title: Single-Stage Treatment of Osteomyelitis for Digital Salvage by Using an Antibiotic-Eluting, Methylmethacrylate Joint-Spanning Spacer.
abstract: Osteomyelitis of the digit is a challenging problem that can result in amputation. We describe 13 cases of osteomyelitis involving bones of the hand managed with a novel technique. We reviewed records of 12 patients (13 digits) who had joint-spanning, antibiotic-eluting (tobramycin or vancomycin), methylmethacrylate spacers placed as definitive, single-stage treatment for digital osteomyelitis. The primary outcome was digit salvage. Secondary outcomes were infection eradication (no recurrence at 3 months) and spacer removal. Patients were followed up until the infection resolved (ie, no cutaneous signs of infection, including pain, erythema, or swelling). At a mean of 24 months, 10 of 13 infections had successful one-stage treatment. One patient required a second operation to revise a soft tissue flap but the spacer remained in place. Two spacers were removed because of malalignment. An antibiotic-eluting methylmethacrylate spacer is an innovative treatment for digital osteomyelitis. In 12 consecutive patients (13 digits), we successfully salvaged the digit.
authors.affiliation: Department of Surgery, Mayo Clinic Hospital, Phoenix, AZ. Electronic address: aime.victoria@mayo.edu.
authors.forename: Victoria L
authors.initials: VL
authors.lastname: Aimé
authors.affiliation: Department of Surgery, Mayo Clinic Hospital, Phoenix, AZ.
authors.forename: John T
authors.initials: JT
authors.lastname: Kidwell
authors.affiliation: Department of Surgery, Mayo Clinic Hospital, Phoenix, AZ.
authors.forename: Leland H
authors.initials: LH
authors.lastname: Webb
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001178:Arthroplasty / Q000295:instrumentation*; D005260:Female; D050278:Finger Phalanges; D006801:Humans; D007595:Joint Prosthesis; D008297:Male; D020366:Methylmethacrylate; D008875:Middle Aged; D010019:Osteomyelitis / Q000601:surgery*; D016879:Salvage Therapy
chemical_list: D000900:Anti-Bacterial Agents; D020366:Methylmethacrylate
keywords: Digital salvage; methylmethacrylate spacer; one-stage; osteomyelitis