors: Schnetzke
authors: Benedict
authors: B
authors: Swartman
authors: Peter
authors: P
authors: Herrmann
authors: Christoph
authors: C
authors: Woelfl
authors: Volkmar
authors: V
authors: Heppert
authors: Paul Alfred
authors: PA
authors: Gruetzner
authors: Thorsten
authors: T
authors: Guehring
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003646:Debridement; D005260:Female; D005402:Fistula / Q000601:surgery*; D017102:Fracture Healing; D050723:Fractures, Bone / Q000601:surgery*; D005597:Fractures, Open / Q000601:surgery; D006801:Humans; D015601:Injury Severity Score; D016268:Internal Fixators; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000209:etiology / Q000382:microbiology / Q000601:surgery*; D011184:Postoperative Period; D012086:Reoperation; D016896:Treatment Outcome; D014945:Wound Healing; D055815:Young Adult