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Research article
Cheng-He Qin
Guangdong Second Provincial General Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0002-5472-7964
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: The management of chronic tibial osteomyelitis is still a challenge, even with various methods have been introduced. This study aims to assess a combined treatment method, local debridement combined with antibiotic-loaded calcium sulfate implantation, for the management of the local (Cierny-Mader type III) tibial osteomyelitis.
Methods: 42 patients (43 limbs) with type III tibial osteomyelitis, from January 2012 to December 2018, who received above mentioned treatment method were included in the study. The infection remission rate, recurrence rate, complication rate and bone healing rate were respectively analyzed.
Results: With a mean follow-up of 42.8 months, 38 limbs (37 patients) (88.4%, 38/43) achieved infection remission without recurrence. Among those patients, pain, limitation of movement, sinus tracts, topical redness and swelling were generally eliminated. Only 4 patients felt slight pain after a long-distance walk, while another 6 patients showed slight but acceptable discomfort in affected limbs. 5 patients (11.6%) suffered from osteomyelitis recurrence that required secondary surgical and medical treatment, but no amputation was necessary to eliminate the infection. Prolonged postoperative drainage was the most frequent complication that was seen in 13 patients (30.0%). They were successfully managed by appropriate wound caring in 10 patients and by re-debridement, months later, in 3 patients. According to the final X-rays examination, bone losses caused by local debridement were generally repaired, though the shape of tibia was not well restored to its initial form. No fracture was recorded during follow-up.
Conclusion: Local debridement combined with antibiotic-loaded calcium sulfate implantation is effective and safe in a single-stage treatment of chronic Cierny-Mader III tibial osteomyelitis.
Keywords
chronic localized tibial osteomyelitis, local debridement, antibiotic-loaded calcium sulfate implantation
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View the published article at Journal of Orthopaedic Surgery and Research.
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Editorial decision: Major revision
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Received 18 Mar, 2020
Reviewer #1 agreed
On 01 Mar, 2020
Reviewers invited
Invitations sent on 28 Feb, 2020
Editor assigned
On 27 Feb, 2020
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On 26 Feb, 2020
Editor invited
On 26 Feb, 2020
Version 1
Posted 03 Jan, 2020
No comments provided
Editorial decision: Major revision
On 03 Feb, 2020
Reviewer #4 agreed
On 02 Feb, 2020
Review #4 received
Received 02 Feb, 2020
Review #2 received
Received 02 Feb, 2020
Reviewer #3 agreed
On 27 Jan, 2020
Review #1 received
Received 20 Jan, 2020
Reviewer #2 agreed
On 07 Jan, 2020
Editor assigned
On 06 Jan, 2020
Reviewers invited
Invitations sent on 06 Jan, 2020
Reviewer #1 agreed
On 06 Jan, 2020
Editor invited
On 05 Jan, 2020
Submission checks complete
On 30 Dec, 2019
First submitted
On 28 Dec, 2019
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Subject Areas
Orthopedic Surgery
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See the published version of this preprint at Journal of Orthopaedic Surgery and Research.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Cheng-He Qin
Guangdong Second Provincial General Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0002-5472-7964
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at Journal of Orthopaedic Surgery and Research.
No community comments so far
Editor assigned
On 28 Apr, 2020
Reviewers invited
Invitations sent on 28 Apr, 2020
Submission checks complete
On 27 Apr, 2020
Editor invited
On 27 Apr, 2020
No comments provided
Editorial decision: Major revision
On 21 Apr, 2020
Review #1 received
Received 18 Mar, 2020
Reviewer #1 agreed
On 01 Mar, 2020
Reviewers invited
Invitations sent on 28 Feb, 2020
Editor assigned
On 27 Feb, 2020
Submission checks complete
On 26 Feb, 2020
Editor invited
On 26 Feb, 2020
Version 1
Posted 03 Jan, 2020
No comments provided
Editorial decision: Major revision
On 03 Feb, 2020
Reviewer #4 agreed
On 02 Feb, 2020
Review #4 received
Received 02 Feb, 2020
Review #2 received
Received 02 Feb, 2020
Reviewer #3 agreed
On 27 Jan, 2020
Review #1 received
Received 20 Jan, 2020
Reviewer #2 agreed
On 07 Jan, 2020
Editor assigned
On 06 Jan, 2020
Reviewers invited
Invitations sent on 06 Jan, 2020
Reviewer #1 agreed
On 06 Jan, 2020
Editor invited
On 05 Jan, 2020
Submission checks complete
On 30 Dec, 2019
First submitted
On 28 Dec, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Orthopedic Surgery
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at Journal of Orthopaedic Surgery and Research.
Background: The management of chronic tibial osteomyelitis is still a challenge, even with various methods have been introduced. This study aims to assess a combined treatment method, local debridement combined with antibiotic-loaded calcium sulfate implantation, for the management of the local (Cierny-Mader type III) tibial osteomyelitis.
Methods: 42 patients (43 limbs) with type III tibial osteomyelitis, from January 2012 to December 2018, who received above mentioned treatment method were included in the study. The infection remission rate, recurrence rate, complication rate and bone healing rate were respectively analyzed.
Results: With a mean follow-up of 42.8 months, 38 limbs (37 patients) (88.4%, 38/43) achieved infection remission without recurrence. Among those patients, pain, limitation of movement, sinus tracts, topical redness and swelling were generally eliminated. Only 4 patients felt slight pain after a long-distance walk, while another 6 patients showed slight but acceptable discomfort in affected limbs. 5 patients (11.6%) suffered from osteomyelitis recurrence that required secondary surgical and medical treatment, but no amputation was necessary to eliminate the infection. Prolonged postoperative drainage was the most frequent complication that was seen in 13 patients (30.0%). They were successfully managed by appropriate wound caring in 10 patients and by re-debridement, months later, in 3 patients. According to the final X-rays examination, bone losses caused by local debridement were generally repaired, though the shape of tibia was not well restored to its initial form. No fracture was recorded during follow-up.
Conclusion: Local debridement combined with antibiotic-loaded calcium sulfate implantation is effective and safe in a single-stage treatment of chronic Cierny-Mader III tibial osteomyelitis.
Figure 1
Figure 2
Figure 3
Figure 4
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